|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,832.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$1,982.40 |
| Rate for Payer: BCBS Complete |
$1,132.80
|
| Rate for Payer: Cash Price |
$2,265.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,982.40
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$292.80 |
| Max. Negotiated Rate |
$512.40 |
| Rate for Payer: BCBS Complete |
$292.80
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.40
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$3,041.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$1,216.40 |
| Max. Negotiated Rate |
$2,128.70 |
| Rate for Payer: BCBS Complete |
$1,216.40
|
| Rate for Payer: BCBS Complete |
$610.00
|
| Rate for Payer: Cash Price |
$2,432.80
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,067.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.70
|
|
|
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 |
$131.84
|
| Rate for Payer: Aetna Medicare |
$102.33
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$98.39
|
| Rate for Payer: BCBS Trust/PPO |
$729.05
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: BCN Medicare Advantage |
$98.39
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cofinity Commercial |
$141.68
|
| Rate for Payer: Cofinity Commercial |
$131.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.39
|
| Rate for Payer: Mclaren Medicaid |
$66.67
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$103.31
|
| Rate for Payer: PACE SWMI |
$98.39
|
| Rate for Payer: PHP Medicare Advantage |
$98.39
|
| 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 Medicare |
$98.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.39
|
| Rate for Payer: UHC Medicare Advantage |
$101.34
|
|
|
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 |
$172.86
|
| Rate for Payer: Aetna Medicare |
$134.16
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS MAPPO |
$129.00
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: BCN Commercial |
$194.01
|
| Rate for Payer: BCN Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.00
|
| Rate for Payer: Mclaren Medicaid |
$84.56
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.45
|
| Rate for Payer: PACE SWMI |
$129.00
|
| Rate for Payer: PHP Medicare Advantage |
$129.00
|
| 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 Medicare |
$129.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.00
|
| Rate for Payer: UHC Medicare Advantage |
$132.87
|
|
|
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 |
$204.07
|
| Rate for Payer: Aetna Medicare |
$158.38
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS MAPPO |
$152.29
|
| Rate for Payer: BCBS Trust/PPO |
$493.43
|
| Rate for Payer: BCN Commercial |
$227.73
|
| Rate for Payer: BCN Medicare Advantage |
$152.29
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Cofinity Commercial |
$204.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.29
|
| Rate for Payer: Mclaren Medicaid |
$100.96
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.90
|
| Rate for Payer: PACE SWMI |
$152.29
|
| Rate for Payer: PHP Medicare Advantage |
$152.29
|
| 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 Medicare |
$152.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.29
|
| Rate for Payer: UHC Medicare Advantage |
$156.86
|
|
|
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 |
$267.29
|
| Rate for Payer: Aetna Medicare |
$207.45
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$199.47
|
| Rate for Payer: BCBS Trust/PPO |
$399.39
|
| Rate for Payer: BCN Commercial |
$300.05
|
| Rate for Payer: BCN Medicare Advantage |
$199.47
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cofinity Commercial |
$287.24
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.47
|
| Rate for Payer: Mclaren Medicaid |
$130.14
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$209.44
|
| Rate for Payer: PACE SWMI |
$199.47
|
| Rate for Payer: PHP Medicare Advantage |
$199.47
|
| 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 Medicare |
$199.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.47
|
| Rate for Payer: UHC Medicare Advantage |
$205.45
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$449.35
|
|
|
Service Code
|
NDC 0904-7002-61
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.06 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: BCBS Trust/PPO |
$347.26
|
| Rate for Payer: BCN Commercial |
$347.26
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.95
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.43
|
| Rate for Payer: UHC Core |
$375.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$3,260.81
|
|
|
Service Code
|
NDC 0071-1016-41
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,988.77 |
| Max. Negotiated Rate |
$2,934.73 |
| Rate for Payer: Aetna Commercial |
$2,771.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,519.95
|
| Rate for Payer: BCN Commercial |
$2,519.95
|
| Rate for Payer: Cash Price |
$2,608.65
|
| Rate for Payer: Cofinity Commercial |
$2,804.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,608.65
|
| Rate for Payer: Healthscope Commercial |
$2,934.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,445.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,771.69
|
| Rate for Payer: PHP Commercial |
