|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.42
|
|
|
Service Code
|
NDC 43598007858
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna American Axle |
$19.12
|
| Rate for Payer: Aetna Commercial |
$25.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Commercial |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$26.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.01
|
| Rate for Payer: PHP Commercial |
$25.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.12
|
| Rate for Payer: Priority Health SBD |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 64679092502
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 64679092502
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
OP
|
$442.70
|
|
|
Service Code
|
NDC 00904561061
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.75
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.75
|
| Rate for Payer: BCBS Complete |
$177.08
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.75
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$163.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 00904561061
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.79 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.75
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.75
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.75
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$194.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
|
Facility
|
OP
|
$2,390.47
|
|
|
Service Code
|
CPT 57505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$455.18 |
| Max. Negotiated Rate |
$2,390.47 |
| Rate for Payer: Aetna Medicare |
$883.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,061.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,061.53
|
| Rate for Payer: BCBS Complete |
$477.94
|
| Rate for Payer: BCBS MAPPO |
$849.22
|
| Rate for Payer: BCN Medicare Advantage |
$849.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.22
|
| Rate for Payer: Mclaren Medicaid |
$455.18
|
| Rate for Payer: Mclaren Medicare |
$849.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.68
|
| Rate for Payer: Meridian Medicaid |
$477.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$976.60
|
| Rate for Payer: PACE Medicare |
$806.76
|
| Rate for Payer: PACE SWMI |
$849.22
|
| Rate for Payer: PHP Medicare Advantage |
$849.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.18
|
| Rate for Payer: Priority Health Medicare |
$849.22
|
| Rate for Payer: Railroad Medicare Medicare |
$849.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,390.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.22
|
| Rate for Payer: UHC Exchange |
$1,622.94
|
| Rate for Payer: UHC Medicare Advantage |
$849.22
|
| Rate for Payer: UHCCP Medicaid |
$455.18
|
| Rate for Payer: VA VA |
$849.22
|
|
|
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
|
Facility
|
OP
|
$13,552.11
|
|
|
Service Code
|
CPT 58353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Exchange |
$9,200.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,580.53
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$552.28
|
|
|
Service Code
|
CPT 58100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$374.96
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$552.28
|
|
|
Service Code
|
CPT 58100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$374.96
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR [S OR J]); WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,502.92
|
|
|
Service Code
|
CPT 44386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,502.92 |
| Rate for Payer: Aetna Medicare |
$924.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,502.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER NECK
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 51715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
ENDOSCOPIC MARKER
|
Facility
|
OP
|
$77.70
|
|
|
Service Code
|
NDC 09900000099
|
| Hospital Charge Code |
2138700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$69.93 |
| Rate for Payer: Aetna American Axle |
$50.51
|
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: Aetna Medicare |
$38.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.51
|
| Rate for Payer: BCBS Complete |
$31.08
|
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$66.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.16
|
| Rate for Payer: Healthscope Commercial |
$69.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.05
|
| Rate for Payer: PHP Commercial |
$66.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.51
|
| Rate for Payer: Priority Health SBD |
$48.95
|
| Rate for Payer: UMR Bronson Commercial |
$28.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.27
|
|
|
ENDOSCOPIC MARKER
|
Facility
|
IP
|
$77.70
|
|
|
Service Code
|
NDC 09900000099
|
| Hospital Charge Code |
2138700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$69.93 |
| Rate for Payer: Aetna American Axle |
$50.51
|
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.51
|
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$66.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.16
|
| Rate for Payer: Healthscope Commercial |
