Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO

Professional

Both

$205.00

Service Code	HCPCS 95717
Min. Negotiated Rate	$66.67
Max. Negotiated Rate	$729.05
Rate for Payer: Aetna Commercial	$111.64
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: BCBS Trust/PPO	$729.05
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Mclaren Medicaid	$66.67
Rate for Payer: Meridian Medicaid	$70.00
Rate for Payer: Priority Health Choice Medicaid	$66.67
Rate for Payer: Priority Health Cigna Priority Health	$143.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$133.39
Rate for Payer: Priority Health Narrow Network	$133.39
Rate for Payer: Priority Health SBD	$133.39

PR EEG PHYS/QHP 2-12 HR WITH VEEG

Professional

Both

$269.00

Service Code	HCPCS 95718
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$379.32
Rate for Payer: Aetna Commercial	$147.36
Rate for Payer: BCBS Complete	$88.79
Rate for Payer: BCBS Trust/PPO	$379.32
Rate for Payer: Cash Price	$215.20
Rate for Payer: Cash Price	$215.20
Rate for Payer: Mclaren Medicaid	$84.56
Rate for Payer: Meridian Medicaid	$88.79
Rate for Payer: Priority Health Choice Medicaid	$84.56
Rate for Payer: Priority Health Cigna Priority Health	$188.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$175.17
Rate for Payer: Priority Health Narrow Network	$175.17
Rate for Payer: Priority Health SBD	$175.17

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID

Professional

Both

$317.00

Service Code	HCPCS 95719
Min. Negotiated Rate	$100.96
Max. Negotiated Rate	$493.43
Rate for Payer: Aetna Commercial	$172.27
Rate for Payer: BCBS Complete	$106.01
Rate for Payer: BCBS Trust/PPO	$493.43
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$253.60
Rate for Payer: Mclaren Medicaid	$100.96
Rate for Payer: Meridian Medicaid	$106.01
Rate for Payer: Priority Health Choice Medicaid	$100.96
Rate for Payer: Priority Health Cigna Priority Health	$221.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$206.60
Rate for Payer: Priority Health Narrow Network	$206.60
Rate for Payer: Priority Health SBD	$206.60

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG

Professional

Both

$417.00

Service Code	HCPCS 95720
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$399.39
Rate for Payer: Aetna Commercial	$226.36
Rate for Payer: BCBS Complete	$136.65
Rate for Payer: BCBS Trust/PPO	$399.39
Rate for Payer: Cash Price	$333.60
Rate for Payer: Cash Price	$333.60
Rate for Payer: Mclaren Medicaid	$130.14
Rate for Payer: Meridian Medicaid	$136.65
Rate for Payer: Priority Health Choice Medicaid	$130.14
Rate for Payer: Priority Health Cigna Priority Health	$291.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$270.83
Rate for Payer: Priority Health Narrow Network	$270.83
Rate for Payer: Priority Health SBD	$270.83

PREGABALIN 100 MG CAPSULE

Facility

$3,647.83

Service Code	NDC 0071-1015-41
Hospital Charge Code	42165
Hospital Revenue Code	637
Min. Negotiated Rate	$2,298.13
Max. Negotiated Rate	$3,283.05
Rate for Payer: Aetna Commercial	$3,100.66
Rate for Payer: Aetna New Business (MI Preferred)	$2,371.09
Rate for Payer: Cash Price	$2,918.26
Rate for Payer: Cofinity Commercial	$2,553.48
Rate for Payer: Cofinity Commercial	$3,137.13
Rate for Payer: Healthscope Commercial	$3,283.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,100.66
Rate for Payer: PHP Commercial	$3,100.66
Rate for Payer: Priority Health Cigna Priority Health	$2,553.48
Rate for Payer: Priority Health SBD	$2,298.13

PREGABALIN 100 MG CAPSULE

Facility

$2,984.68

Service Code	NDC 0071-1015-68
Hospital Charge Code	42165
Hospital Revenue Code	637
Min. Negotiated Rate	$1,880.35
Max. Negotiated Rate	$2,686.21
Rate for Payer: Aetna Commercial	$2,536.98
Rate for Payer: Aetna New Business (MI Preferred)	$1,940.04
Rate for Payer: Cash Price	$2,387.74
Rate for Payer: Cofinity Commercial	$2,089.28
Rate for Payer: Cofinity Commercial	$2,566.82
Rate for Payer: Healthscope Commercial	$2,686.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,536.98
Rate for Payer: PHP Commercial	$2,536.98
Rate for Payer: Priority Health Cigna Priority Health	$2,089.28
Rate for Payer: Priority Health SBD	$1,880.35

