|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$3,258.59
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,303.44 |
| Max. Negotiated Rate |
$2,932.73 |
| Rate for Payer: Aetna Commercial |
$2,769.80
|
| Rate for Payer: Aetna Medicare |
$1,629.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.08
|
| Rate for Payer: BCBS Complete |
$1,303.44
|
| 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: Cofinity Medicare Advantage |
$2,281.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,769.80
|
| Rate for Payer: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.08
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.23 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.38 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.26
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$275.98
|
| Rate for Payer: Cofinity Commercial |
$339.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: PHP Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health SBD |
$248.38
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,540.98 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: Aetna Medicare |
$1,926.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,504.09
|
| Rate for Payer: BCBS Complete |
$1,540.98
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$2,696.71
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,696.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,274.57
|
| Rate for Payer: PHP Commercial |
$3,274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health SBD |
$2,427.04
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,427.04 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,504.09
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$2,696.71
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,696.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,274.57
|
| Rate for Payer: PHP Commercial |
$3,274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health SBD |
$2,427.04
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.23 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna Medicare |
$197.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.26
|
| Rate for Payer: BCBS Complete |
$157.70
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$275.98
|
| Rate for Payer: Cofinity Commercial |
$339.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: PHP Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health SBD |
$248.38
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,413.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$211.74 |
| Max. Negotiated Rate |
$918.45 |
| Rate for Payer: Aetna Commercial |
$283.73
|
| Rate for Payer: Aetna Medicare |
$220.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.73
|
| Rate for Payer: BCBS Complete |
$565.20
|
| Rate for Payer: BCBS MAPPO |
$211.74
|
| Rate for Payer: BCN Medicare Advantage |
$211.74
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cofinity Commercial |
$304.91
|
| Rate for Payer: Cofinity Commercial |
$283.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.74
|
| Rate for Payer: Healthscope Commercial |
$338.78
|
| Rate for Payer: Healthscope Commercial |
$391.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$918.45
|
| Rate for Payer: Nomi Health Commercial |
$254.09
|
| Rate for Payer: PACE SWMI |
$211.74
|
| Rate for Payer: PHP Medicare Advantage |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.45
|
| Rate for Payer: Priority Health Medicare |
$211.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.74
|
| Rate for Payer: UHC Medicare Advantage |
$211.74
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Medicare |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.83
|
| Rate for Payer: BCBS Complete |
$720.80
|
| Rate for Payer: BCBS MAPPO |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$144.65
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$208.30
|
| Rate for Payer: Cofinity Commercial |
$193.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.65
|
| Rate for Payer: Healthscope Commercial |
$267.60
|
| Rate for Payer: Healthscope Commercial |
$231.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,171.30
|
| Rate for Payer: Nomi Health Commercial |
$173.58
|
| Rate for Payer: PACE SWMI |
$144.65
|
| Rate for Payer: PHP Medicare Advantage |
$144.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$144.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.65
|
| Rate for Payer: UHC Medicare Advantage |
$144.65
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,261.40
|
| Rate for Payer: Cofinity Commercial |
$1,549.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,261.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$1,531.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health SBD |
$1,135.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$1,041.61
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Medicare |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.30
|
| Rate for Payer: BCBS Complete |
$720.80
|
| Rate for Payer: BCBS MAPPO |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$144.65
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$208.30
|
| Rate for Payer: Cofinity Commercial |
$193.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.65
|
| Rate for Payer: Healthscope Commercial |
$231.44
|
| Rate for Payer: Healthscope Commercial |
$267.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,171.30
|
| Rate for Payer: Nomi Health Commercial |
$173.58
|
| Rate for Payer: PACE SWMI |
$144.65
|
| Rate for Payer: PHP Medicare Advantage |
$144.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$144.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.65
|
| Rate for Payer: UHC Medicare Advantage |
$144.65
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,135.26 |
| Max. Negotiated Rate |
$1,621.80 |
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.30
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,261.40
|
| Rate for Payer: Cofinity Commercial |
$1,549.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,261.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: PHP Commercial |
$1,531.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health SBD |
$1,135.26
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$230.04 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$308.25
|
| Rate for Payer: Aetna Medicare |
$239.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.25
|
| Rate for Payer: BCBS Complete |
$454.80
|
| Rate for Payer: BCBS MAPPO |
$230.04
|
| Rate for Payer: BCN Medicare Advantage |
$230.04
