|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,715.79
|
|
|
Service Code
|
CPT 43260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.44 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,304.96
|
| Rate for Payer: BCN Commercial |
$3,304.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.08
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$306.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
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
|
$11,715.79
|
|
|
Service Code
|
CPT 43278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$411.26 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,062.48
|
| Rate for Payer: BCN Commercial |
$2,062.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.39
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$411.26
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$11,715.79
|
|
|
Service Code
|
CPT 43261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.68 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,767.85
|
| Rate for Payer: BCN Commercial |
$1,767.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.85
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$321.68
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH DESTRUCTION OF CALCULI, ANY METHOD (EG, MECHANICAL, ELECTROHYDRAULIC, LITHOTRIPSY)
|
Facility
|
OP
|
$18,331.27
|
|
|
Service Code
|
CPT 43265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$411.21 |
| Max. Negotiated Rate |
$18,331.27 |
| Rate for Payer: Aetna Medicare |
$6,065.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,290.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,290.55
|
| Rate for Payer: BCBS Complete |
$3,282.50
|
| Rate for Payer: BCBS MAPPO |
$5,832.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,729.09
|
| Rate for Payer: BCN Commercial |
$2,729.09
|
| Rate for Payer: BCN Medicare Advantage |
$5,832.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,832.44
|
| Rate for Payer: Mclaren Medicaid |
$3,126.19
|
| Rate for Payer: Mclaren Medicare |
$5,832.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,124.06
|
| Rate for Payer: Meridian Medicaid |
$3,282.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,707.31
|
| Rate for Payer: Nomi Health Commercial |
$12,248.12
|
| Rate for Payer: PACE Medicare |
$5,540.82
|
| Rate for Payer: PACE SWMI |
$5,832.44
|
| Rate for Payer: PHP Medicare Advantage |
$5,832.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,126.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,331.27
|
| Rate for Payer: Priority Health Medicare |
$5,832.44
|
| Rate for Payer: Priority Health Narrow Network |
$14,665.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5,832.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.33
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,832.44
|
| Rate for Payer: UHC Exchange |
$411.21
|
| Rate for Payer: UHC Medicare Advantage |
$5,832.44
|
| Rate for Payer: UHCCP Medicaid |
$3,126.19
|
| Rate for Payer: VA VA |
$5,832.44
|
|
|
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
|
$18,331.27
|
|
|
Service Code
|
CPT 43274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$439.45 |
| Max. Negotiated Rate |
$18,331.27 |
| Rate for Payer: Aetna Medicare |
$6,065.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,290.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,290.55
|
| Rate for Payer: BCBS Complete |
$3,282.50
|
| Rate for Payer: BCBS MAPPO |
$5,832.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,599.29
|
| Rate for Payer: BCN Commercial |
$4,599.29
|
| Rate for Payer: BCN Medicare Advantage |
$5,832.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,832.44
|
| Rate for Payer: Mclaren Medicaid |
$3,126.19
|
| Rate for Payer: Mclaren Medicare |
$5,832.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,124.06
|
| Rate for Payer: Meridian Medicaid |
$3,282.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,707.31
|
| Rate for Payer: Nomi Health Commercial |
$12,248.12
|
| Rate for Payer: PACE Medicare |
$5,540.82
|
| Rate for Payer: PACE SWMI |
$5,832.44
|
| Rate for Payer: PHP Medicare Advantage |
$5,832.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,126.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,331.27
|
| Rate for Payer: Priority Health Medicare |
$5,832.44
|
| Rate for Payer: Priority Health Narrow Network |
$14,665.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5,832.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,832.44
|
| Rate for Payer: UHC Exchange |
$439.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,832.44
|
| Rate for Payer: UHCCP Medicaid |
$3,126.19
|
| Rate for Payer: VA VA |
$5,832.44
|
|
|
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
|
$18,331.27
|
|
|
Service Code
|
CPT 43274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.45 |
| Max. Negotiated Rate |
$18,331.27 |
| Rate for Payer: Aetna Medicare |
$6,065.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,290.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,290.55
|
| Rate for Payer: BCBS Complete |
$3,282.50
|
| Rate for Payer: BCBS MAPPO |
$5,832.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,599.29
|
| Rate for Payer: BCN Commercial |
$4,599.29
|
| Rate for Payer: BCN Medicare Advantage |
$5,832.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,832.44
|
| Rate for Payer: Mclaren Medicaid |
$3,126.19
|
| Rate for Payer: Mclaren Medicare |
$5,832.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,124.06
