|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$265.81
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$239.23 |
| Rate for Payer: Aetna American Axle |
$172.78
|
| Rate for Payer: Aetna American Axle |
$285.57
|
| Rate for Payer: Aetna Commercial |
$225.94
|
| Rate for Payer: Aetna Commercial |
$373.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.57
|
| Rate for Payer: Cash Price |
$212.65
|
| Rate for Payer: Cash Price |
$351.47
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Cofinity Commercial |
$307.54
|
| Rate for Payer: Cofinity Commercial |
$186.07
|
| Rate for Payer: Cofinity Commercial |
$228.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.47
|
| Rate for Payer: Healthscope Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$395.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.94
|
| Rate for Payer: PHP Commercial |
$373.44
|
| Rate for Payer: PHP Commercial |
$225.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.57
|
| Rate for Payer: Priority Health SBD |
$167.46
|
| Rate for Payer: Priority Health SBD |
$276.78
|
| Rate for Payer: UMR Bronson Commercial |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$193.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.50
|
|
|
SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 31020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.82
|
| Rate for Payer: BCN Commercial |
$1,708.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.45
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$319.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION
|
Facility
|
OP
|
$328,138.18
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
104852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29,767.56 |
| Max. Negotiated Rate |
$295,324.36 |
| Rate for Payer: Aetna American Axle |
$213,289.82
|
| Rate for Payer: Aetna Commercial |
$278,917.45
|
| Rate for Payer: Aetna Medicare |
$57,757.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213,289.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69,420.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69,420.62
|
| Rate for Payer: BCBS Complete |
$31,255.94
|
| Rate for Payer: BCBS MAPPO |
$55,536.50
|
| Rate for Payer: BCBS Trust/PPO |
$102,971.42
|
| Rate for Payer: BCN Commercial |
$102,971.42
|
| Rate for Payer: BCN Medicare Advantage |
$55,536.50
|
| Rate for Payer: Cash Price |
$262,510.54
|
| Rate for Payer: Cash Price |
$262,510.54
|
| Rate for Payer: Cofinity Commercial |
$282,198.83
|
| Rate for Payer: Cofinity Commercial |
$229,696.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$229,696.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262,510.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55,536.50
|
| Rate for Payer: Healthscope Commercial |
$295,324.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229,696.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246,103.64
|
| Rate for Payer: Mclaren Medicaid |
$29,767.56
|
| Rate for Payer: Mclaren Medicare |
$55,536.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58,313.32
|
| Rate for Payer: Meridian Medicaid |
$31,255.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63,866.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278,917.45
|
| Rate for Payer: Nomi Health Commercial |
$166,609.50
|
| Rate for Payer: PACE Medicare |
$52,759.68
|
| Rate for Payer: PACE SWMI |
$55,536.50
|
| Rate for Payer: PHP Commercial |
$278,917.45
|
| Rate for Payer: PHP Medicare Advantage |
$55,536.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,767.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213,289.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158,334.81
|
| Rate for Payer: Priority Health Medicare |
$55,536.50
|
| Rate for Payer: Priority Health Narrow Network |
$126,667.85
|
| Rate for Payer: Priority Health SBD |
$206,727.05
|
| Rate for Payer: Railroad Medicare Medicare |
$55,536.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156,329.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$55,536.50
|
| Rate for Payer: UHC Exchange |
$106,135.81
|
| Rate for Payer: UHC Medicare Advantage |
$55,536.50
|
| Rate for Payer: UHCCP Medicaid |
$29,767.56
|
| Rate for Payer: UMR Bronson Commercial |
$121,411.13
|
| Rate for Payer: VA VA |
$55,536.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246,103.64
|
|
|
SIROLIMUS 0.5 MG TABLET
|
Facility
|
IP
|
$1,498.50
|
|
|
Service Code
|
NDC 59762100101
|
| Hospital Charge Code |
104764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$659.34 |
| Max. Negotiated Rate |
$1,348.65 |
| Rate for Payer: Aetna American Axle |
$974.02
|
| Rate for Payer: Aetna Commercial |
$1,273.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.02
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cofinity Commercial |
$1,048.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,048.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.80
|
