|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$98.27 |
| 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 |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| 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) |
$108.10
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$98.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.17 |
| 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 |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| 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) |
$172.89
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$157.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$98.95 |
| 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 |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| 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) |
$108.84
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$98.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.23 |
| 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 |
$789.21
|
| Rate for Payer: BCN Commercial |
$789.21
|
| 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) |
$164.15
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$149.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$18,331.27
|
|
|
Service Code
|
CPT 43212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.08 |
| 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 |
$4,007.01
|
| Rate for Payer: BCN Commercial |
$4,007.01
|
| 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) |
$199.19
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,832.44
|
| Rate for Payer: UHC Exchange |
$181.08
|
| 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
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$135.36 |
| 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 |
$868.11
|
| Rate for Payer: BCN Commercial |
$868.11
|
| 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) |
$148.90
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$135.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.55 |
| 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 |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| 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) |
$123.80
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$112.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.52 |
| 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 |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| 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) |
$164.47
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$149.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$11,715.79
|
|
|
Service Code
|
CPT 43195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.07 |
| 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) |
$195.88
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$178.07
|
| 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
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.89 |
| 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 |
$1,105.16
|
| Rate for Payer: BCN Commercial |
$1,105.16
|
| 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) |
$179.18
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$162.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.48 |
| 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 |
$1,105.16
|
| Rate for Payer: BCN Commercial |
$1,105.16
|
| 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) |
$179.83
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$163.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL WITH DIVERTICULECTOMY OF HYPOPHARYNX OR CERVICAL ESOPHAGUS (EG, ZENKER'S DIVERTICULUM), WITH CRICOPHARYNGEAL MYOTOMY, INCLUDES USE OF TELESCOPE OR OPERATING MICROSCOPE AND REPAIR, WHEN PERFORMED
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 43180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$528.43 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,174.78
|
| Rate for Payer: BCN Commercial |
$3,174.78
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.27
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$528.43
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$5,841.66
|
|
|
Service Code
|
CPT 43194
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.47 |
| 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 |
$1,105.16
|
| Rate for Payer: BCN Commercial |
$1,105.16
|
| 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) |
$202.92
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$184.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,633.95
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$957.66
|
| Rate for Payer: BCN Commercial |
$957.66
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.99
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$412.72
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,633.95
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$957.66
|
| Rate for Payer: BCN Commercial |
$957.66
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.99
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$412.72
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,633.95
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$957.66
|
| Rate for Payer: BCN Commercial |
$957.66
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.99
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$412.72
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER PH ELECTRODE(S) PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,633.95
|
|
|
Service Code
|
CPT 91034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.74 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$603.25
|
| Rate for Payer: BCN Commercial |
$603.25
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.21
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$174.74
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
OP
|
$521.28
|
|
|
Service Code
|
NDC 15310002001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.87 |
| Max. Negotiated Rate |
$469.15 |
| Rate for Payer: Aetna American Axle |
$338.83
|
| Rate for Payer: Aetna Commercial |
$443.09
|
| Rate for Payer: Aetna Medicare |
$260.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.83
|
| Rate for Payer: BCBS Complete |
$208.51
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cofinity Commercial |
$364.90
|
| Rate for Payer: Cofinity Commercial |
$448.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.02
|
| Rate for Payer: Healthscope Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.09
|
| Rate for Payer: PHP Commercial |
$443.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.83
|
| Rate for Payer: Priority Health SBD |
$328.41
|
| Rate for Payer: UMR Bronson Commercial |