$69.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.05
|
| Rate for Payer: PHP Commercial |
$66.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.51
|
| Rate for Payer: Priority Health SBD |
$48.95
|
| Rate for Payer: UMR Bronson Commercial |
$34.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.27
|
|
|
ENDOSCOPIC PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 29893
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,444.63
|
|
|
Service Code
|
CPT 43260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,988.82 |
| Max. Negotiated Rate |
$10,444.63 |
| Rate for Payer: Aetna Medicare |
$3,858.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,638.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,638.10
|
| Rate for Payer: BCBS Complete |
$2,088.26
|
| Rate for Payer: BCBS MAPPO |
$3,710.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,710.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,710.48
|
| Rate for Payer: Mclaren Medicaid |
$1,988.82
|
| Rate for Payer: Mclaren Medicare |
$3,710.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,896.00
|
| Rate for Payer: Meridian Medicaid |
$2,088.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,267.05
|
| Rate for Payer: PACE Medicare |
$3,524.96
|
| Rate for Payer: PACE SWMI |
$3,710.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,988.82
|
| Rate for Payer: Priority Health Medicare |
$3,710.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,710.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,444.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,710.48
|
| Rate for Payer: UHC Exchange |
$7,091.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,710.48
|
| Rate for Payer: UHCCP Medicaid |
$1,988.82
|
| Rate for Payer: VA VA |
$3,710.48
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S), INCLUDING PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED
|
Facility
|
OP
|
$10,444.63
|
|
|
Service Code
|
CPT 43278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,988.82 |
| Max. Negotiated Rate |
$10,444.63 |
| Rate for Payer: Aetna Medicare |
$3,858.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,638.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,638.10
|
| Rate for Payer: BCBS Complete |
$2,088.26
|
| Rate for Payer: BCBS MAPPO |
$3,710.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,710.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,710.48
|
| Rate for Payer: Mclaren Medicaid |
$1,988.82
|
| Rate for Payer: Mclaren Medicare |
$3,710.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,896.00
|
| Rate for Payer: Meridian Medicaid |
$2,088.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,267.05
|
| Rate for Payer: PACE Medicare |
$3,524.96
|
| Rate for Payer: PACE SWMI |
$3,710.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,988.82
|
| Rate for Payer: Priority Health Medicare |
$3,710.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,710.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,444.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,710.48
|
| Rate for Payer: UHC Exchange |
$7,091.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,710.48
|
| Rate for Payer: UHCCP Medicaid |
$1,988.82
|
| Rate for Payer: VA VA |
$3,710.48
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$10,444.63
|
|
|
Service Code
|
CPT 43261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,988.82 |
| Max. Negotiated Rate |
$10,444.63 |
| Rate for Payer: Aetna Medicare |
$3,858.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,638.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,638.10
|
| Rate for Payer: BCBS Complete |
$2,088.26
|
| Rate for Payer: BCBS MAPPO |
$3,710.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,710.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,710.48
|
| Rate for Payer: Mclaren Medicaid |
$1,988.82
|
| Rate for Payer: Mclaren Medicare |
$3,710.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,896.00
|
| Rate for Payer: Meridian Medicaid |
$2,088.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,267.05
|
| Rate for Payer: PACE Medicare |
$3,524.96
|
| Rate for Payer: PACE SWMI |
$3,710.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,988.82
|
| Rate for Payer: Priority Health Medicare |
$3,710.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,710.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,444.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,710.48
|
| Rate for Payer: UHC Exchange |
$7,091.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,710.48
|
| Rate for Payer: UHCCP Medicaid |
$1,988.82
|
| Rate for Payer: VA VA |
$3,710.48
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH DESTRUCTION OF CALCULI, ANY METHOD (EG, MECHANICAL, ELECTROHYDRAULIC, LITHOTRIPSY)
|
Facility
|
OP
|
$16,342.35
|
|
|
Service Code
|
CPT 43265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,111.83 |
| Max. Negotiated Rate |
$16,342.35 |
| Rate for Payer: Aetna Medicare |
$6,037.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,257.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,257.07
|
| Rate for Payer: BCBS Complete |
$3,267.43
|
| Rate for Payer: BCBS MAPPO |