| Rate for Payer: Healthscope Commercial |
$1,348.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,048.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.72
|
| Rate for Payer: PHP Commercial |
$1,273.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.02
|
| Rate for Payer: Priority Health SBD |
$944.06
|
| Rate for Payer: UMR Bronson Commercial |
$659.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,123.88
|
|
|
SIROLIMUS 0.5 MG TABLET
|
Facility
|
OP
|
$1,498.50
|
|
|
Service Code
|
NDC 59762100101
|
| Hospital Charge Code |
104764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,348.65 |
| Rate for Payer: Aetna American Axle |
$974.02
|
| Rate for Payer: Aetna Commercial |
$1,273.72
|
| Rate for Payer: Aetna Medicare |
$749.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.02
|
| Rate for Payer: BCBS Complete |
$599.40
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cofinity Commercial |
$1,048.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,048.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.80
|
| Rate for Payer: Healthscope Commercial |
$1,348.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,048.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.72
|
| Rate for Payer: PHP Commercial |
$1,273.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.02
|
| Rate for Payer: Priority Health SBD |
$944.06
|
| Rate for Payer: UMR Bronson Commercial |
$554.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,123.88
|
|
|
SIROLIMUS 1 MG TABLET
|
Facility
|
IP
|
$11,896.61
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
28958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,234.51 |
| Max. Negotiated Rate |
$10,706.95 |
| Rate for Payer: Aetna American Axle |
$7,732.80
|
| Rate for Payer: Aetna American Axle |
$579.44
|
| Rate for Payer: Aetna Commercial |
$10,112.12
|
| Rate for Payer: Aetna Commercial |
$757.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,732.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.44
|
| Rate for Payer: Cash Price |
$9,517.29
|
| Rate for Payer: Cash Price |
$713.16
|
| Rate for Payer: Cofinity Commercial |
$766.65
|
| Rate for Payer: Cofinity Commercial |
$624.02
|
| Rate for Payer: Cofinity Commercial |
$10,231.08
|
| Rate for Payer: Cofinity Commercial |
$8,327.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,327.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$624.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,517.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.16
|
| Rate for Payer: Healthscope Commercial |
$10,706.95
|
| Rate for Payer: Healthscope Commercial |
$802.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,327.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$624.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,922.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,112.12
|
| Rate for Payer: PHP Commercial |
$757.73
|
| Rate for Payer: PHP Commercial |
$10,112.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,732.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.44
|
| Rate for Payer: Priority Health SBD |
$7,494.86
|
| Rate for Payer: Priority Health SBD |
$561.61
|
| Rate for Payer: UMR Bronson Commercial |
$5,234.51
|
| Rate for Payer: UMR Bronson Commercial |
$392.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,922.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.59
|
|
|
SIROLIMUS 1 MG TABLET
|
Facility
|
OP
|
$11,896.61
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
28958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$10,706.95 |
| Rate for Payer: Aetna American Axle |
$7,732.80
|
| Rate for Payer: Aetna American Axle |
$579.44
|
| Rate for Payer: Aetna Commercial |
$757.73
|
| Rate for Payer: Aetna Commercial |
$10,112.12
|
| Rate for Payer: Aetna Medicare |
$5,948.30
|
| Rate for Payer: Aetna Medicare |
$445.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,732.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.44
|
| Rate for Payer: BCBS Complete |
$356.58
|
| Rate for Payer: BCBS Complete |
$4,758.64
|
| Rate for Payer: BCBS Trust/PPO |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$3.57
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$713.16
|
| Rate for Payer: Cash Price |
$713.16
|
| Rate for Payer: Cash Price |
$9,517.29
|
| Rate for Payer: Cash Price |
$9,517.29
|
| Rate for Payer: Cofinity Commercial |
$766.65
|
| Rate for Payer: Cofinity Commercial |
$10,231.08
|
| Rate for Payer: Cofinity Commercial |
$624.02
|
| Rate for Payer: Cofinity Commercial |
$8,327.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,327.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$624.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,517.29
|
| Rate for Payer: Healthscope Commercial |
$802.30
|
| Rate for Payer: Healthscope Commercial |