PREGABALIN 100 MG CAPSULE

Facility

$422.75

Service Code	NDC 0904-7001-61
Hospital Charge Code	42165
Hospital Revenue Code	637
Min. Negotiated Rate	$266.33
Max. Negotiated Rate	$380.48
Rate for Payer: Aetna Commercial	$359.34
Rate for Payer: Aetna New Business (MI Preferred)	$274.79
Rate for Payer: Cash Price	$338.20
Rate for Payer: Cofinity Commercial	$295.92
Rate for Payer: Cofinity Commercial	$363.56
Rate for Payer: Healthscope Commercial	$380.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$359.34
Rate for Payer: PHP Commercial	$359.34
Rate for Payer: Priority Health Cigna Priority Health	$295.92
Rate for Payer: Priority Health SBD	$266.33

PREGABALIN 20 MG/ML ORAL SOLUTION

Facility

$4,179.24

Service Code	HCPCS J8499
Hospital Charge Code	161926
Hospital Revenue Code	636
Min. Negotiated Rate	$2,632.92
Max. Negotiated Rate	$3,761.32
Rate for Payer: Aetna Commercial	$3,552.35
Rate for Payer: Aetna Commercial	$1,294.41
Rate for Payer: Aetna Commercial	$1,549.51
Rate for Payer: Aetna New Business (MI Preferred)	$989.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,184.92
Rate for Payer: Aetna New Business (MI Preferred)	$2,716.51
Rate for Payer: Cash Price	$1,458.36
Rate for Payer: Cash Price	$1,218.26
Rate for Payer: Cash Price	$3,343.39
Rate for Payer: Cofinity Commercial	$2,925.47
Rate for Payer: Cofinity Commercial	$1,276.06
Rate for Payer: Cofinity Commercial	$1,309.63
Rate for Payer: Cofinity Commercial	$1,567.74
Rate for Payer: Cofinity Commercial	$3,594.15
Rate for Payer: Cofinity Commercial	$1,065.98
Rate for Payer: Healthscope Commercial	$1,370.55
Rate for Payer: Healthscope Commercial	$1,640.66
Rate for Payer: Healthscope Commercial	$3,761.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,294.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,552.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,549.51
Rate for Payer: PHP Commercial	$3,552.35
Rate for Payer: PHP Commercial	$1,294.41
Rate for Payer: PHP Commercial	$1,549.51
Rate for Payer: Priority Health Cigna Priority Health	$1,276.06
Rate for Payer: Priority Health Cigna Priority Health	$1,065.98
Rate for Payer: Priority Health Cigna Priority Health	$2,925.47
Rate for Payer: Priority Health SBD	$959.38
Rate for Payer: Priority Health SBD	$1,148.46
Rate for Payer: Priority Health SBD	$2,632.92

PREGABALIN 25 MG CAPSULE

Facility

$131.13

Service Code	NDC 72205-011-90
Hospital Charge Code	42162
Hospital Revenue Code	637
Min. Negotiated Rate	$82.61
Max. Negotiated Rate	$118.02
Rate for Payer: Aetna Commercial	$111.46
Rate for Payer: Aetna New Business (MI Preferred)	$85.23
Rate for Payer: Cash Price	$104.90
Rate for Payer: Cofinity Commercial	$112.77
Rate for Payer: Cofinity Commercial	$91.79
Rate for Payer: Healthscope Commercial	$118.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.46
Rate for Payer: PHP Commercial	$111.46
Rate for Payer: Priority Health Cigna Priority Health	$91.79
Rate for Payer: Priority Health SBD	$82.61

PREGABALIN 25 MG CAPSULE

Facility

$2,984.68

Service Code	NDC 0071-1012-68
Hospital Charge Code	42162
Hospital Revenue Code	637
Min. Negotiated Rate	$1,880.35
Max. Negotiated Rate	$2,686.21
Rate for Payer: Aetna Commercial	$2,536.98
Rate for Payer: Aetna New Business (MI Preferred)	$1,940.04
Rate for Payer: Cash Price	$2,387.74
Rate for Payer: Cofinity Commercial	$2,089.28
Rate for Payer: Cofinity Commercial	$2,566.82
Rate for Payer: Healthscope Commercial	$2,686.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,536.98
Rate for Payer: PHP Commercial	$2,536.98
Rate for Payer: Priority Health Cigna Priority Health	$2,089.28
Rate for Payer: Priority Health SBD	$1,880.35