|
| Rate for Payer: Meridian Medicaid |
$3,282.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,707.31
|
| Rate for Payer: Nomi Health Commercial |
$12,248.12
|
| Rate for Payer: PACE Medicare |
$5,540.82
|
| Rate for Payer: PACE SWMI |
$5,832.44
|
| Rate for Payer: PHP Medicare Advantage |
$5,832.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,126.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,331.27
|
| Rate for Payer: Priority Health Medicare |
$5,832.44
|
| Rate for Payer: Priority Health Narrow Network |
$14,665.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5,832.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,832.44
|
| Rate for Payer: UHC Exchange |
$439.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,832.44
|
| Rate for Payer: UHCCP Medicaid |
$3,126.19
|
| Rate for Payer: VA VA |
$5,832.44
|
|
|
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
|
$18,331.27
|
|
|
Service Code
|
CPT 43276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$457.55 |
| Max. Negotiated Rate |
$18,331.27 |
| Rate for Payer: Aetna Medicare |
$6,065.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,290.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,290.55
|
| Rate for Payer: BCBS Complete |
$3,282.50
|
| Rate for Payer: BCBS MAPPO |
$5,832.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,900.74
|
| Rate for Payer: BCN Commercial |
$4,900.74
|
| Rate for Payer: BCN Medicare Advantage |
$5,832.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,832.44
|
| Rate for Payer: Mclaren Medicaid |
$3,126.19
|
| Rate for Payer: Mclaren Medicare |
$5,832.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,124.06
|
| Rate for Payer: Meridian Medicaid |
$3,282.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,707.31
|
| Rate for Payer: Nomi Health Commercial |
$12,248.12
|
| Rate for Payer: PACE Medicare |
$5,540.82
|
| Rate for Payer: PACE SWMI |
$5,832.44
|
| Rate for Payer: PHP Medicare Advantage |
$5,832.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,126.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,331.27
|
| Rate for Payer: Priority Health Medicare |
$5,832.44
|
| Rate for Payer: Priority Health Narrow Network |
$14,665.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5,832.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.30
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,832.44
|
| Rate for Payer: UHC Exchange |
$457.55
|
| Rate for Payer: UHC Medicare Advantage |
$5,832.44
|
| Rate for Payer: UHCCP Medicaid |
$3,126.19
|
| Rate for Payer: VA VA |
$5,832.44
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF CALCULI/DEBRIS FROM BILIARY/PANCREATIC DUCT(S)
|
Facility
|
OP
|
$11,715.79
|
|
|
Service Code
|
CPT 43264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$345.49 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: BCBS Trust/PPO |
$3,138.30
|
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCN Commercial |
$3,138.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.04
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$345.49
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF FOREIGN BODY(S) OR STENT(S) FROM BILIARY/PANCREATIC DUCT(S)
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$357.16 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,158.37
|
| Rate for Payer: BCN Commercial |
$3,158.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.88
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$357.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY
|
Facility
|
OP
|
$11,715.79
|
|
|
Service Code
|
CPT 43262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$338.68 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,431.95
|
| Rate for Payer: BCN Commercial |
$3,431.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.55
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$338.68
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
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
|
$11,715.79
|
|
|
Service Code
|
CPT 43277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$359.06 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,820.95
|
| Rate for Payer: BCN Commercial |
$3,820.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.97
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$359.06
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD), INCLUDING ENDOSCOPY OR COLONOSCOPY, MUCOSAL CLOSURE, WHEN PERFORMED
|
Facility
|
OP
|
$11,715.79
|
|
|
Service Code
|
CPT C9779
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,997.99 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,492.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$7,123.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD), INCLUDING ENDOSCOPY OR COLONOSCOPY, MUCOSAL CLOSURE, WHEN PERFORMED
|
Facility
|
OP
|
$11,715.79
|
|
|
Service Code
|
CPT C9779
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,997.99 |
| Max. Negotiated Rate |
$11,715.79 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,492.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$7,123.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 29848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$496.91 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,557.08
|
| Rate for Payer: BCN Commercial |
$2,557.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.60
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$496.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, LASER; FIRST VEIN TREATED
