Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CLOZAPINE 25 MG TABLET

Facility

$2.92

Service Code	NDC 0093-4359-19
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.63
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna New Business (MI Preferred)	$1.90
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cofinity Commercial	$2.04
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.48
Rate for Payer: PHP Commercial	$2.48
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.84

CLOZAPINE 25 MG TABLET

Facility

$291.36

Service Code	NDC 0093-4359-93
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$183.56
Max. Negotiated Rate	$262.22
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: Aetna New Business (MI Preferred)	$189.38
Rate for Payer: Cash Price	$233.09
Rate for Payer: Cofinity Commercial	$203.95
Rate for Payer: Cofinity Commercial	$250.57
Rate for Payer: Healthscope Commercial	$262.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$247.66
Rate for Payer: PHP Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$203.95
Rate for Payer: Priority Health SBD	$183.56

COAGULATION DISORDERS

Facility

$28,035.06

Service Code	MS-DRG 813
Min. Negotiated Rate	$11,141.14
Max. Negotiated Rate	$28,035.06
Rate for Payer: Aetna Medicare	$12,196.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,659.40
Rate for Payer: Amish Plain Church Group Commercial	$14,659.40
Rate for Payer: BCBS MAPPO	$11,727.52
Rate for Payer: BCBS Trust/PPO	$28,035.06
Rate for Payer: BCN Medicare Advantage	$11,727.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,727.52
Rate for Payer: Mclaren Medicare	$11,727.52
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,313.90
Rate for Payer: MI Amish Medical Board Commercial	$13,486.65
Rate for Payer: PACE Medicare	$11,141.14
Rate for Payer: PACE SWMI	$11,727.52
Rate for Payer: PHP Medicare Advantage	$11,727.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,385.88
Rate for Payer: Priority Health Medicare	$11,727.52
Rate for Payer: Priority Health Narrow Network	$17,908.70
Rate for Payer: Railroad Medicare Medicare	$11,727.52
Rate for Payer: UHC All Payor (Choice/PPO)	$23,796.24
Rate for Payer: UHC Core	$14,601.60
Rate for Payer: UHC Dual Complete DSNP	$11,727.52
Rate for Payer: UHC Exchange	$15,639.00
Rate for Payer: UHC Medicare Advantage	$12,079.35
Rate for Payer: VA VA	$11,727.52

COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION

Facility

$6,034.81

Service Code	HCPCS J7189
Hospital Charge Code	92853
Hospital Revenue Code	636
Min. Negotiated Rate	$3,801.93
Max. Negotiated Rate	$5,431.33
Rate for Payer: Aetna Commercial	$5,129.59
Rate for Payer: Aetna New Business (MI Preferred)	$3,922.63
Rate for Payer: Cash Price	$4,827.85
Rate for Payer: Cofinity Commercial	$5,189.94
Rate for Payer: Cofinity Commercial	$4,224.37
Rate for Payer: Healthscope Commercial	$5,431.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,129.59
Rate for Payer: PHP Commercial	$5,129.59
Rate for Payer: Priority Health Cigna Priority Health	$4,224.37
Rate for Payer: Priority Health SBD	$3,801.93

COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION

Facility

$30,174.07

Service Code	HCPCS J7189
Hospital Charge Code	92855
Hospital Revenue Code	636
Min. Negotiated Rate	$19,009.66
Max. Negotiated Rate	$27,156.66
Rate for Payer: Aetna Commercial	$25,647.96
Rate for Payer: Aetna New Business (MI Preferred)	$19,613.15
Rate for Payer: Cash Price	$24,139.26
Rate for Payer: Cofinity Commercial	$21,121.85
Rate for Payer: Cofinity Commercial	$25,949.70
Rate for Payer: Healthscope Commercial	$27,156.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25,647.96
Rate for Payer: PHP Commercial	$25,647.96
Rate for Payer: Priority Health Cigna Priority Health	$21,121.85
Rate for Payer: Priority Health SBD	$19,009.66