$2,771.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,282.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,836.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,988.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,869.51
|
| Rate for Payer: UHC Core |
$2,722.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,445.61
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$2,984.68
|
|
|
Service Code
|
NDC 0071-1016-68
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,820.36 |
| Max. Negotiated Rate |
$2,686.21 |
| Rate for Payer: Aetna Commercial |
$2,536.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,306.56
|
| Rate for Payer: BCN Commercial |
$2,306.56
|
| Rate for Payer: Cash Price |
$2,387.74
|
| Rate for Payer: Cofinity Commercial |
$2,566.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,387.74
|
| Rate for Payer: Healthscope Commercial |
$2,686.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,238.51
|
| 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 HMO/PPO/Tiered Network |
$2,596.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,820.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,626.52
|
| Rate for Payer: UHC Core |
$2,492.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,238.51
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$262.56
|
|
|
Service Code
|
NDC 0904-6991-61
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.14 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Aetna Commercial |
$223.18
|
| Rate for Payer: BCBS Trust/PPO |
$202.91
|
| Rate for Payer: BCN Commercial |
$202.91
|
| Rate for Payer: Cash Price |
$210.05
|
| Rate for Payer: Cofinity Commercial |
$225.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.05
|
| Rate for Payer: Healthscope Commercial |
$236.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.18
|
| Rate for Payer: PHP Commercial |
$223.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.05
|
| Rate for Payer: UHC Core |
$219.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.92
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$2,984.68
|
|
|
Service Code
|
NDC 0071-1012-68
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,820.36 |
| Max. Negotiated Rate |
$2,686.21 |
| Rate for Payer: Aetna Commercial |
$2,536.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,306.56
|
| Rate for Payer: BCN Commercial |
$2,306.56
|
| Rate for Payer: Cash Price |
$2,387.74
|
| Rate for Payer: Cofinity Commercial |
$2,566.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,387.74
|
| Rate for Payer: Healthscope Commercial |
$2,686.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,238.51
|
| 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 HMO/PPO/Tiered Network |
$2,596.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,820.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,626.52
|
| Rate for Payer: UHC Core |
$2,492.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,238.51
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$2,984.68
|
|
|
Service Code
|
NDC 0071-1013-68
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,820.36 |
| Max. Negotiated Rate |
$2,686.21 |
| Rate for Payer: Aetna Commercial |
$2,536.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,306.56
|
| Rate for Payer: BCN Commercial |
$2,306.56
|
| Rate for Payer: Cash Price |
$2,387.74
|
| Rate for Payer: Cofinity Commercial |
$2,566.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,387.74
|
| Rate for Payer: Healthscope Commercial |
$2,686.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,238.51
|
| 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 HMO/PPO/Tiered Network |
$2,596.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,820.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,626.52
|
| Rate for Payer: UHC Core |
$2,492.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,238.51
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
NDC 0904-6992-61
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.76 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: BCBS Trust/PPO |
$293.66
|
| Rate for Payer: BCN Commercial |
$293.66
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| 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 HMO/PPO/Tiered Network |
$330.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.40
|
| Rate for Payer: UHC Core |
$317.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 0904-7000-61
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: BCBS Trust/PPO |
$299.54
|
| Rate for Payer: BCN Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| 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 HMO/PPO/Tiered Network |
$337.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,647.83
|
|
|
Service Code
|
NDC 0071-1014-41
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,224.81 |
| Max. Negotiated Rate |
$3,283.05 |
| Rate for Payer: Aetna Commercial |
$3,100.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,819.04
|
| Rate for Payer: BCN Commercial |
$2,819.04
|
| Rate for Payer: Cash Price |
$2,918.26
|
| Rate for Payer: Cofinity Commercial |
$3,137.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,918.26
|
| Rate for Payer: Healthscope Commercial |
$3,283.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,735.87
|
| 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 HMO/PPO/Tiered Network |
$3,173.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,224.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,210.09
|
| Rate for Payer: UHC Core |