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$267.91 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.38
|
| Rate for Payer: BCN Commercial |
$2,592.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.70
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$267.91
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.43 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,741.94
|
| Rate for Payer: BCN Commercial |
$2,741.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.27
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$268.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.43 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,741.94
|
| Rate for Payer: BCN Commercial |
$2,741.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.27
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$268.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,060.06
|
|
|
Service Code
|
CPT 36476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.86 |
| Max. Negotiated Rate |
$1,060.06 |
| Rate for Payer: BCBS Trust/PPO |
$1,060.06
|
| Rate for Payer: BCN Commercial |
$1,060.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.75
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$128.86
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,612.41
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
192400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$11,351.17 |
| Rate for Payer: Aetna American Axle |
$8,198.07
|
| Rate for Payer: Aetna Commercial |
$10,720.55
|
| Rate for Payer: Aetna Medicare |
$38.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,198.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.81
|
| Rate for Payer: BCBS Complete |
$20.63
|
| Rate for Payer: BCBS MAPPO |
$36.65
|
| Rate for Payer: BCBS Trust/PPO |
$99.05
|
| Rate for Payer: BCN Commercial |
$99.05
|
| Rate for Payer: BCN Medicare Advantage |
$36.65
|
| Rate for Payer: Cash Price |
$10,089.93
|
| Rate for Payer: Cash Price |
$10,089.93
|
| Rate for Payer: Cofinity Commercial |
$8,828.69
|
| Rate for Payer: Cofinity Commercial |
$10,846.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,828.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,089.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.65
|
| Rate for Payer: Healthscope Commercial |
$11,351.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,828.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,459.31
|
| Rate for Payer: Mclaren Medicaid |
$19.64
|
| Rate for Payer: Mclaren Medicare |
$36.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.48
|
| Rate for Payer: Meridian Medicaid |
$20.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,720.55
|
| Rate for Payer: Nomi Health Commercial |
$109.95
|
| Rate for Payer: PACE Medicare |
$34.82
|
| Rate for Payer: PACE SWMI |
$36.65
|
| Rate for Payer: PHP Commercial |
$10,720.55
|
| Rate for Payer: PHP Medicare Advantage |
$36.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,198.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.73
|
| Rate for Payer: Priority Health Medicare |
$36.65
|
| Rate for Payer: Priority Health Narrow Network |
$84.58
|
| Rate for Payer: Priority Health SBD |
$7,945.82
|
| Rate for Payer: Railroad Medicare Medicare |
$36.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.65
|
| Rate for Payer: UHC Exchange |
$70.04
|
| Rate for Payer: UHC Medicare Advantage |
$36.65
|
| Rate for Payer: UHCCP Medicaid |
$19.64
|
| Rate for Payer: UMR Bronson Commercial |
$4,666.59
|
| Rate for Payer: VA VA |
$36.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,459.31
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18,918.62
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
192401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$17,026.76 |
| Rate for Payer: Aetna American Axle |
$12,297.10
|
| Rate for Payer: Aetna Commercial |
$16,080.83
|
| Rate for Payer: Aetna Medicare |
$38.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,297.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.81
|
| Rate for Payer: BCBS Complete |
$20.63
|
| Rate for Payer: BCBS MAPPO |
$36.65
|
| Rate for Payer: BCBS Trust/PPO |
$99.05
|
| Rate for Payer: BCN Commercial |
$99.05
|
| Rate for Payer: BCN Medicare Advantage |
$36.65
|
| Rate for Payer: Cash Price |
$15,134.90
|
| Rate for Payer: Cash Price |
$15,134.90
|
| Rate for Payer: Cofinity Commercial |
$16,270.01
|
| Rate for Payer: Cofinity Commercial |
$13,243.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,243.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,134.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.65
|
| Rate for Payer: Healthscope Commercial |
$17,026.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,243.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,188.96
|
| Rate for Payer: Mclaren Medicaid |
$19.64
|
| Rate for Payer: Mclaren Medicare |
$36.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.48
|
| Rate for Payer: Meridian Medicaid |
$20.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,080.83
|
| Rate for Payer: Nomi Health Commercial |
$109.95
|
| Rate for Payer: PACE Medicare |
$34.82
|
| Rate for Payer: PACE SWMI |
$36.65
|
| Rate for Payer: PHP Commercial |
$16,080.83
|
| Rate for Payer: PHP Medicare Advantage |
$36.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,297.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.73
|
| Rate for Payer: Priority Health Medicare |
$36.65
|