COCAINE 4 % NASAL SOLUTION

Facility

$690.54

Service Code	HCPCS C9143
Hospital Charge Code	186568
Hospital Revenue Code	636
Min. Negotiated Rate	$435.04
Max. Negotiated Rate	$621.49
Rate for Payer: Aetna Commercial	$586.96
Rate for Payer: Aetna New Business (MI Preferred)	$448.85
Rate for Payer: Cash Price	$552.43
Rate for Payer: Cofinity Commercial	$483.38
Rate for Payer: Cofinity Commercial	$593.86
Rate for Payer: Healthscope Commercial	$621.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$586.96
Rate for Payer: PHP Commercial	$586.96
Rate for Payer: Priority Health Cigna Priority Health	$483.38
Rate for Payer: Priority Health SBD	$435.04

COLCHICINE 0.6 MG TABLET

Facility

$583.86

Service Code	NDC 50268-187-15
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$367.83
Max. Negotiated Rate	$525.47
Rate for Payer: Aetna Commercial	$496.28
Rate for Payer: Aetna New Business (MI Preferred)	$379.51
Rate for Payer: Cash Price	$467.09
Rate for Payer: Cofinity Commercial	$408.70
Rate for Payer: Cofinity Commercial	$502.12
Rate for Payer: Healthscope Commercial	$525.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$496.28
Rate for Payer: PHP Commercial	$496.28
Rate for Payer: Priority Health Cigna Priority Health	$408.70
Rate for Payer: Priority Health SBD	$367.83

COLCHICINE 0.6 MG TABLET

Facility

$777.89

Service Code	NDC 60687-389-21
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$490.07
Max. Negotiated Rate	$700.10
Rate for Payer: Aetna Commercial	$661.21
Rate for Payer: Aetna New Business (MI Preferred)	$505.63
Rate for Payer: Cash Price	$622.31
Rate for Payer: Cofinity Commercial	$544.52
Rate for Payer: Cofinity Commercial	$668.99
Rate for Payer: Healthscope Commercial	$700.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$661.21
Rate for Payer: PHP Commercial	$661.21
Rate for Payer: Priority Health Cigna Priority Health	$544.52
Rate for Payer: Priority Health SBD	$490.07

COLCHICINE 0.6 MG TABLET

Facility

$11.68

Service Code	NDC 50268-187-11
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$10.51
Rate for Payer: Aetna Commercial	$9.93
Rate for Payer: Aetna New Business (MI Preferred)	$7.59
Rate for Payer: Cash Price	$9.34
Rate for Payer: Cofinity Commercial	$10.04
Rate for Payer: Cofinity Commercial	$8.18
Rate for Payer: Healthscope Commercial	$10.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9.93
Rate for Payer: PHP Commercial	$9.93
Rate for Payer: Priority Health Cigna Priority Health	$8.18
Rate for Payer: Priority Health SBD	$7.36

COLCHICINE 0.6 MG TABLET

Facility

$356.20

Service Code	NDC 0904-7120-04
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$224.41
Max. Negotiated Rate	$320.58
Rate for Payer: Aetna Commercial	$302.77
Rate for Payer: Aetna New Business (MI Preferred)	$231.53
Rate for Payer: Cash Price	$284.96
Rate for Payer: Cofinity Commercial	$249.34
Rate for Payer: Cofinity Commercial	$306.33
Rate for Payer: Healthscope Commercial	$320.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$302.77
Rate for Payer: PHP Commercial	$302.77
Rate for Payer: Priority Health Cigna Priority Health	$249.34
Rate for Payer: Priority Health SBD	$224.41

COLCHICINE 0.6 MG TABLET

Facility

$22.53

Service Code	NDC 42292-054-01
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$20.28
Rate for Payer: Aetna Commercial	$19.15
Rate for Payer: Aetna New Business (MI Preferred)	$14.64
Rate for Payer: Cash Price	$18.02
Rate for Payer: Cofinity Commercial	$15.77
Rate for Payer: Cofinity Commercial	$19.38
Rate for Payer: Healthscope Commercial	$20.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.15
Rate for Payer: PHP Commercial	$19.15
Rate for Payer: Priority Health Cigna Priority Health	$15.77
Rate for Payer: Priority Health SBD	$14.19