$5,805.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,805.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,805.66
|
| Rate for Payer: Mclaren Medicaid |
$3,111.83
|
| Rate for Payer: Mclaren Medicare |
$5,805.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,095.94
|
| Rate for Payer: Meridian Medicaid |
$3,267.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,676.51
|
| Rate for Payer: PACE Medicare |
$5,515.38
|
| Rate for Payer: PACE SWMI |
$5,805.66
|
| Rate for Payer: PHP Medicare Advantage |
$5,805.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,111.83
|
| Rate for Payer: Priority Health Medicare |
$5,805.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5,805.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,342.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,805.66
|
| Rate for Payer: UHC Exchange |
$11,095.20
|
| Rate for Payer: UHC Medicare Advantage |
$5,805.66
|
| Rate for Payer: UHCCP Medicaid |
$3,111.83
|
| Rate for Payer: VA VA |
$5,805.66
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PLACEMENT OF ENDOSCOPIC STENT INTO BILIARY OR PANCREATIC DUCT, INCLUDING PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED, EACH STENT
|
Facility
|
OP
|
$16,342.35
|
|
|
Service Code
|
CPT 43274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,111.83 |
| Max. Negotiated Rate |
$16,342.35 |
| Rate for Payer: Aetna Medicare |
$6,037.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,257.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,257.07
|
| Rate for Payer: BCBS Complete |
$3,267.43
|
| Rate for Payer: BCBS MAPPO |
$5,805.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,805.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,805.66
|
| Rate for Payer: Mclaren Medicaid |
$3,111.83
|
| Rate for Payer: Mclaren Medicare |
$5,805.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,095.94
|
| Rate for Payer: Meridian Medicaid |
$3,267.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,676.51
|
| Rate for Payer: PACE Medicare |
$5,515.38
|
| Rate for Payer: PACE SWMI |
$5,805.66
|
| Rate for Payer: PHP Medicare Advantage |
$5,805.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,111.83
|
| Rate for Payer: Priority Health Medicare |
$5,805.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5,805.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,342.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,805.66
|
| Rate for Payer: UHC Exchange |
$11,095.20
|
| Rate for Payer: UHC Medicare Advantage |
$5,805.66
|
| Rate for Payer: UHCCP Medicaid |
$3,111.83
|
| Rate for Payer: VA VA |
$5,805.66
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PLACEMENT OF ENDOSCOPIC STENT INTO BILIARY OR PANCREATIC DUCT, INCLUDING PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED, EACH STENT
|
Facility
|
OP
|
$16,342.35
|
|
|
Service Code
|
CPT 43274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,111.83 |
| Max. Negotiated Rate |
$16,342.35 |
| Rate for Payer: Aetna Medicare |
$6,037.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,257.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,257.07
|
| Rate for Payer: BCBS Complete |
$3,267.43
|
| Rate for Payer: BCBS MAPPO |
$5,805.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,805.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,805.66
|
| Rate for Payer: Mclaren Medicaid |
$3,111.83
|
| Rate for Payer: Mclaren Medicare |
$5,805.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,095.94
|
| Rate for Payer: Meridian Medicaid |
$3,267.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,676.51
|
| Rate for Payer: PACE Medicare |
$5,515.38
|
| Rate for Payer: PACE SWMI |
$5,805.66
|
| Rate for Payer: PHP Medicare Advantage |
$5,805.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,111.83
|
| Rate for Payer: Priority Health Medicare |
$5,805.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5,805.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,342.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,805.66
|
| Rate for Payer: UHC Exchange |
$11,095.20
|
| Rate for Payer: UHC Medicare Advantage |
$5,805.66
|
| Rate for Payer: UHCCP Medicaid |
$3,111.83
|
| Rate for Payer: VA VA |
$5,805.66
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL AND EXCHANGE OF STENT(S), BILIARY OR PANCREATIC DUCT, INCLUDING PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED, EACH STENT EXCHANGED
|
Facility
|
OP
|
$16,342.35
|
|
|
Service Code
|
CPT 43276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,111.83 |
| Max. Negotiated Rate |
$16,342.35 |
| Rate for Payer: Aetna Medicare |
$6,037.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,257.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,257.07
|
| Rate for Payer: BCBS Complete |
$3,267.43
|
| Rate for Payer: BCBS MAPPO |
$5,805.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,805.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,805.66
|
| Rate for Payer: Mclaren Medicaid |
$3,111.83
|
| Rate for Payer: Mclaren Medicare |
$5,805.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,095.94
|
| Rate for Payer: Meridian Medicaid |
$3,267.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,676.51
|
| Rate for Payer: PACE Medicare |