PREGABALIN 50 MG CAPSULE

Facility

$3.99

Service Code	NDC 60687-484-11
Hospital Charge Code	42163
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$3.59
Rate for Payer: Aetna Commercial	$3.39
Rate for Payer: Aetna New Business (MI Preferred)	$2.59
Rate for Payer: Cash Price	$3.19
Rate for Payer: Cofinity Commercial	$2.79
Rate for Payer: Cofinity Commercial	$3.43
Rate for Payer: Healthscope Commercial	$3.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.39
Rate for Payer: PHP Commercial	$3.39
Rate for Payer: Priority Health Cigna Priority Health	$2.79
Rate for Payer: Priority Health SBD	$2.51

PREGABALIN 50 MG CAPSULE

Facility

$3,258.59

Service Code	NDC 0071-1013-41
Hospital Charge Code	42163
Hospital Revenue Code	637
Min. Negotiated Rate	$2,052.91
Max. Negotiated Rate	$2,932.73
Rate for Payer: Aetna Commercial	$2,769.80
Rate for Payer: Aetna New Business (MI Preferred)	$2,118.08
Rate for Payer: Cash Price	$2,606.87
Rate for Payer: Cofinity Commercial	$2,281.01
Rate for Payer: Cofinity Commercial	$2,802.39
Rate for Payer: Healthscope Commercial	$2,932.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,769.80
Rate for Payer: PHP Commercial	$2,769.80
Rate for Payer: Priority Health Cigna Priority Health	$2,281.01
Rate for Payer: Priority Health SBD	$2,052.91

PREGABALIN 50 MG CAPSULE

Facility

$380.00

Service Code	NDC 0904-6992-61
Hospital Charge Code	42163
Hospital Revenue Code	637
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna New Business (MI Preferred)	$247.00
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cofinity Commercial	$266.00
Rate for Payer: Cofinity Commercial	$326.80
Rate for Payer: Healthscope Commercial	$342.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$323.00
Rate for Payer: PHP Commercial	$323.00
Rate for Payer: Priority Health Cigna Priority Health	$266.00
Rate for Payer: Priority Health SBD	$239.40

PREGABALIN 50 MG CAPSULE

Facility

$398.88

Service Code	NDC 60687-484-01
Hospital Charge Code	42163
Hospital Revenue Code	637
Min. Negotiated Rate	$251.29
Max. Negotiated Rate	$358.99
Rate for Payer: Aetna Commercial	$339.05
Rate for Payer: Aetna New Business (MI Preferred)	$259.27
Rate for Payer: Cash Price	$319.10
Rate for Payer: Cofinity Commercial	$279.22
Rate for Payer: Cofinity Commercial	$343.04
Rate for Payer: Healthscope Commercial	$358.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$339.05
Rate for Payer: PHP Commercial	$339.05
Rate for Payer: Priority Health Cigna Priority Health	$279.22
Rate for Payer: Priority Health SBD	$251.29

PREGABALIN 75 MG CAPSULE

Facility

$3,647.83

Service Code	NDC 0071-1014-41
Hospital Charge Code	42164
Hospital Revenue Code	637
Min. Negotiated Rate	$2,298.13
Max. Negotiated Rate	$3,283.05
Rate for Payer: Aetna Commercial	$3,100.66
Rate for Payer: Aetna New Business (MI Preferred)	$2,371.09
Rate for Payer: Cash Price	$2,918.26
Rate for Payer: Cofinity Commercial	$2,553.48
Rate for Payer: Cofinity Commercial	$3,137.13
Rate for Payer: Healthscope Commercial	$3,283.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,100.66
Rate for Payer: PHP Commercial	$3,100.66
Rate for Payer: Priority Health Cigna Priority Health	$2,553.48
Rate for Payer: Priority Health SBD	$2,298.13