$10,706.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$624.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,327.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$668.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,922.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,112.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.73
|
| Rate for Payer: PHP Commercial |
$10,112.12
|
| Rate for Payer: PHP Commercial |
$757.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,732.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.44
|
| Rate for Payer: Priority Health SBD |
$561.61
|
| Rate for Payer: Priority Health SBD |
$7,494.86
|
| Rate for Payer: UMR Bronson Commercial |
$4,401.75
|
| Rate for Payer: UMR Bronson Commercial |
$329.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$668.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,922.46
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
|
OP
|
$3,785.10
|
|
|
Service Code
|
NDC 00006027728
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,400.49 |
| Max. Negotiated Rate |
$3,406.59 |
| Rate for Payer: Aetna American Axle |
$2,460.32
|
| Rate for Payer: Aetna Commercial |
$3,217.34
|
| Rate for Payer: Aetna Medicare |
$1,892.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,460.32
|
| Rate for Payer: BCBS Complete |
$1,514.04
|
| Rate for Payer: Cash Price |
$3,028.08
|
| Rate for Payer: Cofinity Commercial |
$2,649.57
|
| Rate for Payer: Cofinity Commercial |
$3,255.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,649.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,028.08
|
| Rate for Payer: Healthscope Commercial |
$3,406.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,649.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,838.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,217.34
|
| Rate for Payer: PHP Commercial |
$3,217.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,460.32
|
| Rate for Payer: Priority Health SBD |
$2,384.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,400.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,838.82
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
|
IP
|
$37.86
|
|
|
Service Code
|
NDC 00006027701
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$34.07 |
| Rate for Payer: Aetna American Axle |
$24.61
|
| Rate for Payer: Aetna Commercial |
$32.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.61
|
| Rate for Payer: Cash Price |
$30.29
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$32.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.29
|
| Rate for Payer: Healthscope Commercial |
$34.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.18
|
| Rate for Payer: PHP Commercial |
$32.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.61
|
| Rate for Payer: Priority Health SBD |
$23.85
|
| Rate for Payer: UMR Bronson Commercial |
$16.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.40
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
|
OP
|
$37.86
|
|
|
Service Code
|
NDC 00006027701
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$34.07 |
| Rate for Payer: Aetna American Axle |
$24.61
|
| Rate for Payer: Aetna Commercial |
$32.18
|
| Rate for Payer: Aetna Medicare |
$18.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.61
|
| Rate for Payer: BCBS Complete |
$15.14
|
| Rate for Payer: Cash Price |
$30.29
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$32.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.29
|
| Rate for Payer: Healthscope Commercial |
$34.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.18
|
| Rate for Payer: PHP Commercial |
$32.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.61
|
| Rate for Payer: Priority Health SBD |
$23.85
|
| Rate for Payer: UMR Bronson Commercial |
$14.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.40
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
|
IP
|
$1,135.31
|
|
|
Service Code
|
NDC 00006027731
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.54 |
| Max. Negotiated Rate |
$1,021.78 |
| Rate for Payer: Aetna American Axle |
$737.95
|
| Rate for Payer: Aetna Commercial |
$965.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.95
|
| Rate for Payer: Cash Price |
$908.25
|
| Rate for Payer: Cofinity Commercial |
$794.72
|
| Rate for Payer: Cofinity Commercial |
$976.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.25
|
| Rate for Payer: Healthscope Commercial |
$1,021.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.01
|
| Rate for Payer: PHP Commercial |
$965.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.95
|
| Rate for Payer: Priority Health SBD |
$715.25
|
| Rate for Payer: UMR Bronson Commercial |
$499.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.48
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
|
IP
|
$3,785.10
|
|
|
Service Code
|
NDC 00006027728
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,665.44 |
| Max. Negotiated Rate |
$3,406.59 |
| Rate for Payer: Aetna American Axle |
$2,460.32
|
