|
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); POSTERIOR SYNECHIAE
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 65875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 00074445604
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$94.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
IP
|
$223.13
|
|
|
Service Code
|
NDC 10019065164
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.18 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna American Axle |
$145.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$156.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.35
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$98.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.35
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
OP
|
$214.38
|
|
|
Service Code
|
NDC 00074445651
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
OP
|
$214.38
|
|
|
Service Code
|
NDC 00074445604
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 00074445651
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$94.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
OP
|
$223.13
|
|
|
Service Code
|
NDC 10019065164
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna American Axle |
$145.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$156.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.35
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$82.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.35
|
|
|
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 11311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 11302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42335
|
|
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 Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID, UNCOMPLICATED, INTRAORAL
|
Facility
|
OP
|
$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 Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| 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
|
OP
|
$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 Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| 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
|
OP
|
$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 Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45350
|
|
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 Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$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 Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$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 Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$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 Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 45349
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
|
Facility
|
OP
|
$2,502.92
|
|
|
Service Code
|
CPT 45341
|
|
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 Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$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 Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$2,502.92
|
|
|
Service Code
|
CPT 45333
|
|
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 Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$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 Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45340
|
|
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 Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S)
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45342
|
|
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 Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
SILDENAFIL 100 MG TABLET
|
Facility
|
OP
|
$9,025.19
|
|
|
Service Code
|
NDC 00069422030
|
| Hospital Charge Code |
22838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,339.32 |
| Max. Negotiated Rate |
$8,122.67 |
| Rate for Payer: Aetna American Axle |
$5,866.37
|
| Rate for Payer: Aetna Commercial |
$7,671.41
|
| Rate for Payer: Aetna Medicare |
$4,512.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,866.37
|
| Rate for Payer: BCBS Complete |
$3,610.08
|
| Rate for Payer: Cash Price |
$7,220.15
|
| Rate for Payer: Cofinity Commercial |
$6,317.63
|
| Rate for Payer: Cofinity Commercial |
$7,761.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,317.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,220.15
|
| Rate for Payer: Healthscope Commercial |
$8,122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,317.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,768.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,671.41
|
| Rate for Payer: PHP Commercial |
$7,671.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,866.37
|
| Rate for Payer: Priority Health SBD |
$5,685.87
|
| Rate for Payer: UMR Bronson Commercial |
$3,339.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,768.89
|
|
