|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.56
|
|
|
Service Code
|
NDC 00143978601
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Aetna American Axle |
$37.41
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$28.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.41
|
| Rate for Payer: BCBS Complete |
$23.02
|
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.41
|
| Rate for Payer: Priority Health SBD |
$36.26
|
| Rate for Payer: UMR Bronson Commercial |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.17
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
NDC 00143978601
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Aetna American Axle |
$37.41
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.41
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.41
|
| Rate for Payer: Priority Health SBD |
$36.26
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.17
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.42
|
|
|
Service Code
|
NDC 43598007811
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna American Axle |
$19.12
|
| Rate for Payer: Aetna Commercial |
$25.01
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: BCBS Complete |
$11.77
|
| 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 |
$22.06
|
| 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 |
$10.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.06
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.74
|
|
|
Service Code
|
NDC 55390001010
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$21.37 |
| Rate for Payer: Aetna American Axle |
$15.43
|
| Rate for Payer: Aetna Commercial |
$20.18
|
| Rate for Payer: Aetna Medicare |
$11.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.43
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$21.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.18
|
| Rate for Payer: PHP Commercial |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.43
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.80
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.42
|
|
|
Service Code
|
NDC 43598007811
|
| 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 |
$22.06
|
| 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 |
$22.06
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.38
|
|
|
Service Code
|
NDC 00143978710
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna American Axle |
$12.60
|
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.47
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health SBD |
$12.21
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.74
|
|
|
Service Code
|
NDC 55390001010
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$21.37 |
| Rate for Payer: Aetna American Axle |
$15.43
|
| Rate for Payer: Aetna Commercial |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.43
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$21.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.18
|
| Rate for Payer: PHP Commercial |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.43
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.80
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.42
|
|
|
Service Code
|
NDC 43598007858
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna American Axle |
$19.12
|
| Rate for Payer: Aetna Commercial |
$25.01
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: BCBS Complete |
$11.77
|
| 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 |
$22.06
|
| 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 |
$10.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.06
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.38
|
|
|
Service Code
|
NDC 00143978710
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna American Axle |
$12.60
|
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna Medicare |
$9.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: BCBS Complete |
$7.75
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.47
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health SBD |
$12.21
|
| Rate for Payer: UMR Bronson Commercial |
$7.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
NDC 00143978610
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Aetna American Axle |
$37.41
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.41
|
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.05
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.41
|
| Rate for Payer: Priority Health SBD |
$36.26
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.17
|
|
|
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 |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| 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 |
$287.76
|
| 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
|
|
|
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 |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| 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 |
$287.76
|
| 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
|
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
|
|
|
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
|
Facility
|
OP
|
$2,681.40
|
|
|
Service Code
|
CPT 57505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.22 |
| Max. Negotiated Rate |
$2,681.40 |
| Rate for Payer: Aetna Medicare |
$887.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,066.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,066.41
|
| Rate for Payer: BCBS Complete |
$480.14
|
| Rate for Payer: BCBS MAPPO |
$853.13
|
| Rate for Payer: BCBS Trust/PPO |
$789.01
|
| Rate for Payer: BCCCP Commercial |
$145.60
|
| Rate for Payer: BCN Commercial |
$789.01
|
| Rate for Payer: BCN Medicare Advantage |
$853.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.13
|
| Rate for Payer: Mclaren Medicaid |
$457.28
|
| Rate for Payer: Mclaren Medicare |
$853.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.79
|
| Rate for Payer: Meridian Medicaid |
$480.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$981.10
|
| Rate for Payer: Nomi Health Commercial |
$1,791.57
|
| Rate for Payer: PACE Medicare |
$810.47
|
| Rate for Payer: PACE SWMI |
$853.13
|
| Rate for Payer: PHP Medicare Advantage |
$853.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,681.40
|
| Rate for Payer: Priority Health Medicare |
$853.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$853.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.64
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.13
|
| Rate for Payer: UHC Exchange |
$104.22
|
| Rate for Payer: UHC Medicare Advantage |
$853.13
|
| Rate for Payer: UHCCP Medicaid |
$457.28
|
| Rate for Payer: VA VA |
$853.13
|
|
|
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 58353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$223.55 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,606.74
|
| Rate for Payer: BCN Commercial |
$3,606.74
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.90
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$223.55
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) PERFORMED IN CONJUNCTION WITH COLPOSCOPY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 58110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$171.82
|
| Rate for Payer: BCN Commercial |
$171.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$39.16
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 58100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$132.24
|
| Rate for Payer: BCCCP Commercial |
$97.15
|
| Rate for Payer: BCN Commercial |
$132.24
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.78
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$61.62
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 58100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$132.24
|
| Rate for Payer: BCCCP Commercial |
$97.15
|
| Rate for Payer: BCN Commercial |
$132.24
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.78
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$61.62
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
ENDOSCOPIC CANNULATION OF PAPILLA WITH DIRECT VISUALIZATION OF PANCREATIC/COMMON BILE DUCT(S) (LIST SEPARATELY IN ADDITION TO CODE(S) FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 43273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$444.75
|
| Rate for Payer: BCN Commercial |
$444.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.48
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$113.16
|
|
|
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR [S OR J]); WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,807.55
|
|
|
Service Code
|
CPT 44386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.05 |
| Max. Negotiated Rate |
$2,807.55 |
| Rate for Payer: Aetna Medicare |
$929.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,576.57
|
| Rate for Payer: BCN Commercial |
$1,576.57
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Nomi Health Commercial |
$1,875.89
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,807.55
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,246.04
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.56
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$85.05
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$478.80
|
| Rate for Payer: VA VA |
$893.28
|
|
|
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER NECK
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 51715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.84 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,122.57
|
| Rate for Payer: BCN Commercial |
$3,122.57
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.02
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$191.84
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
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 |
$50.50
|
| Rate for Payer: Aetna Commercial |
$66.04
|
| Rate for Payer: Aetna Medicare |
$38.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.50
|
| 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 |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.04
|
| Rate for Payer: PHP Commercial |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.50
|
| 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 |
$58.28
|
|
|
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 |
$50.50
|
| Rate for Payer: Aetna Commercial |
$66.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.50
|
| 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 |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.04
|
| Rate for Payer: PHP Commercial |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.50
|
| 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 |
$58.28
|
|
|
ENDOSCOPIC PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 29893
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$419.49 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.44
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$419.49
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
