|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43236
|
|
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 |
$2,337.31
|
| Rate for Payer: BCN Commercial |
$2,337.31
|
| 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 ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43254
|
|
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 |
$3,077.29
|
| Rate for Payer: BCN Commercial |
$3,077.29
|
| 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 ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE ESOPHAGUS, STOMACH OR DUODENUM, AND ADJACENT STRUCTURES
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43237
|
|
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 |
$1,934.03
|
| Rate for Payer: BCN Commercial |
$1,934.03
|
| 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 INSERTION OF GUIDE WIRE FOLLOWED BY PASSAGE OF DILATOR(S) THROUGH ESOPHAGUS OVER GUIDE WIRE
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43248
|
|
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 |
$830.14
|
| Rate for Payer: BCN Commercial |
$830.14
|
| 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 INSERTION OF INTRALUMINAL TUBE OR CATHETER
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43241
|
|
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 |
$1,144.39
|
| Rate for Payer: BCN Commercial |
$1,144.39
|
| 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 PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$19,562.14
|
|
|
Service Code
|
CPT 43266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,163.66 |
| Max. Negotiated Rate |
$19,562.14 |
| Rate for Payer: Aetna Medicare |
$6,291.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,561.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,561.34
|
| Rate for Payer: BCBS Complete |
$3,322.15
|
| Rate for Payer: BCBS MAPPO |
$6,049.07
|
| Rate for Payer: BCBS Trust/PPO |
$5,260.42
|
| Rate for Payer: BCN Commercial |
$5,260.42
|
| Rate for Payer: BCN Medicare Advantage |
$6,049.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,049.07
|
| Rate for Payer: Mclaren Medicaid |
$6,049.07
|
| Rate for Payer: Mclaren Medicare |
$6,049.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,351.52
|
| Rate for Payer: Meridian Medicaid |
$6,351.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,956.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,653.98
|
| Rate for Payer: Nomi Health Commercial |
$18,147.21
|
| Rate for Payer: PACE Medicare |
$5,746.62
|
| Rate for Payer: PACE SWMI |
$6,049.07
|
| Rate for Payer: PHP Medicare Advantage |
$6,049.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,163.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,562.14
|
| Rate for Payer: Priority Health Medicare |
$6,049.07
|
| Rate for Payer: Priority Health Tiered Network |
$15,649.71
|
| Rate for Payer: Railroad Medicare Medicare |
$6,049.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,049.07
|
| Rate for Payer: UHC Medicaid |
$3,163.66
|
| Rate for Payer: UHCCP Medicaid |
$3,163.66
|
| Rate for Payer: VA VA |
$6,049.07
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$2,922.56
|
|
|
Service Code
|
CPT 43247
|
|
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 |
$1,946.54
|
| Rate for Payer: BCN Commercial |
$1,946.54
|
| 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 REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43251
|
|
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 |
$1,760.28
|
| Rate for Payer: BCN Commercial |
$1,760.28
|
| 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 TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43249
|
|
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 |
$1,335.14
|
| Rate for Payer: BCN Commercial |
$1,335.14
|
| 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 TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE ESOPHAGUS, STOMACH OR DUODENUM, AND ADJACENT STRUCTURES)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43238
|
|
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 |
$2,187.70
|
| Rate for Payer: BCN Commercial |
$2,187.70
|
| 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 TRANSENDOSCOPIC ULTRASOUND-GUIDED TRANSMURAL INJECTION OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, NEUROLYTIC AGENT) OR FIDUCIAL MARKER(S) (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION OF THE ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM OR A SURGICALLY ALTERED STOMACH WHERE THE JEJUNUM IS EXAMINED DISTAL TO THE ANASTOMOSIS)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43253
|
|
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 |
$1,335.14
|
| Rate for Payer: BCN Commercial |
$1,335.14
|
| 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
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43215
|
|
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 |
$1,048.76
|
| Rate for Payer: BCN Commercial |
$1,048.76
|
