|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$1,931.77
|
|
|
Service Code
|
NDC 00254200801
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$772.71 |
| Max. Negotiated Rate |
$1,738.59 |
| Rate for Payer: Aetna Commercial |
$1,642.00
|
| Rate for Payer: Aetna Medicare |
$965.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,255.65
|
| Rate for Payer: BCBS Complete |
$772.71
|
| Rate for Payer: Cash Price |
$1,545.42
|
| Rate for Payer: Cofinity Commercial |
$1,352.24
|
| Rate for Payer: Cofinity Commercial |
$1,661.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,352.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,545.42
|
| Rate for Payer: Healthscope Commercial |
$1,738.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,642.00
|
| Rate for Payer: PHP Commercial |
$1,642.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,255.65
|
| Rate for Payer: Priority Health SBD |
$1,217.02
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 67877058901
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.26 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$210.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: BCBS Complete |
$168.26
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$294.46
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health SBD |
$265.01
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$595.33
|
|
|
Service Code
|
NDC 50268018715
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.06 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna Commercial |
$506.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.96
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cofinity Commercial |
$416.73
|
| Rate for Payer: Cofinity Commercial |
$511.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$416.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.26
|
| Rate for Payer: Healthscope Commercial |
$535.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.03
|
| Rate for Payer: PHP Commercial |
$506.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.96
|
| Rate for Payer: Priority Health SBD |
$375.06
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$14.37
|
|
|
Service Code
|
NDC 42292005401
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$12.93 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Medicare |
$7.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.34
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.50
|
| Rate for Payer: Healthscope Commercial |
$12.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.34
|
| Rate for Payer: Priority Health SBD |
$9.05
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$431.02
|
|
|
Service Code
|
NDC 42292005403
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.41 |
| Max. Negotiated Rate |
$387.92 |
| Rate for Payer: Aetna Commercial |
$366.37
|
| Rate for Payer: Aetna Medicare |
$215.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.16
|
| Rate for Payer: BCBS Complete |
$172.41
|
| Rate for Payer: Cash Price |
$344.82
|
| Rate for Payer: Cofinity Commercial |
$301.71
|
| Rate for Payer: Cofinity Commercial |
$370.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.82
|
| Rate for Payer: Healthscope Commercial |
$387.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.37
|
| Rate for Payer: PHP Commercial |
$366.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.16
|
| Rate for Payer: Priority Health SBD |
$271.54
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$14.37
|
|
|
Service Code
|
NDC 42292005401
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$12.93 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.34
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.50
|
| Rate for Payer: Healthscope Commercial |
$12.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.34
|
| Rate for Payer: Priority Health SBD |
$9.05
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$777.89
|
|
|
Service Code
|
NDC 60687038921
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.16 |
| Max. Negotiated Rate |
$700.10 |
| Rate for Payer: Aetna Commercial |
$661.21
|
| Rate for Payer: Aetna Medicare |
$388.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.63
|
| Rate for Payer: BCBS Complete |
$311.16
|
| Rate for Payer: Cash Price |
$622.31
|
| Rate for Payer: Cofinity Commercial |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$668.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.31
|
| Rate for Payer: Healthscope Commercial |
$700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.21
|
| Rate for Payer: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.63
|
| Rate for Payer: Priority Health SBD |
$490.07
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 67877058901
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.01 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$294.46
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health SBD |
$265.01
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.81 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$182.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: BCBS Complete |
$145.81
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.94
|
| Rate for Payer: Priority Health SBD |
$229.65
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$430.46
|
|
|
Service Code
|
NDC 60687071521
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.19 |
| Max. Negotiated Rate |
$387.41 |
| Rate for Payer: Aetna Commercial |
$365.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.80
|
| Rate for Payer: Cash Price |
$344.37
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$370.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.37
|
| Rate for Payer: Healthscope Commercial |
$387.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.89
|
| Rate for Payer: PHP Commercial |
$365.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.80
|
| Rate for Payer: Priority Health SBD |
$271.19
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$430.46
|
|
|
Service Code
|
NDC 60687071521
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$387.41 |
| Rate for Payer: Aetna Commercial |
$365.89
|
| Rate for Payer: Aetna Medicare |
$215.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.80
|
| Rate for Payer: BCBS Complete |
$172.18
|
| Rate for Payer: Cash Price |
$344.37
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$370.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.37
|
| Rate for Payer: Healthscope Commercial |
$387.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.89
|
| Rate for Payer: PHP Commercial |
