|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 12002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$96.73
|
| Rate for Payer: BCN Commercial |
$96.73
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.48
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 12004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.54 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$126.08
|
| Rate for Payer: BCN Commercial |
$126.08
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.54
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
SIMPLE SYRUP
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
NDC 00395266116
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Medicare |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health SBD |
$90.72
|
|
|
SIMPLE SYRUP
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
NDC 00395266116
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.72 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health SBD |
$90.72
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$439.34
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.78 |
| Max. Negotiated Rate |
$395.41 |
| Rate for Payer: Aetna Commercial |
$373.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.57
|
| Rate for Payer: Cash Price |
$351.47
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.47
|
| Rate for Payer: Healthscope Commercial |
$395.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.44
|
| Rate for Payer: PHP Commercial |
$373.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.57
|
| Rate for Payer: Priority Health SBD |
$276.78
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$439.34
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.74 |
| Max. Negotiated Rate |
$395.41 |
| Rate for Payer: Aetna Commercial |
$373.44
|
| Rate for Payer: Aetna Medicare |
$219.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.57
|
| Rate for Payer: BCBS Complete |
$175.74
|
| Rate for Payer: BCBS Trust/PPO |
$349.20
|
| Rate for Payer: BCN Commercial |
$349.20
|
| Rate for Payer: Cash Price |
$351.47
|
| Rate for Payer: Cash Price |
$351.47
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.47
|
| Rate for Payer: Healthscope Commercial |
$395.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.44
|
| Rate for Payer: PHP Commercial |
$373.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.57
|
| Rate for Payer: Priority Health SBD |
$276.78
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION
|
Facility
|
OP
|
$328,138.18
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
104852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29,767.56 |
| Max. Negotiated Rate |
$295,324.36 |
| Rate for Payer: Aetna Commercial |
$278,917.45
|
| Rate for Payer: Aetna Medicare |
$57,757.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213,289.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69,420.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69,420.62
|
| Rate for Payer: BCBS Complete |
$31,255.94
|
| Rate for Payer: BCBS MAPPO |
$55,536.50
|
| Rate for Payer: BCBS Trust/PPO |
$107,877.98
|
| Rate for Payer: BCN Commercial |
$107,877.98
|
| Rate for Payer: BCN Medicare Advantage |
$55,536.50
|
| Rate for Payer: Cash Price |
$262,510.54
|
| Rate for Payer: Cash Price |
$262,510.54
|
| Rate for Payer: Cofinity Commercial |
$282,198.83
|
| Rate for Payer: Cofinity Commercial |
$229,696.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$229,696.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262,510.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55,536.50
|
| Rate for Payer: Healthscope Commercial |
$295,324.36
|
| Rate for Payer: Mclaren Medicaid |
$29,767.56
|
| Rate for Payer: Mclaren Medicare |
$55,536.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58,313.32
|
| Rate for Payer: Meridian Medicaid |
$31,255.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63,866.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278,917.45
|
| Rate for Payer: Nomi Health Commercial |
$166,609.50
|
| Rate for Payer: PACE Medicare |
$52,759.68
|
| Rate for Payer: PACE SWMI |
$55,536.50
|
| Rate for Payer: PHP Commercial |
$278,917.45
|
| Rate for Payer: PHP Medicare Advantage |
$55,536.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,767.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213,289.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158,334.81
|
| Rate for Payer: Priority Health Medicare |
$55,536.50
|
| Rate for Payer: Priority Health Narrow Network |
$126,667.85
|
| Rate for Payer: Priority Health SBD |
$206,727.05
|
| Rate for Payer: Railroad Medicare Medicare |
$55,536.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156,329.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$55,536.50
|
| Rate for Payer: UHC Medicare Advantage |
$55,536.50
|
| Rate for Payer: UHCCP Medicaid |
$31,267.05
|
| Rate for Payer: VA VA |
$55,536.50
|
|
|
SKIN CARE CONSULT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 00177
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
SLING OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$40,009.30
|
|
|
Service Code
|
CPT 53440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$796.50 |
| Max. Negotiated Rate |
$40,009.30 |
| Rate for Payer: Aetna Medicare |
$13,238.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,912.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,912.14
|
| Rate for Payer: BCBS Complete |
$7,164.28
|
| Rate for Payer: BCBS MAPPO |
$12,729.71
|
| Rate for Payer: BCBS Trust/PPO |
$6,463.26
|
| Rate for Payer: BCN Commercial |
$6,463.26
|
| Rate for Payer: BCN Medicare Advantage |
$12,729.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,729.71
|
| Rate for Payer: Mclaren Medicaid |
$6,823.12
|
| Rate for Payer: Mclaren Medicare |
$12,729.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,366.20
|
| Rate for Payer: Meridian Medicaid |
$7,164.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,639.17
|
| Rate for Payer: Nomi Health Commercial |
$26,732.39
|
| Rate for Payer: PACE Medicare |
$12,093.22
|
| Rate for Payer: PACE SWMI |
$12,729.71
|
| Rate for Payer: PHP Medicare Advantage |
$12,729.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,823.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,009.30
|
| Rate for Payer: Priority Health Medicare |
$12,729.71
|
| Rate for Payer: Priority Health Narrow Network |
$32,007.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12,729.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.50
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,729.71
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$12,729.71
|
| Rate for Payer: UHCCP Medicaid |
$7,166.83
|
| Rate for Payer: VA VA |
$12,729.71
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$792.01 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,704.09
|
| Rate for Payer: BCN Commercial |
$2,704.09
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.01
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,723.02
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 54001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.52 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$855.81
|
| Rate for Payer: BCN Commercial |
$855.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.52
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 44360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.27 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$543.65
|
| Rate for Payer: BCN Commercial |
$543.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.27
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$1,046.41
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 44361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$165.56 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$543.65
|
| Rate for Payer: BCN Commercial |
$543.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.56
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$1,046.41
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 44364
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.14 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$634.26
|
| Rate for Payer: BCN Commercial |
$634.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.14
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$1,046.41
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health SBD |
$16.54
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
NDC 00409729973
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409329905
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 00409729973
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 00409329906
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health SBD |
$16.54
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
NDC 00409729983
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409329915
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
NDC 00409329905
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
NDC 00409329915
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$13.40
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)
|
Facility
|
IP
|
$64.97
|
|
|
Service Code
|
NDC 09900001916
|
| Hospital Charge Code |
300441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$58.47 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.23
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Cofinity Commercial |
$55.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.98
|
| Rate for Payer: Healthscope Commercial |
$58.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.22
|
| Rate for Payer: PHP Commercial |
$55.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.23
|
| Rate for Payer: Priority Health SBD |
$40.93
|
|