PREGABALIN 75 MG CAPSULE

Facility

$507.36

Service Code	NDC 60687-495-01
Hospital Charge Code	42164
Hospital Revenue Code	637
Min. Negotiated Rate	$319.64
Max. Negotiated Rate	$456.62
Rate for Payer: Aetna Commercial	$431.26
Rate for Payer: Aetna New Business (MI Preferred)	$329.78
Rate for Payer: Cash Price	$405.89
Rate for Payer: Cofinity Commercial	$355.15
Rate for Payer: Cofinity Commercial	$436.33
Rate for Payer: Healthscope Commercial	$456.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$431.26
Rate for Payer: PHP Commercial	$431.26
Rate for Payer: Priority Health Cigna Priority Health	$355.15
Rate for Payer: Priority Health SBD	$319.64

PREGABALIN 75 MG CAPSULE

Facility

$387.60

Service Code	NDC 0904-7000-61
Hospital Charge Code	42164
Hospital Revenue Code	637
Min. Negotiated Rate	$244.19
Max. Negotiated Rate	$348.84
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna New Business (MI Preferred)	$251.94
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$271.32
Rate for Payer: Cofinity Commercial	$333.34
Rate for Payer: Healthscope Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$329.46
Rate for Payer: PHP Commercial	$329.46
Rate for Payer: Priority Health Cigna Priority Health	$271.32
Rate for Payer: Priority Health SBD	$244.19

PREGABALIN 75 MG CAPSULE

Facility

$5.08

Service Code	NDC 60687-495-11
Hospital Charge Code	42164
Hospital Revenue Code	637
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$4.57
Rate for Payer: Aetna Commercial	$4.32
Rate for Payer: Aetna New Business (MI Preferred)	$3.30
Rate for Payer: Cash Price	$4.06
Rate for Payer: Cofinity Commercial	$3.56
Rate for Payer: Cofinity Commercial	$4.37
Rate for Payer: Healthscope Commercial	$4.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.32
Rate for Payer: PHP Commercial	$4.32
Rate for Payer: Priority Health Cigna Priority Health	$3.56
Rate for Payer: Priority Health SBD	$3.20

PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE

Professional

Both

$1,385.00

Service Code	HCPCS 43270
Min. Negotiated Rate	$140.79
Max. Negotiated Rate	$969.50
Rate for Payer: Aetna Commercial	$298.44
Rate for Payer: BCBS Complete	$147.83
Rate for Payer: BCBS Trust/PPO	$724.83
Rate for Payer: Cash Price	$1,108.00
Rate for Payer: Cash Price	$1,108.00
Rate for Payer: Mclaren Medicaid	$140.79
Rate for Payer: Meridian Medicaid	$147.83
Rate for Payer: Priority Health Choice Medicaid	$140.79
Rate for Payer: Priority Health Cigna Priority Health	$969.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$386.30
Rate for Payer: Priority Health Narrow Network	$386.30
Rate for Payer: Priority Health SBD	$386.30

PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM

Professional

Both

$1,767.00

Service Code	HCPCS 43249
Hospital Charge Code	43249
Min. Negotiated Rate	$96.70
Max. Negotiated Rate	$1,236.90
Rate for Payer: Aetna Commercial	$204.01
Rate for Payer: BCBS Complete	$101.54
Rate for Payer: BCBS Trust/PPO	$845.81
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Mclaren Medicaid	$96.70
Rate for Payer: Meridian Medicaid	$101.54
Rate for Payer: Priority Health Choice Medicaid	$96.70
Rate for Payer: Priority Health Cigna Priority Health	$1,236.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$265.17
Rate for Payer: Priority Health Narrow Network	$265.17
Rate for Payer: Priority Health SBD	$265.17

PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM

Facility

$1,767.00

Service Code	CPT 43249
Hospital Charge Code	43249
Hospital Revenue Code	960
Min. Negotiated Rate	$148.66
Max. Negotiated Rate	$5,222.22
Rate for Payer: Aetna Commercial	$1,501.95
Rate for Payer: Aetna Medicare	$1,760.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,148.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,116.40
Rate for Payer: Amish Plain Church Group Commercial	$2,116.40
Rate for Payer: BCBS Complete	$972.53
Rate for Payer: BCBS MAPPO	$1,693.12
Rate for Payer: BCBS Trust/PPO	$615.94
Rate for Payer: BCN Medicare Advantage	$1,693.12
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Cofinity Commercial	$1,519.62
Rate for Payer: Cofinity Commercial	$1,236.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,693.12
Rate for Payer: Healthscope Commercial	$1,590.30
Rate for Payer: Mclaren Medicaid	$926.14
Rate for Payer: Mclaren Medicare	$1,693.12
Rate for Payer: Meridian Medicaid	$972.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,777.78
Rate for Payer: MI Amish Medical Board Commercial	$1,947.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,501.95
Rate for Payer: PACE Medicare	$1,608.46
Rate for Payer: PACE SWMI	$1,693.12
Rate for Payer: PHP Commercial	$1,501.95
Rate for Payer: PHP Medicare Advantage	$1,693.12
Rate for Payer: Priority Health Choice Medicaid	$926.14
Rate for Payer: Priority Health Cigna Priority Health	$1,236.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,222.22
Rate for Payer: Priority Health Medicare	$1,693.12
Rate for Payer: Priority Health Narrow Network	$4,177.77
Rate for Payer: Priority Health SBD	$1,113.21
Rate for Payer: Railroad Medicare Medicare	$1,693.12
Rate for Payer: UHC All Payor (Choice/PPO)	$163.53
Rate for Payer: UHC Dual Complete DSNP	$1,693.12
Rate for Payer: UHC Exchange	$148.66
Rate for Payer: UHC Medicare Advantage	$1,743.91
Rate for Payer: VA VA	$1,693.12

PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM

Facility

$1,767.00

Service Code	CPT 43249
Hospital Charge Code	43249
Hospital Revenue Code	960
Min. Negotiated Rate	$1,113.21
Max. Negotiated Rate	$1,590.30
Rate for Payer: Aetna Commercial	$1,501.95
Rate for Payer: Aetna New Business (MI Preferred)	$1,148.55
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Cofinity Commercial	$1,236.90
Rate for Payer: Cofinity Commercial	$1,519.62
Rate for Payer: Healthscope Commercial	$1,590.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,501.95
Rate for Payer: PHP Commercial	$1,501.95
Rate for Payer: Priority Health Cigna Priority Health	$1,236.90
Rate for Payer: Priority Health SBD	$1,113.21

PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM

Professional

Both

$1,767.00

Service Code	HCPCS 43249
Min. Negotiated Rate	$96.70
Max. Negotiated Rate	$1,236.90
Rate for Payer: Aetna Commercial	$204.01
Rate for Payer: BCBS Complete	$101.54
Rate for Payer: BCBS Trust/PPO	$845.81
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Cash Price	$1,413.60
Rate for Payer: Mclaren Medicaid	$96.70
Rate for Payer: Meridian Medicaid	$101.54
Rate for Payer: Priority Health Choice Medicaid	$96.70
Rate for Payer: Priority Health Cigna Priority Health	$1,236.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$265.17
Rate for Payer: Priority Health Narrow Network	$265.17
Rate for Payer: Priority Health SBD	$265.17

PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES

Professional

Both

$1,115.00

Service Code	HCPCS 43244
Min. Negotiated Rate	$129.43
Max. Negotiated Rate	$780.50
Rate for Payer: Aetna Commercial	$325.46
Rate for Payer: BCBS Complete	$161.48
Rate for Payer: BCBS Trust/PPO	$129.43
Rate for Payer: Cash Price	$892.00
Rate for Payer: Cash Price	$892.00
Rate for Payer: Mclaren Medicaid	$153.79
Rate for Payer: Meridian Medicaid	$161.48
Rate for Payer: Priority Health Choice Medicaid	$153.79
Rate for Payer: Priority Health Cigna Priority Health	$780.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$422.16
Rate for Payer: Priority Health Narrow Network	$422.16
Rate for Payer: Priority Health SBD	$422.16

PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD

Professional

Both

$575.00

Service Code	HCPCS 43257
Min. Negotiated Rate	$147.18
Max. Negotiated Rate	$850.03
Rate for Payer: Aetna Commercial	$308.63
Rate for Payer: BCBS Complete	$154.54
Rate for Payer: BCBS Trust/PPO	$850.03
Rate for Payer: Cash Price	$460.00
Rate for Payer: Cash Price	$460.00
Rate for Payer: Mclaren Medicaid	$147.18
Rate for Payer: Meridian Medicaid	$154.54
Rate for Payer: Priority Health Choice Medicaid	$147.18
Rate for Payer: Priority Health Cigna Priority Health	$402.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$400.41
Rate for Payer: Priority Health Narrow Network	$400.41
Rate for Payer: Priority Health SBD	$400.41

Know your out-of-pocket cost for care.

All Charges