| Rate for Payer: Priority Health Narrow Network |
$84.58
|
| Rate for Payer: Priority Health SBD |
$11,918.73
|
| Rate for Payer: Railroad Medicare Medicare |
$36.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.65
|
| Rate for Payer: UHC Exchange |
$70.04
|
| Rate for Payer: UHC Medicare Advantage |
$36.65
|
| Rate for Payer: UHCCP Medicaid |
$19.64
|
| Rate for Payer: UMR Bronson Commercial |
$6,999.89
|
| Rate for Payer: VA VA |
$36.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,188.96
|
|
|
ENFUVIRTIDE 90 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$9,322.41
|
|
|
Service Code
|
NDC 00004038140
|
| Hospital Charge Code |
159192
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,101.86 |
| Max. Negotiated Rate |
$8,390.17 |
| Rate for Payer: Aetna American Axle |
$6,059.57
|
| Rate for Payer: Aetna Commercial |
$7,924.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,059.57
|
| Rate for Payer: Cash Price |
$7,457.93
|
| Rate for Payer: Cofinity Commercial |
$6,525.69
|
| Rate for Payer: Cofinity Commercial |
$8,017.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,525.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,457.93
|
| Rate for Payer: Healthscope Commercial |
$8,390.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,525.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,991.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,924.05
|
| Rate for Payer: PHP Commercial |
$7,924.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,059.57
|
| Rate for Payer: Priority Health SBD |
$5,873.12
|
| Rate for Payer: UMR Bronson Commercial |
$4,101.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,991.81
|
|
|
ENFUVIRTIDE 90 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$9,322.41
|
|
|
Service Code
|
NDC 00004038140
|
| Hospital Charge Code |
159192
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,449.29 |
| Max. Negotiated Rate |
$8,390.17 |
| Rate for Payer: Aetna American Axle |
$6,059.57
|
| Rate for Payer: Aetna Commercial |
$7,924.05
|
| Rate for Payer: Aetna Medicare |
$4,661.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,059.57
|
| Rate for Payer: BCBS Complete |
$3,728.96
|
| Rate for Payer: Cash Price |
$7,457.93
|
| Rate for Payer: Cofinity Commercial |
$6,525.69
|
| Rate for Payer: Cofinity Commercial |
$8,017.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,525.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,457.93
|
| Rate for Payer: Healthscope Commercial |
$8,390.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,525.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,991.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,924.05
|
| Rate for Payer: PHP Commercial |
$7,924.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,059.57
|
| Rate for Payer: Priority Health SBD |
$5,873.12
|
| Rate for Payer: UMR Bronson Commercial |
$3,449.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,991.81
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$30.43
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$27.39 |
| Rate for Payer: Aetna American Axle |
$19.78
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$24.78
|
| Rate for Payer: Aetna American Axle |
$70.04
|
| Rate for Payer: Aetna American Axle |
$41.22
|
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: Aetna Commercial |
$91.60
|
| Rate for Payer: Aetna Commercial |
$53.91
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$19.06
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: Aetna Medicare |
$15.22
|
| Rate for Payer: Aetna Medicare |
$53.88
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: BCBS Complete |
$12.17
|
| Rate for Payer: BCBS Complete |
$43.10
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Complete |
$25.37
|
| Rate for Payer: BCBS Complete |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$24.34
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$86.21
|
| Rate for Payer: Cash Price |
$24.34
|
| Rate for Payer: Cash Price |
$86.21
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$21.30
|
| Rate for Payer: Cofinity Commercial |
$54.54
|
| Rate for Payer: Cofinity Commercial |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$92.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$96.98
|
| Rate for Payer: Healthscope Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Healthscope Commercial |
$57.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.60
|
| Rate for Payer: PHP Commercial |
$53.91
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: PHP Commercial |
$91.60
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.78
|
| Rate for Payer: Priority Health SBD |
$19.17
|
| Rate for Payer: Priority Health SBD |
$39.95
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$67.89
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: UMR Bronson Commercial |
$39.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.26
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.82
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$62.08
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$55.87 |
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$70.04
|
| Rate for Payer: Aetna American Axle |
$19.78
|
| Rate for Payer: Aetna American Axle |
$41.22
|
| Rate for Payer: Aetna American Axle |
$24.78
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: Aetna Commercial |
$91.60
|
| Rate for Payer: Aetna Commercial |
$53.91
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.78