| 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
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43220
|
|
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 |
$1,144.39
|
| Rate for Payer: BCN Commercial |
$1,144.39
|
| 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
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43191
|
|
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 |
$1,144.39
|
| Rate for Payer: BCN Commercial |
$1,144.39
|
| 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
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$12,423.42
|
|
|
Service Code
|
CPT 43195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,009.16 |
| Max. Negotiated Rate |
$12,423.42 |
| Rate for Payer: Aetna Medicare |
$3,995.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,802.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,802.01
|
| Rate for Payer: BCBS Complete |
$2,109.81
|
| Rate for Payer: BCBS MAPPO |
$3,841.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,135.74
|
| Rate for Payer: BCN Commercial |
$2,135.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,841.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,841.61
|
| Rate for Payer: Mclaren Medicaid |
$3,841.61
|
| Rate for Payer: Mclaren Medicare |
$3,841.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,033.69
|
| Rate for Payer: Meridian Medicaid |
$4,033.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,417.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,225.77
|
| Rate for Payer: Nomi Health Commercial |
$11,524.83
|
| Rate for Payer: PACE Medicare |
$3,649.53
|
| Rate for Payer: PACE SWMI |
$3,841.61
|
| Rate for Payer: PHP Medicare Advantage |
$3,841.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,009.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,423.42
|
| Rate for Payer: Priority Health Medicare |
$3,841.61
|
| Rate for Payer: Priority Health Tiered Network |
$9,938.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,841.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,841.61
|
| Rate for Payer: UHC Medicaid |
$2,009.16
|
| Rate for Payer: UHCCP Medicaid |
$2,009.16
|
| Rate for Payer: VA VA |
$3,841.61
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 43192
|
|
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 |
$1,335.14
|
| Rate for Payer: BCN Commercial |
$1,335.14
|
| 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
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL WITH DIVERTICULECTOMY OF HYPOPHARYNX OR CERVICAL ESOPHAGUS (EG, ZENKER'S DIVERTICULUM), WITH CRICOPHARYNGEAL MYOTOMY, INCLUDES USE OF TELESCOPE OR OPERATING MICROSCOPE AND REPAIR, WHEN PERFORMED
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 43180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,835.44
|
| Rate for Payer: BCN Commercial |
$3,835.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$2,767.09
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$2,767.09 |
| Rate for Payer: Aetna Medicare |
$889.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.94
|
| Rate for Payer: BCN Commercial |
$1,156.94
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$898.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Nomi Health Commercial |
$2,566.95
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Tiered Network |
$2,213.67
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$2,767.09
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$2,767.09 |
| Rate for Payer: Aetna Medicare |
$889.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.94
|
| Rate for Payer: BCN Commercial |
$1,156.94
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$898.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Nomi Health Commercial |
$2,566.95
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Tiered Network |
$2,213.67
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
OP
|
$1,032.30
|
|
|
Service Code
|
NDC 62559015001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.95 |
| Max. Negotiated Rate |
$929.07 |
| Rate for Payer: Aetna American Axle |
$671.00
|
| Rate for Payer: Aetna Commercial |
$877.46
|
| Rate for Payer: Aetna Medicare |
$516.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.00
|
| Rate for Payer: BCBS Complete |
$412.92
|
| Rate for Payer: Cash Price |
$825.84
|
| Rate for Payer: Cofinity Advantage |
$722.61
|
| Rate for Payer: Cofinity Commercial |
$887.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.84
|
| Rate for Payer: Healthscope Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$825.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$774.23
|
| Rate for Payer: PHP Commercial |
$877.46
|
| Rate for Payer: Priority Health SBD |
$650.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.00
|
| Rate for Payer: UHC Core |
$537.83
|
| Rate for Payer: UHC Exchange |
$405.69
|
| Rate for Payer: UMR Bronson Commercial |
$381.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.23
