|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$395.72
|
|
|
Service Code
|
NDC 0115-5211-16
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.12 |
| Max. Negotiated Rate |
$356.15 |
| Rate for Payer: Aetna American Axle |
$257.22
|
| Rate for Payer: Aetna Commercial |
$336.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.22
|
| Rate for Payer: Cash Price |
$316.58
|
| Rate for Payer: Cofinity Commercial |
$277.00
|
| Rate for Payer: Cofinity Commercial |
$340.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.58
|
| Rate for Payer: Healthscope Commercial |
$356.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.36
|
| Rate for Payer: PHP Commercial |
$336.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.00
|
| Rate for Payer: Priority Health SBD |
$249.30
|
| Rate for Payer: UMR Bronson Commercial |
$174.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.79
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
NDC 59762-0450-1
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna American Axle |
$374.40
|
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.60
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.20
|
| Rate for Payer: Priority Health SBD |
$362.88
|
| Rate for Payer: UMR Bronson Commercial |
$253.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$43.48
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
9681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna American Axle |
$75.82
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Commercial |
$100.31
|
| Rate for Payer: Cofinity Commercial |
$81.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.31
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Healthscope Commercial |
$104.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.14
|
| Rate for Payer: PHP Commercial |
$99.14
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.65
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: Priority Health SBD |
$73.48
|
| Rate for Payer: UMR Bronson Commercial |
$51.32
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.48
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$875.39
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.17 |
| Max. Negotiated Rate |
$787.85 |
| Rate for Payer: Aetna American Axle |
$569.00
|
| Rate for Payer: Aetna Commercial |
$744.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.00
|
| Rate for Payer: Cash Price |
$700.31
|
| Rate for Payer: Cofinity Commercial |
$612.77
|
| Rate for Payer: Cofinity Commercial |
$752.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.31
|
| Rate for Payer: Healthscope Commercial |
$787.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$744.08
|
| Rate for Payer: PHP Commercial |
$744.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.77
|
| Rate for Payer: Priority Health SBD |
$551.50
|
| Rate for Payer: UMR Bronson Commercial |
$385.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.54
|
|
|
COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,557.47
|
|
|
Service Code
|
CPT 45378
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.11
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.31
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.97 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$821.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.07
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$260.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45398
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$227.57 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,240.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.33
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$227.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$769.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45382
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$249.51 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,373.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.46
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$249.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.52 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,615.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.87
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$193.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$7,856.86
|
|
|
Service Code
|
CPT 45390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.57 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,186.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.63
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$320.57
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: VA VA |
$2,495.78
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE RECTUM, SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM, AND ADJACENT STRUCTURES
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$248.53 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$821.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.38
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$248.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$821.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.21
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$230.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45384
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$220.70 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$953.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.77
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$220.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$768.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.78
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$245.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.65 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,462.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.12
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$204.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE RECTUM, SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM, AND ADJACENT STRUCTURES
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45392
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$293.39 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.73
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$293.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,557.47
|
|
|
Service Code
|
CPT 44388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.28 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.04
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.41
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$151.28
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 44389
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$166.01 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$821.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.61
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$166.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 44392
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.52 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$821.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.87
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$193.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 44394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$821.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.52
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$217.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
|
Facility
|
OP
|
$2,557.47
|
|
|
Service Code
|
CPT G0105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$714.42
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.31
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$2,557.47
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$716.25
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.66
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$178.78
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$2,557.47
|
|
|
Service Code
|
CPT G0104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$888.71
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
COLPOCLEISIS (LE FORT TYPE)
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 57120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$525.54 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,508.88
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.09
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$525.54
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