| Rate for Payer: Aetna Commercial |
$3,217.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,460.32
|
| Rate for Payer: Cash Price |
$3,028.08
|
| Rate for Payer: Cofinity Commercial |
$2,649.57
|
| Rate for Payer: Cofinity Commercial |
$3,255.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,649.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,028.08
|
| Rate for Payer: Healthscope Commercial |
$3,406.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,649.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,838.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,217.34
|
| Rate for Payer: PHP Commercial |
$3,217.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,460.32
|
| Rate for Payer: Priority Health SBD |
$2,384.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,665.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,838.82
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
|
OP
|
$1,135.31
|
|
|
Service Code
|
NDC 00006027731
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.06 |
| Max. Negotiated Rate |
$1,021.78 |
| Rate for Payer: Aetna American Axle |
$737.95
|
| Rate for Payer: Aetna Commercial |
$965.01
|
| Rate for Payer: Aetna Medicare |
$567.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.95
|
| Rate for Payer: BCBS Complete |
$454.12
|
| Rate for Payer: Cash Price |
$908.25
|
| Rate for Payer: Cofinity Commercial |
$794.72
|
| Rate for Payer: Cofinity Commercial |
$976.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.25
|
| Rate for Payer: Healthscope Commercial |
$1,021.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.01
|
| Rate for Payer: PHP Commercial |
$965.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.95
|
| Rate for Payer: Priority Health SBD |
$715.25
|
| Rate for Payer: UMR Bronson Commercial |
$420.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.48
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET
|
Facility
|
IP
|
$1,135.31
|
|
|
Service Code
|
NDC 00006011231
|
| Hospital Charge Code |
77616
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.54 |
| Max. Negotiated Rate |
$1,021.78 |
| Rate for Payer: Aetna American Axle |
$737.95
|
| Rate for Payer: Aetna Commercial |
$965.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.95
|
| Rate for Payer: Cash Price |
$908.25
|
| Rate for Payer: Cofinity Commercial |
$794.72
|
| Rate for Payer: Cofinity Commercial |
$976.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.25
|
| Rate for Payer: Healthscope Commercial |
$1,021.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.01
|
| Rate for Payer: PHP Commercial |
$965.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.95
|
| Rate for Payer: Priority Health SBD |
$715.25
|
| Rate for Payer: UMR Bronson Commercial |
$499.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.48
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET
|
Facility
|
OP
|
$1,135.31
|
|
|
Service Code
|
NDC 00006011231
|
| Hospital Charge Code |
77616
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.06 |
| Max. Negotiated Rate |
$1,021.78 |
| Rate for Payer: Aetna American Axle |
$737.95
|
| Rate for Payer: Aetna Commercial |
$965.01
|
| Rate for Payer: Aetna Medicare |
$567.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.95
|
| Rate for Payer: BCBS Complete |
$454.12
|
| Rate for Payer: Cash Price |
$908.25
|
| Rate for Payer: Cofinity Commercial |
$794.72
|
| Rate for Payer: Cofinity Commercial |
$976.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.25
|
| Rate for Payer: Healthscope Commercial |
$1,021.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.01
|
| Rate for Payer: PHP Commercial |
$965.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.95
|
| Rate for Payer: Priority Health SBD |
$715.25
|
| Rate for Payer: UMR Bronson Commercial |
$420.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.48
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET
|
Facility
|
IP
|
$3,785.10
|
|
|
Service Code
|
NDC 00006011228
|
| Hospital Charge Code |
77616
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,665.44 |
| Max. Negotiated Rate |
$3,406.59 |
| Rate for Payer: Aetna American Axle |
$2,460.32
|
| Rate for Payer: Aetna Commercial |
$3,217.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,460.32
|
| Rate for Payer: Cash Price |
$3,028.08
|
| Rate for Payer: Cofinity Commercial |
$2,649.57
|
| Rate for Payer: Cofinity Commercial |
$3,255.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,649.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,028.08
|
| Rate for Payer: Healthscope Commercial |
$3,406.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,649.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,838.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,217.34
|
| Rate for Payer: PHP Commercial |
$3,217.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,460.32
|
| Rate for Payer: Priority Health SBD |