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: Cash Price |
$24.34
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$86.21
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Commercial |
$26.68
|
| Rate for Payer: Cofinity Commercial |
$21.30
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$92.67
|
| Rate for Payer: Cofinity Commercial |
$54.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$34.31
|
| Rate for Payer: Healthscope Commercial |
$57.08
|
| Rate for Payer: Healthscope Commercial |
$96.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.60
|
| Rate for Payer: PHP Commercial |
$91.60
|
| Rate for Payer: PHP Commercial |
$53.91
|
| Rate for Payer: PHP Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.04
|
| Rate for Payer: Priority Health SBD |
$39.95
|
| Rate for Payer: Priority Health SBD |
$24.02
|
| Rate for Payer: Priority Health SBD |
$19.17
|
| Rate for Payer: Priority Health SBD |
$67.89
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: UMR Bronson Commercial |
$47.41
|
| Rate for Payer: UMR Bronson Commercial |
$13.39
|
| Rate for Payer: UMR Bronson Commercial |
$27.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.90
|
| Rate for Payer: UMR Bronson Commercial |
$16.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
105904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Aetna American Axle |
$49.46
|
| Rate for Payer: Aetna American Axle |
$48.42
|
| Rate for Payer: Aetna American Axle |
$29.65
|
| Rate for Payer: Aetna American Axle |
$22.94
|
| Rate for Payer: Aetna American Axle |
$47.97
|
| Rate for Payer: Aetna American Axle |
$68.97
|
| Rate for Payer: Aetna American Axle |
$18.92
|
| Rate for Payer: Aetna American Axle |
$84.08
|
| Rate for Payer: Aetna Commercial |
$24.74
|
| Rate for Payer: Aetna Commercial |
$90.19
|
| Rate for Payer: Aetna Commercial |
$109.96
|
| Rate for Payer: Aetna Commercial |
$38.77
|
| Rate for Payer: Aetna Commercial |
$30.00
|
| Rate for Payer: Aetna Commercial |
$62.73
|
| Rate for Payer: Aetna Commercial |
$63.32
|
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Aetna Medicare |
$17.64
|
| Rate for Payer: Aetna Medicare |
$64.68
|
| Rate for Payer: Aetna Medicare |
$37.25
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: Aetna Medicare |
$38.05
|
| Rate for Payer: Aetna Medicare |
$22.80
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: Aetna Medicare |
$36.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: BCBS Complete |
$30.44
|
| Rate for Payer: BCBS Complete |
$29.52
|
| Rate for Payer: BCBS Complete |
$14.12
|
| Rate for Payer: BCBS Complete |
$51.74
|
| Rate for Payer: BCBS Complete |
$42.44
|
| Rate for Payer: BCBS Complete |
$11.64
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS Complete |
$18.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$23.28
|
| Rate for Payer: Cash Price |
$103.49
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Cash Price |
$103.49
|
| Rate for Payer: Cash Price |
$84.89
|
| Rate for Payer: Cash Price |
$23.28
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cash Price |
$59.04
|
| Rate for Payer: Cash Price |
$59.04
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$63.47
|
| Rate for Payer: Cofinity Commercial |
$51.66
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$90.55
|
| Rate for Payer: Cofinity Commercial |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$30.35
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Cofinity Commercial |
$20.37
|
| Rate for Payer: Cofinity Commercial |
$111.25
|
| Rate for Payer: Cofinity Commercial |
$91.25
|
| Rate for Payer: Cofinity Commercial |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$31.93
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Commercial |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.89
|
| Rate for Payer: Healthscope Commercial |
$26.19
|
| Rate for Payer: Healthscope Commercial |
$31.76
|
| Rate for Payer: Healthscope Commercial |
$67.05
|
| Rate for Payer: Healthscope Commercial |
$68.49
|
| Rate for Payer: Healthscope Commercial |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$95.50
|
| Rate for Payer: Healthscope Commercial |
$116.42
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.00
|
| Rate for Payer: PHP Commercial |
$62.73
|
| Rate for Payer: PHP Commercial |
$109.96
|
| Rate for Payer: PHP Commercial |
$64.68
|
| Rate for Payer: PHP Commercial |
$38.77
|
| Rate for Payer: PHP Commercial |
$90.19
|
| Rate for Payer: PHP Commercial |
$24.74
|
| Rate for Payer: PHP Commercial |
$63.32
|
| Rate for Payer: PHP Commercial |
$30.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.42
|
| Rate for Payer: Priority Health SBD |
$66.85
|
| Rate for Payer: Priority Health SBD |
$47.94
|
| Rate for Payer: Priority Health SBD |
$22.23
|
| Rate for Payer: Priority Health SBD |
$28.73
|
| Rate for Payer: Priority Health SBD |
$81.50
|
| Rate for Payer: Priority Health SBD |
$18.33
|
| Rate for Payer: Priority Health SBD |
$46.94
|
| Rate for Payer: Priority Health SBD |
$46.49
|
| Rate for Payer: UMR Bronson Commercial |
$27.56
|
| Rate for Payer: UMR Bronson Commercial |
$28.16
|
| Rate for Payer: UMR Bronson Commercial |
$27.31
|
| Rate for Payer: UMR Bronson Commercial |
$16.88
|
| Rate for Payer: UMR Bronson Commercial |
$13.06
|
| Rate for Payer: UMR Bronson Commercial |
$47.86
|
| Rate for Payer: UMR Bronson Commercial |
$39.26
|
| Rate for Payer: UMR Bronson Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.58
|
|
