|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$280.72
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Aetna American Axle |
$182.47
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cofinity Advantage |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: UMR Bronson Commercial |
$123.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
OP
|
$366.56
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$329.90 |
| Rate for Payer: Aetna American Axle |
$238.26
|
| Rate for Payer: Aetna American Axle |
$152.31
|
| Rate for Payer: Aetna American Axle |
$379.65
|
| Rate for Payer: Aetna Commercial |
$311.58
|
| Rate for Payer: Aetna Commercial |
$496.47
|
| Rate for Payer: Aetna Commercial |
$199.17
|
| Rate for Payer: Aetna Medicare |
$183.28
|
| Rate for Payer: Aetna Medicare |
$117.16
|
| Rate for Payer: Aetna Medicare |
$292.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.65
|
| Rate for Payer: BCBS Complete |
$93.73
|
| Rate for Payer: BCBS Complete |
$146.62
|
| Rate for Payer: BCBS Complete |
$233.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: Cash Price |
$467.26
|
| Rate for Payer: Cash Price |
$467.26
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cofinity Advantage |
$408.86
|
| Rate for Payer: Cofinity Advantage |
$256.59
|
| Rate for Payer: Cofinity Advantage |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$201.52
|
| Rate for Payer: Cofinity Commercial |
$315.24
|
| Rate for Payer: Cofinity Commercial |
$502.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Healthscope Commercial |
$210.89
|
| Rate for Payer: Healthscope Commercial |
$329.90
|
| Rate for Payer: Healthscope Commercial |
$525.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$467.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.06
|
| Rate for Payer: PHP Commercial |
$311.58
|
| Rate for Payer: PHP Commercial |
$199.17
|
| Rate for Payer: PHP Commercial |
$496.47
|
| Rate for Payer: Priority Health SBD |
$147.62
|
| Rate for Payer: Priority Health SBD |
$367.97
|
| Rate for Payer: Priority Health SBD |
$230.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UMR Bronson Commercial |
$216.11
|
| Rate for Payer: UMR Bronson Commercial |
$86.70
|
| Rate for Payer: UMR Bronson Commercial |
$135.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.06
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
OP
|
$280.72
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Aetna American Axle |
$182.47
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Medicare |
$140.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: BCBS Complete |
$112.29
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cofinity Advantage |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.68
|
| Rate for Payer: UHC Exchange |
$0.68
|
| Rate for Payer: UMR Bronson Commercial |
$103.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186502054
|
| Hospital Charge Code |
29745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,051.11 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna Medicare |
$1,420.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: BCBS Complete |
$1,136.33
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Advantage |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,272.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,130.62
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,846.54
|
| Rate for Payer: UHC Core |
$1,480.07
|
| Rate for Payer: UHC Exchange |
$1,116.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,051.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186502054
|
| Hospital Charge Code |
29745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,249.97 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Advantage |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,130.62
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186504054
|
| Hospital Charge Code |
29746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,051.11 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna Medicare |
$1,420.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: BCBS Complete |
$1,136.33
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Advantage |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,272.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,130.62
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,846.54
|
| Rate for Payer: UHC Core |
$1,480.07
|
| Rate for Payer: UHC Exchange |
$1,116.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,051.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186504054
|
| Hospital Charge Code |
29746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,249.97 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Advantage |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,130.62
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
OP
|
$987.46
|
|
|
Service Code
|
NDC 00186401001
|
| Hospital Charge Code |
91031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.36 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna Medicare |
$493.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: BCBS Complete |
$394.98
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Advantage |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$740.60
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.85
|
| Rate for Payer: UHC Core |
$514.47
|
| Rate for Payer: UHC Exchange |
$388.07
|
| Rate for Payer: UMR Bronson Commercial |
$365.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
IP
|
$987.46
|
|
|
Service Code
|
NDC 00186401001
|
| Hospital Charge Code |
91031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Advantage |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$740.60
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$434.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 2.5 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
IP
|
$987.46
|
|
|
Service Code
|
NDC 00186402501
|
| Hospital Charge Code |
162053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Advantage |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$740.60
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$434.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 2.5 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
OP
|
$987.46
|
|
|
Service Code
|
NDC 00186402501
|
| Hospital Charge Code |