$5,515.38
|
| Rate for Payer: PACE SWMI |
$5,805.66
|
| Rate for Payer: PHP Medicare Advantage |
$5,805.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,111.83
|
| Rate for Payer: Priority Health Medicare |
$5,805.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5,805.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,342.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,805.66
|
| Rate for Payer: UHC Exchange |
$11,095.20
|
| Rate for Payer: UHC Medicare Advantage |
$5,805.66
|
| Rate for Payer: UHCCP Medicaid |
$3,111.83
|
| Rate for Payer: VA VA |
$5,805.66
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF CALCULI/DEBRIS FROM BILIARY/PANCREATIC DUCT(S)
|
Facility
|
OP
|
$10,444.63
|
|
|
Service Code
|
CPT 43264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,988.82 |
| Max. Negotiated Rate |
$10,444.63 |
| Rate for Payer: Aetna Medicare |
$3,858.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,638.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,638.10
|
| Rate for Payer: BCBS Complete |
$2,088.26
|
| Rate for Payer: BCBS MAPPO |
$3,710.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,710.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,710.48
|
| Rate for Payer: Mclaren Medicaid |
$1,988.82
|
| Rate for Payer: Mclaren Medicare |
$3,710.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,896.00
|
| Rate for Payer: Meridian Medicaid |
$2,088.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,267.05
|
| Rate for Payer: PACE Medicare |
$3,524.96
|
| Rate for Payer: PACE SWMI |
$3,710.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,988.82
|
| Rate for Payer: Priority Health Medicare |
$3,710.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,710.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,444.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,710.48
|
| Rate for Payer: UHC Exchange |
$7,091.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,710.48
|
| Rate for Payer: UHCCP Medicaid |
$1,988.82
|
| Rate for Payer: VA VA |
$3,710.48
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF FOREIGN BODY(S) OR STENT(S) FROM BILIARY/PANCREATIC DUCT(S)
|
Facility
|
OP
|
$5,207.85
|
|
|
Service Code
|
CPT 43275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY
|
Facility
|
OP
|
$10,444.63
|
|
|
Service Code
|
CPT 43262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,988.82 |
| Max. Negotiated Rate |
$10,444.63 |
| Rate for Payer: Aetna Medicare |
$3,858.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,638.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,638.10
|
| Rate for Payer: BCBS Complete |
$2,088.26
|
| Rate for Payer: BCBS MAPPO |
$3,710.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,710.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,710.48
|
| Rate for Payer: Mclaren Medicaid |
$1,988.82
|
| Rate for Payer: Mclaren Medicare |
$3,710.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,896.00
|
| Rate for Payer: Meridian Medicaid |
$2,088.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,267.05
|
| Rate for Payer: PACE Medicare |
$3,524.96
|
| Rate for Payer: PACE SWMI |
$3,710.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,988.82
|
| Rate for Payer: Priority Health Medicare |
$3,710.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,710.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,444.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,710.48
|
| Rate for Payer: UHC Exchange |
$7,091.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,710.48
|
| Rate for Payer: UHCCP Medicaid |
$1,988.82
|
| Rate for Payer: VA VA |
$3,710.48
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH TRANS-ENDOSCOPIC BALLOON DILATION OF BILIARY/PANCREATIC DUCT(S) OR OF AMPULLA (SPHINCTEROPLASTY), INCLUDING SPHINCTEROTOMY, WHEN PERFORMED, EACH DUCT
|
Facility
|
OP
|
$10,444.63
|
|
|
Service Code
|
CPT 43277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,988.82 |
| Max. Negotiated Rate |
$10,444.63 |
| Rate for Payer: Aetna Medicare |
$3,858.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,638.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,638.10
|
| Rate for Payer: BCBS Complete |
$2,088.26
|
| Rate for Payer: BCBS MAPPO |
$3,710.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,710.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,710.48
|
| Rate for Payer: Mclaren Medicaid |
$1,988.82
|
| Rate for Payer: Mclaren Medicare |
$3,710.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,896.00
|
| Rate for Payer: Meridian Medicaid |
$2,088.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,267.05
|
| Rate for Payer: PACE Medicare |
$3,524.96
|
| Rate for Payer: PACE SWMI |
$3,710.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,988.82
|
| Rate for Payer: Priority Health Medicare |
$3,710.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,710.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,444.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,710.48
|
| Rate for Payer: UHC Exchange |
$7,091.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,710.48
|
| Rate for Payer: UHCCP Medicaid |
$1,988.82
|
| Rate for Payer: VA VA |
$3,710.48
|
|