$365.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.80
|
| Rate for Payer: Priority Health SBD |
$271.19
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$14.35
|
|
|
Service Code
|
NDC 60687071511
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Aetna Commercial |
$12.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.20
|
| Rate for Payer: PHP Commercial |
$12.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.33
|
| Rate for Payer: Priority Health SBD |
$9.04
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$14.35
|
|
|
Service Code
|
NDC 60687071511
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Aetna Commercial |
$12.20
|
| Rate for Payer: Aetna Medicare |
$7.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.20
|
| Rate for Payer: PHP Commercial |
$12.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.33
|
| Rate for Payer: Priority Health SBD |
$9.04
|
|
|
COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$116.64
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
9681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.48 |
| Max. Negotiated Rate |
$104.98 |
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$100.31
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Commercial |
$81.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$104.98
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$99.14
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.82
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: Priority Health SBD |
$73.48
|
|
|
COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$116.64
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
9681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$104.98 |
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna Medicare |
$21.74
|
| Rate for Payer: Aetna Medicare |
$58.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: BCBS Complete |
$17.39
|
| Rate for Payer: BCBS Complete |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$34.68
|
| Rate for Payer: BCN Commercial |
$34.68
|
| Rate for Payer: BCN Commercial |
$34.68
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$81.65
|
| Rate for Payer: Cofinity Commercial |
$100.31
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Healthscope Commercial |
$104.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.14
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.82
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: Priority Health SBD |
$73.48
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$964.01
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$867.61 |
| Rate for Payer: Aetna Commercial |
$819.41
|
| Rate for Payer: Aetna Medicare |
$482.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.61
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: Cash Price |
$771.21
|
| Rate for Payer: Cofinity Commercial |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$829.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$674.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.21
|
| Rate for Payer: Healthscope Commercial |
$867.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.41
|
| Rate for Payer: PHP Commercial |
$819.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.61
|
| Rate for Payer: Priority Health SBD |
$607.33
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$964.01
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$607.33 |
| Max. Negotiated Rate |
$867.61 |
| Rate for Payer: Aetna Commercial |
$819.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.61
|
| Rate for Payer: Cash Price |
$771.21
|
| Rate for Payer: Cofinity Commercial |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$829.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$674.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.21
|
| Rate for Payer: Healthscope Commercial |
$867.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.41
|
| Rate for Payer: PHP Commercial |
$819.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.61
|
| Rate for Payer: Priority Health SBD |
$607.33
|
|
|
COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT 45378
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Medicare |
$929.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$450.59
|
| Rate for Payer: BCN Commercial |
$450.59
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Nomi Health Commercial |
$1,875.89
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,807.55
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,246.04
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.25
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$502.92
|
| Rate for Payer: VA VA |
$893.28
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$283.11 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$494.57
|
| Rate for Payer: BCN Commercial |
$494.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.11
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45398
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.46 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$494.36
|
| Rate for Payer: BCN Commercial |
$494.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.46
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.81 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$494.36
|
| Rate for Payer: BCN Commercial |
$494.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.81
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45382
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$270.16 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$494.36
|
| Rate for Payer: BCN Commercial |
$494.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.16
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.48 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$494.36
|
| Rate for Payer: BCN Commercial |
$494.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.48
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 45390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.39 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$965.55
|
| Rate for Payer: BCN Commercial |
$965.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.39
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,512.75
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45384
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$240.05 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$494.36
|
| Rate for Payer: BCN Commercial |
$494.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.05
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