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$1,032.30
|
|
|
Service Code
|
NDC 62559015001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.21 |
| Max. Negotiated Rate |
$929.07 |
| Rate for Payer: Aetna American Axle |
$671.00
|
| Rate for Payer: Aetna Commercial |
$877.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.00
|
| Rate for Payer: Cash Price |
$825.84
|
| Rate for Payer: Cofinity Advantage |
$722.61
|
| Rate for Payer: Cofinity Commercial |
$887.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.84
|
| Rate for Payer: Healthscope Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$774.23
|
| Rate for Payer: PHP Commercial |
$877.46
|
| Rate for Payer: Priority Health SBD |
$650.35
|
| Rate for Payer: UMR Bronson Commercial |
$454.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.23
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
OP
|
$521.28
|
|
|
Service Code
|
NDC 15310002001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.87 |
| Max. Negotiated Rate |
$469.15 |
| Rate for Payer: Aetna American Axle |
$338.83
|
| Rate for Payer: Aetna Commercial |
$443.09
|
| Rate for Payer: Aetna Medicare |
$260.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.83
|
| Rate for Payer: BCBS Complete |
$208.51
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cofinity Advantage |
$364.90
|
| Rate for Payer: Cofinity Commercial |
$448.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.02
|
| Rate for Payer: Healthscope Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$417.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.96
|
| Rate for Payer: PHP Commercial |
$443.09
|
| Rate for Payer: Priority Health SBD |
$328.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.83
|
| Rate for Payer: UHC Core |
$271.59
|
| Rate for Payer: UHC Exchange |
$204.86
|
| Rate for Payer: UMR Bronson Commercial |
$192.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.96
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$521.28
|
|
|
Service Code
|
NDC 15310002001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.36 |
| Max. Negotiated Rate |
$469.15 |
| Rate for Payer: Aetna American Axle |
$338.83
|
| Rate for Payer: Aetna Commercial |
$443.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.83
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cofinity Advantage |
$364.90
|
| Rate for Payer: Cofinity Commercial |
$448.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.02
|
| Rate for Payer: Healthscope Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.96
|
| Rate for Payer: PHP Commercial |
$443.09
|
| Rate for Payer: Priority Health SBD |
$328.41
|
| Rate for Payer: UMR Bronson Commercial |
$229.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.96
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET
|
Facility
|
IP
|
$1,037.85
|
|
|
Service Code
|
NDC 11528001001
|
| Hospital Charge Code |
9960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.65 |
| Max. Negotiated Rate |
$934.07 |
| Rate for Payer: Aetna American Axle |
$674.60
|
| Rate for Payer: Aetna Commercial |
$882.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.60
|
| Rate for Payer: Cash Price |
$830.28
|
| Rate for Payer: Cofinity Advantage |
$726.50
|
| Rate for Payer: Cofinity Commercial |
$892.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$830.28
|
| Rate for Payer: Healthscope Commercial |
$934.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$726.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$778.39
|
| Rate for Payer: PHP Commercial |
$882.17
|
| Rate for Payer: Priority Health SBD |
$653.85
|
| Rate for Payer: UMR Bronson Commercial |
$456.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.39
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET
|
Facility
|
OP
|
$1,037.85
|
|
|
Service Code
|
NDC 11528001001
|
| Hospital Charge Code |
9960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$934.07 |
| Rate for Payer: Aetna American Axle |
$674.60
|
| Rate for Payer: Aetna Commercial |
$882.17
|
| Rate for Payer: Aetna Medicare |
$518.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.60
|
| Rate for Payer: BCBS Complete |
$415.14
|
| Rate for Payer: Cash Price |
$830.28
|
| Rate for Payer: Cofinity Advantage |
$726.50
|
| Rate for Payer: Cofinity Commercial |
$892.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$830.28
|
| Rate for Payer: Healthscope Commercial |
$934.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$726.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$830.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$778.39
|
| Rate for Payer: PHP Commercial |
$882.17
|
| Rate for Payer: Priority Health SBD |
$653.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$674.60
|
| Rate for Payer: UHC Core |
$540.72
|
| Rate for Payer: UHC Exchange |
$407.88
|
| Rate for Payer: UMR Bronson Commercial |
$384.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.39
|
|