$192.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.96
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$974.95
|
|
|
Service Code
|
NDC 62559015001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$877.46 |
| Rate for Payer: Aetna American Axle |
$633.72
|
| Rate for Payer: Aetna Commercial |
$828.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.72
|
| Rate for Payer: Cash Price |
$779.96
|
| Rate for Payer: Cofinity Commercial |
$682.46
|
| Rate for Payer: Cofinity Commercial |
$838.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.96
|
| Rate for Payer: Healthscope Commercial |
$877.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.71
|
| Rate for Payer: PHP Commercial |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.72
|
| Rate for Payer: Priority Health SBD |
$614.22
|
| Rate for Payer: UMR Bronson Commercial |
$428.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.21
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$521.28
|
|
|
Service Code
|
NDC 15310002001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.36 |
| Max. Negotiated Rate |
$469.15 |
| Rate for Payer: Aetna American Axle |
$338.83
|
| Rate for Payer: Aetna Commercial |
$443.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.83
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cofinity Commercial |
$364.90
|
| Rate for Payer: Cofinity Commercial |
$448.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.02
|
| Rate for Payer: Healthscope Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.09
|
| Rate for Payer: PHP Commercial |
$443.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.83
|
| Rate for Payer: Priority Health SBD |
$328.41
|
| Rate for Payer: UMR Bronson Commercial |
$229.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.96
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
OP
|
$974.95
|
|
|
Service Code
|
NDC 62559015001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.73 |
| Max. Negotiated Rate |
$877.46 |
| Rate for Payer: Aetna American Axle |
$633.72
|
| Rate for Payer: Aetna Commercial |
$828.71
|
| Rate for Payer: Aetna Medicare |
$487.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.72
|
| Rate for Payer: BCBS Complete |
$389.98
|
| Rate for Payer: Cash Price |
$779.96
|
| Rate for Payer: Cofinity Commercial |
$682.46
|
| Rate for Payer: Cofinity Commercial |
$838.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.96
|
| Rate for Payer: Healthscope Commercial |
$877.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.71
|
| Rate for Payer: PHP Commercial |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.72
|
| Rate for Payer: Priority Health SBD |
$614.22
|
| Rate for Payer: UMR Bronson Commercial |
$360.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.21
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET
|
Facility
|
IP
|
$1,037.85
|
|
|
Service Code
|
NDC 11528001001
|
| Hospital Charge Code |
9960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.65 |
| Max. Negotiated Rate |
$934.06 |
| Rate for Payer: Aetna American Axle |
$674.60
|
| Rate for Payer: Aetna Commercial |
$882.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.60
|
| Rate for Payer: Cash Price |
$830.28
|
| Rate for Payer: Cofinity Commercial |
$726.50
|
| Rate for Payer: Cofinity Commercial |
$892.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$830.28
|
| Rate for Payer: Healthscope Commercial |
$934.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$726.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.17
|
| Rate for Payer: PHP Commercial |
$882.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.60
|
| Rate for Payer: Priority Health SBD |
$653.85
|
| Rate for Payer: UMR Bronson Commercial |
$456.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.39
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET
|
Facility
|
OP
|
$1,037.85
|
|
|
Service Code
|
NDC 11528001001
|
| Hospital Charge Code |
9960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$934.06 |
| Rate for Payer: Aetna American Axle |
$674.60
|
| Rate for Payer: Aetna Commercial |
$882.17
|
| Rate for Payer: Aetna Medicare |
$518.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.60
|
| Rate for Payer: BCBS Complete |
$415.14
|
| Rate for Payer: Cash Price |
$830.28
|
| Rate for Payer: Cofinity Commercial |
$726.50
|
| Rate for Payer: Cofinity Commercial |
$892.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$830.28
|
| Rate for Payer: Healthscope Commercial |
$934.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$726.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.17
|
| Rate for Payer: PHP Commercial |
$882.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.60
|
| Rate for Payer: Priority Health SBD |
$653.85
|
| Rate for Payer: UMR Bronson Commercial |
$384.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.39
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$82.41
|
|
|
Service Code
|
NDC 66993000210
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$74.17 |
| Rate for Payer: Aetna American Axle |
$53.57
|
| Rate for Payer: Aetna Commercial |
$70.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.57
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Cofinity Commercial |
$57.69
|
| Rate for Payer: Cofinity Commercial |
$70.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.93
|
| Rate for Payer: Healthscope Commercial |
$74.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.05
|
| Rate for Payer: PHP Commercial |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.57
|
| Rate for Payer: Priority Health SBD |
$51.92
|
| Rate for Payer: UMR Bronson Commercial |
$36.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.81
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
OP
|
$1,122.32
|
|
|
Service Code
|
NDC 00430375414
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$415.26 |
| Max. Negotiated Rate |
$1,010.09 |
| Rate for Payer: Aetna American Axle |
$729.51
|
| Rate for Payer: Aetna Commercial |
$953.97
|
| Rate for Payer: Aetna Medicare |
$561.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.51
|
| Rate for Payer: BCBS Complete |
$448.93
|
| Rate for Payer: Cash Price |
$897.86
|
| Rate for Payer: Cofinity Commercial |
$785.62
|
| Rate for Payer: Cofinity Commercial |
$965.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.86
|
| Rate for Payer: Healthscope Commercial |
$1,010.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.97
|
| Rate for Payer: PHP Commercial |
$953.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.51
|
| Rate for Payer: Priority Health SBD |
$707.06
|
| Rate for Payer: UMR Bronson Commercial |
$415.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.74
|
|