COLCHICINE 0.6 MG TABLET

Facility

$2,474.19

Service Code	NDC 64764-119-01
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$1,558.74
Max. Negotiated Rate	$2,226.77
Rate for Payer: Aetna Commercial	$2,103.06
Rate for Payer: Aetna New Business (MI Preferred)	$1,608.22
Rate for Payer: Cash Price	$1,979.35
Rate for Payer: Cofinity Commercial	$1,731.93
Rate for Payer: Cofinity Commercial	$2,127.80
Rate for Payer: Healthscope Commercial	$2,226.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,103.06
Rate for Payer: PHP Commercial	$2,103.06
Rate for Payer: Priority Health Cigna Priority Health	$1,731.93
Rate for Payer: Priority Health SBD	$1,558.74

COLCHICINE 0.6 MG TABLET

Facility

$1,931.77

Service Code	NDC 0254-2008-01
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$1,217.02
Max. Negotiated Rate	$1,738.59
Rate for Payer: Aetna Commercial	$1,642.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,255.65
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: Healthscope Commercial	$1,738.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,642.00
Rate for Payer: PHP Commercial	$1,642.00
Rate for Payer: Priority Health Cigna Priority Health	$1,352.24
Rate for Payer: Priority Health SBD	$1,217.02

COLCHICINE 0.6 MG TABLET

Facility

$25.93

Service Code	NDC 60687-389-11
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$23.34
Rate for Payer: Aetna Commercial	$22.04
Rate for Payer: Aetna New Business (MI Preferred)	$16.85
Rate for Payer: Cash Price	$20.74
Rate for Payer: Cofinity Commercial	$18.15
Rate for Payer: Cofinity Commercial	$22.30
Rate for Payer: Healthscope Commercial	$23.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.04
Rate for Payer: PHP Commercial	$22.04
Rate for Payer: Priority Health Cigna Priority Health	$18.15
Rate for Payer: Priority Health SBD	$16.34

COLCHICINE 0.6 MG TABLET

Facility

$675.77

Service Code	NDC 42292-054-03
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$425.74
Max. Negotiated Rate	$608.19
Rate for Payer: Aetna Commercial	$574.40
Rate for Payer: Aetna New Business (MI Preferred)	$439.25
Rate for Payer: Cash Price	$540.62
Rate for Payer: Cofinity Commercial	$473.04
Rate for Payer: Cofinity Commercial	$581.16
Rate for Payer: Healthscope Commercial	$608.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$574.40
Rate for Payer: PHP Commercial	$574.40
Rate for Payer: Priority Health Cigna Priority Health	$473.04
Rate for Payer: Priority Health SBD	$425.74

COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION

Facility

$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)	$28.26
Rate for Payer: Aetna New Business (MI Preferred)	$75.82
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: Healthscope Commercial	$104.98
Rate for Payer: Healthscope Commercial	$39.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.14
Rate for Payer: PHP Commercial	$99.14
Rate for Payer: PHP Commercial	$36.96
Rate for Payer: Priority Health Cigna Priority Health	$30.44
Rate for Payer: Priority Health Cigna Priority Health	$81.65
Rate for Payer: Priority Health SBD	$73.48
Rate for Payer: Priority Health SBD	$27.39

COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT

Facility

$875.39

Service Code	NDC 50484-010-30
Hospital Charge Code	9682
Hospital Revenue Code	637
Min. Negotiated Rate	$551.50
Max. Negotiated Rate	$787.85
Rate for Payer: Aetna Commercial	$744.08
Rate for Payer: Aetna New Business (MI Preferred)	$569.00
Rate for Payer: Cash Price	$700.31
Rate for Payer: Cofinity Commercial	$612.77
Rate for Payer: Cofinity Commercial	$752.84
Rate for Payer: Healthscope Commercial	$787.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$744.08
Rate for Payer: PHP Commercial	$744.08
Rate for Payer: Priority Health Cigna Priority Health	$612.77
Rate for Payer: Priority Health SBD	$551.50