162053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.36 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna Medicare |
$493.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: BCBS Complete |
$394.98
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Advantage |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$740.60
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.85
|
| Rate for Payer: UHC Core |
$514.47
|
| Rate for Payer: UHC Exchange |
$388.07
|
| Rate for Payer: UMR Bronson Commercial |
$365.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.37
|
|
|
Service Code
|
HCPCS J1370
|
| Hospital Charge Code |
41174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna American Axle |
$15.19
|
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.74
|
| Rate for Payer: BCN Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Advantage |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.53
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.10
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: UHC Exchange |
$2.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.53
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
HCPCS J1370
|
| Hospital Charge Code |
41174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna American Axle |
$15.19
|
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Advantage |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.53
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$10.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.53
|
|
|
ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX TEST WITH NASAL CATHETER INTRALUMINAL IMPEDANCE ELECTRODE(S) PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION; PROLONGED (GREATER THAN 1 HOUR, UP TO 24 HOURS)
|
Facility
|
OP
|
$1,403.25
|
|
|
Service Code
|
CPT 91038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,403.25 |
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,403.25
|
| Rate for Payer: BCN Commercial |
$1,403.25
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY WITH INTERPRETATION AND REPORT;
|
Facility
|
OP
|
$1,202.41
|
|
|
Service Code
|
CPT 91010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$645.27
|
| Rate for Payer: BCN Commercial |
$645.27
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$23,638.06
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$10,639.40 |
| Max. Negotiated Rate |
$23,638.06 |
| Rate for Payer: Aetna Medicare |
$11,647.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,999.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,999.21
|
| Rate for Payer: BCBS MAPPO |
$11,199.37
|
| Rate for Payer: BCBS Trust/PPO |
$23,638.06
|
| Rate for Payer: BCN Commercial |
$23,638.06
|
| Rate for Payer: BCN Medicare Advantage |
$11,199.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,199.37
|
| Rate for Payer: Mclaren Medicare |
$11,199.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,759.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,879.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,319.31
|
| Rate for Payer: Nomi Health Commercial |
$16,361.07
|
| Rate for Payer: PACE Medicare |
$10,639.40
|
| Rate for Payer: PACE SWMI |
$11,199.37
|
| Rate for Payer: PHP Medicare Advantage |
$11,199.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,447.71
|
| Rate for Payer: Priority Health Medicare |
$11,199.37
|
| Rate for Payer: Priority Health Tiered Network |
$16,358.17
|
| Rate for Payer: Railroad Medicare Medicare |
$11,199.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,673.29
|
| Rate for Payer: UHC Core |
$17,295.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,199.37
|
| Rate for Payer: UHC Exchange |
$14,125.06
|
| Rate for Payer: VA VA |
$11,199.37
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,444.72
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$6,756.90 |
| Max. Negotiated Rate |
$14,444.72 |
| Rate for Payer: Aetna Medicare |
$7,397.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,890.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,890.66
|
| Rate for Payer: BCBS MAPPO |
$7,112.53
|
| Rate for Payer: BCBS Trust/PPO |
$14,444.72
|
| Rate for Payer: BCN Commercial |
$14,444.72
|
| Rate for Payer: BCN Medicare Advantage |
$7,112.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,112.53
|
| Rate for Payer: Mclaren Medicare |
$7,112.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,468.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,179.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,823.78
|
| Rate for Payer: Nomi Health Commercial |
$10,056.84
|
| Rate for Payer: PACE Medicare |
$6,756.90
|
| Rate for Payer: PACE SWMI |
$7,112.53
|
| Rate for Payer: PHP Medicare Advantage |
$7,112.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,568.82
|
| Rate for Payer: Priority Health Medicare |
$7,112.53
|
| Rate for Payer: Priority Health Tiered Network |
$10,055.05
|
| Rate for Payer: Railroad Medicare Medicare |
$7,112.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,707.48
|
| Rate for Payer: UHC Core |
$10,631.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,112.53
|
| Rate for Payer: UHC Exchange |
$8,682.41
|
| Rate for Payer: VA VA |
$7,112.53
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$837.39
|
| Rate for Payer: BCN Commercial |
$837.39
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$837.39
|
| Rate for Payer: BCN Commercial |
$837.39
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,033.91
|
| Rate for Payer: BCN Commercial |
$3,033.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BAND LIGATION OF ESOPHAGEAL/GASTRIC VARICES
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,912.98
|
| Rate for Payer: BCN Commercial |
$1,912.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,016.25
|
| Rate for Payer: BCN Commercial |
$1,016.25
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,195.11
|
| Rate for Payer: BCN Commercial |
$2,195.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF GASTRIC/DUODENAL STRICTURE(S) (EG, BALLOON, BOUGIE)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,458.19
|
| Rate for Payer: BCN Commercial |
$2,458.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,897.09
|
| Rate for Payer: BCN Commercial |
$1,897.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