$2,384.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,665.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,838.82
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET
|
Facility
|
OP
|
$3,785.10
|
|
|
Service Code
|
NDC 00006011228
|
| Hospital Charge Code |
77616
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,400.49 |
| Max. Negotiated Rate |
$3,406.59 |
| Rate for Payer: Aetna American Axle |
$2,460.32
|
| Rate for Payer: Aetna Commercial |
$3,217.34
|
| Rate for Payer: Aetna Medicare |
$1,892.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,460.32
|
| Rate for Payer: BCBS Complete |
$1,514.04
|
| Rate for Payer: Cash Price |
$3,028.08
|
| Rate for Payer: Cofinity Commercial |
$2,649.57
|
| Rate for Payer: Cofinity Commercial |
$3,255.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,649.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,028.08
|
| Rate for Payer: Healthscope Commercial |
$3,406.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,649.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,838.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,217.34
|
| Rate for Payer: PHP Commercial |
$3,217.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,460.32
|
| Rate for Payer: Priority Health SBD |
$2,384.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,400.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,838.82
|
|
|
SKIN CARE CONSULT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 00177
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
SKIN SUBSTITUTE, INTEGRA MESHED BILAYER WOUND MATRIX, PER SQUARE CENTIMETER
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT C9363
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
|
|
SLING OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$40,009.30
|
|
|
Service Code
|
CPT 53440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.09 |
| Max. Negotiated Rate |
$40,009.30 |
| Rate for Payer: Aetna Medicare |
$13,238.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,912.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,912.14
|
| Rate for Payer: BCBS Complete |
$7,164.28
|
| Rate for Payer: BCBS MAPPO |
$12,729.71
|
| Rate for Payer: BCBS Trust/PPO |
$11,261.75
|
| Rate for Payer: BCN Commercial |
$11,261.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,729.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,729.71
|
| Rate for Payer: Mclaren Medicaid |
$6,823.12
|
| Rate for Payer: Mclaren Medicare |
$12,729.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,366.20
|
| Rate for Payer: Meridian Medicaid |
$7,164.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,639.17
|
| Rate for Payer: Nomi Health Commercial |
$26,732.39
|
| Rate for Payer: PACE Medicare |
$12,093.22
|
| Rate for Payer: PACE SWMI |
$12,729.71
|
| Rate for Payer: PHP Medicare Advantage |
$12,729.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,823.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,009.30
|
| Rate for Payer: Priority Health Medicare |
$12,729.71
|
| Rate for Payer: Priority Health Narrow Network |
$32,007.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12,729.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.50
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,729.71
|
| Rate for Payer: UHC Exchange |
$724.09
|
| Rate for Payer: UHC Medicare Advantage |
$12,729.71
|
| Rate for Payer: UHCCP Medicaid |
$6,823.12
|
| Rate for Payer: VA VA |
$12,729.71
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$720.01 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,711.67
|
| Rate for Payer: BCN Commercial |
$4,711.67
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.01
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$720.01
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 54001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$135.02 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.19
|
| Rate for Payer: BCN Commercial |
$1,491.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.52
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$135.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 44377
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$284.26 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,105.16
|
| Rate for Payer: BCN Commercial |
$1,105.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.69
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$284.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 44360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.61 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.27
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$136.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 44361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.51 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.56
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$150.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