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

Facility

$3,138.00

Service Code	CPT 45378
Hospital Revenue Code	360
Min. Negotiated Rate	$178.46
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Medicare	$845.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,016.54
Rate for Payer: Amish Plain Church Group Commercial	$1,016.54
Rate for Payer: BCBS Complete	$467.12
Rate for Payer: BCBS MAPPO	$813.23
Rate for Payer: BCBS Trust/PPO	$617.33
Rate for Payer: BCN Medicare Advantage	$813.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$813.23
Rate for Payer: Mclaren Medicaid	$444.84
Rate for Payer: Mclaren Medicare	$813.23
Rate for Payer: Meridian Medicaid	$467.12
Rate for Payer: Meridian Wellcare - Medicare Advantage	$853.89
Rate for Payer: MI Amish Medical Board Commercial	$935.21
Rate for Payer: PACE Medicare	$772.57
Rate for Payer: PACE SWMI	$813.23
Rate for Payer: PHP Medicare Advantage	$813.23
Rate for Payer: Priority Health Choice Medicaid	$444.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,470.91
Rate for Payer: Priority Health Medicare	$813.23
Rate for Payer: Priority Health Narrow Network	$1,976.73
Rate for Payer: Railroad Medicare Medicare	$813.23
Rate for Payer: UHC All Payor (Choice/PPO)	$196.31
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$813.23
Rate for Payer: UHC Exchange	$178.46
Rate for Payer: UHC Medicare Advantage	$837.63
Rate for Payer: VA VA	$813.23

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

$3,228.76

Service Code	CPT 45388
Hospital Revenue Code	360
Min. Negotiated Rate	$260.97
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$480.28
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.76
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health Narrow Network	$2,583.01
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$287.07
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$260.97
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)

Facility

$3,228.76

Service Code	CPT 45398
Hospital Revenue Code	360
Min. Negotiated Rate	$227.57
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$724.94
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.76
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health Narrow Network	$2,583.01
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$250.33
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$227.57
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$3,228.76

Service Code	CPT 45380
Hospital Revenue Code	360
Min. Negotiated Rate	$193.85
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$449.75
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.76
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health Narrow Network	$2,583.01
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$213.24
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$193.85
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD

Facility

$3,228.76

Service Code	CPT 45382
Hospital Revenue Code	360
Min. Negotiated Rate	$249.51
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$802.59
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.76
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health Narrow Network	$2,583.01
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$274.46
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$249.51
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

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

Facility

$3,228.76

Service Code	CPT 45381
Hospital Revenue Code	360
Min. Negotiated Rate	$193.52
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$944.08
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.76
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health Narrow Network	$2,583.01
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$212.87
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$193.52
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION

Facility

$7,606.62

Service Code	CPT 45390
Hospital Revenue Code	360
Min. Negotiated Rate	$320.57
Max. Negotiated Rate	$7,606.62
Rate for Payer: Aetna Medicare	$2,598.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,122.94
Rate for Payer: Amish Plain Church Group Commercial	$3,122.94
Rate for Payer: BCBS Complete	$1,435.05
Rate for Payer: BCBS MAPPO	$2,498.35
Rate for Payer: BCBS Trust/PPO	$1,277.95
Rate for Payer: BCN Medicare Advantage	$2,498.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,498.35
Rate for Payer: Mclaren Medicaid	$1,366.60
Rate for Payer: Mclaren Medicare	$2,498.35
Rate for Payer: Meridian Medicaid	$1,435.05
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,623.27
Rate for Payer: MI Amish Medical Board Commercial	$2,873.10
Rate for Payer: PACE Medicare	$2,373.43
Rate for Payer: PACE SWMI	$2,498.35
Rate for Payer: PHP Medicare Advantage	$2,498.35
Rate for Payer: Priority Health Choice Medicaid	$1,366.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,606.62
Rate for Payer: Priority Health Medicare	$2,498.35
Rate for Payer: Priority Health Narrow Network	$6,085.30
Rate for Payer: Railroad Medicare Medicare	$2,498.35
Rate for Payer: UHC All Payor (Choice/PPO)	$352.63
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$2,498.35
Rate for Payer: UHC Exchange	$320.57
Rate for Payer: UHC Medicare Advantage	$2,573.30
Rate for Payer: VA VA	$2,498.35

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS

Facility

$3,228.76

Service Code	CPT 45384
Hospital Revenue Code	360
Min. Negotiated Rate	$220.70
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$557.15
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.76
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health Narrow Network	$2,583.01
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$242.77
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$220.70
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

Know your out-of-pocket cost for care.

All Charges