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$308.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$368.06
|
| Rate for Payer: Healthscope Commercial |
$425.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$739.05
|
| Rate for Payer: Nomi Health Commercial |
$276.05
|
| Rate for Payer: PACE SWMI |
$230.04
|
| Rate for Payer: PHP Medicare Advantage |
$230.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health Medicare |
$230.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.04
|
| Rate for Payer: UHC Medicare Advantage |
$230.04
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$587.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$218.63 |
| Max. Negotiated Rate |
$404.47 |
| Rate for Payer: Aetna Commercial |
$292.96
|
| Rate for Payer: Aetna Medicare |
$227.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.96
|
| Rate for Payer: BCBS Complete |
$234.80
|
| Rate for Payer: BCBS MAPPO |
$218.63
|
| Rate for Payer: BCN Medicare Advantage |
$218.63
|
| Rate for Payer: Cash Price |
$469.60
|
| Rate for Payer: Cash Price |
$469.60
|
| Rate for Payer: Cofinity Commercial |
$314.83
|
| Rate for Payer: Cofinity Commercial |
$292.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.63
|
| Rate for Payer: Healthscope Commercial |
$404.47
|
| Rate for Payer: Healthscope Commercial |
$349.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.55
|
| Rate for Payer: Nomi Health Commercial |
$262.36
|
| Rate for Payer: PACE SWMI |
$218.63
|
| Rate for Payer: PHP Medicare Advantage |
$218.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.55
|
| Rate for Payer: Priority Health Medicare |
$218.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.63
|
| Rate for Payer: UHC Medicare Advantage |
$218.63
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$167.26 |
| Max. Negotiated Rate |
$658.45 |
| Rate for Payer: Aetna Commercial |
$224.13
|
| Rate for Payer: Aetna Medicare |
$173.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.13
|
| Rate for Payer: BCBS Complete |
$405.20
|
| Rate for Payer: BCBS MAPPO |
$167.26
|
| Rate for Payer: BCN Medicare Advantage |
$167.26
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cofinity Commercial |
$240.85
|
| Rate for Payer: Cofinity Commercial |
$224.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.26
|
| Rate for Payer: Healthscope Commercial |
$267.62
|
| Rate for Payer: Healthscope Commercial |
$309.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.45
|
| Rate for Payer: Nomi Health Commercial |
$200.71
|
| Rate for Payer: PACE SWMI |
$167.26
|
| Rate for Payer: PHP Medicare Advantage |
$167.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.45
|
| Rate for Payer: Priority Health Medicare |
$167.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.26
|
| Rate for Payer: UHC Medicare Advantage |
$167.26
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$205.46 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna Commercial |
$275.32
|
| Rate for Payer: Aetna Medicare |
$213.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.32
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$205.46
|
| Rate for Payer: BCN Medicare Advantage |
$205.46
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$295.86
|
| Rate for Payer: Cofinity Commercial |
$275.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.46
|
| Rate for Payer: Healthscope Commercial |
$380.10
|
| Rate for Payer: Healthscope Commercial |
$328.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.15
|
| Rate for Payer: Nomi Health Commercial |
$246.55
|
| Rate for Payer: PACE SWMI |
$205.46
|
| Rate for Payer: PHP Medicare Advantage |
$205.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$205.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.46
|
| Rate for Payer: UHC Medicare Advantage |
$205.46
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$217.23 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$291.09
|
| Rate for Payer: Aetna Medicare |
$225.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.09
|
| Rate for Payer: BCBS Complete |
$415.60
|
| Rate for Payer: BCBS MAPPO |
$217.23
|
| Rate for Payer: BCN Medicare Advantage |
$217.23
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Cofinity Commercial |
$312.81
|
| Rate for Payer: Cofinity Commercial |
$291.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.23
|
| Rate for Payer: Healthscope Commercial |
$347.57
|
| Rate for Payer: Healthscope Commercial |
$401.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$228.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.35
|
| Rate for Payer: Nomi Health Commercial |
$260.68
|
| Rate for Payer: PACE SWMI |
$217.23
|
| Rate for Payer: PHP Medicare Advantage |
$217.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.35
|
| Rate for Payer: Priority Health Medicare |
$217.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.23
|
| Rate for Payer: UHC Medicare Advantage |
$217.23
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$621.18 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Aetna Commercial |
$838.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.90
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$847.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Healthscope Commercial |
$887.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: PHP Commercial |
$838.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health SBD |
$621.18
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Commercial |
$838.10
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$847.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$887.40
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$838.10
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$621.18
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$514.80
|
| Rate for Payer: VA VA |
$914.38
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$166.46 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$223.06
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.70
|
| Rate for Payer: BCBS Complete |
$394.40
|
| Rate for Payer: BCBS MAPPO |
$166.46
|
| Rate for Payer: BCN Medicare Advantage |
$166.46
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Cofinity Commercial |
$223.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$307.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.90
|
| Rate for Payer: Nomi Health Commercial |
$199.75
|
| Rate for Payer: PACE SWMI |
$166.46
|
| Rate for Payer: PHP Medicare Advantage |
$166.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health Medicare |
$166.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.46
|
| Rate for Payer: UHC Medicare Advantage |
$166.46
|
|