$3,045.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,735.87
|
|
|
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 |
$1,076.07 |
| Rate for Payer: Aetna Commercial |
$291.44
|
| Rate for Payer: Aetna Medicare |
$226.19
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS MAPPO |
$217.49
|
| Rate for Payer: BCBS Trust/PPO |
$724.83
|
| Rate for Payer: BCN Commercial |
$1,076.07
|
| Rate for Payer: BCN Medicare Advantage |
$217.49
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cofinity Commercial |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$291.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.49
|
| Rate for Payer: Mclaren Medicaid |
$140.79
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.36
|
| Rate for Payer: PACE SWMI |
$217.49
|
| Rate for Payer: PHP Medicare Advantage |
$217.49
|
| 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 Medicare |
$217.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.49
|
| Rate for Payer: UHC Medicare Advantage |
$224.01
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,767.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$419.66 |
| Max. Negotiated Rate |
$1,590.30 |
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna Medicare |
$459.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$552.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$552.19
|
| Rate for Payer: BCBS Complete |
$1,310.64
|
| Rate for Payer: BCBS MAPPO |
$441.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,373.84
|
| Rate for Payer: BCN Commercial |
$1,373.84
|
| Rate for Payer: BCN Medicare Advantage |
$441.75
|
| 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: Encore Health Key Benefits Commercial |
$1,413.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.75
|
| Rate for Payer: Healthscope Commercial |
$1,590.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,325.25
|
| Rate for Payer: Mclaren Medicaid |
$1,248.23
|
| Rate for Payer: Meridian Medicaid |
$1,310.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$463.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$508.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,501.95
|
| Rate for Payer: PACE Senior Care Partners |
$419.66
|
| Rate for Payer: PACE SWMI |
$441.75
|
| Rate for Payer: PHP Commercial |
$1,501.95
|
| Rate for Payer: PHP Medicare Advantage |
$441.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,248.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,537.29
|
| Rate for Payer: Priority Health Medicare |
$441.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,077.69
|
| Rate for Payer: Railroad Medicare Medicare |
$441.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,554.96
|
| Rate for Payer: UHC Core |
$1,475.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.75
|
| Rate for Payer: UHC Medicare Advantage |
$455.00
|
| Rate for Payer: VA VA |
$441.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,325.25
|
|
|
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 |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$199.90
|
| Rate for Payer: Aetna Medicare |
$155.15
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$149.18
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: BCN Medicare Advantage |
$149.18
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$199.90
|
| Rate for Payer: Cofinity Commercial |
$214.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.18
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.64
|
| Rate for Payer: PACE SWMI |
$149.18
|
| Rate for Payer: PHP Medicare Advantage |
$149.18
|
| 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 Medicare |
$149.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.18
|
| Rate for Payer: UHC Medicare Advantage |
$153.66
|
|
|
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 |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$199.90
|
| Rate for Payer: Aetna Medicare |
$155.15
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$149.18
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: BCN Medicare Advantage |
$149.18
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$199.90
|
| Rate for Payer: Cofinity Commercial |
$214.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.18
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.64
|
| Rate for Payer: PACE SWMI |
$149.18
|
| Rate for Payer: PHP Medicare Advantage |
$149.18
|
| 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 Medicare |
$149.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.18
|
| Rate for Payer: UHC Medicare Advantage |
$153.66
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,767.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,077.69 |
| Max. Negotiated Rate |
$1,590.30 |
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.54
|
| Rate for Payer: BCN Commercial |
$1,365.54
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,519.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.60
|
| Rate for Payer: Healthscope Commercial |
$1,590.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,325.25
|
| 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 HMO/PPO/Tiered Network |
$1,537.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,077.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,554.96
|
| Rate for Payer: UHC Core |
$1,475.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,325.25
|
|
|
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 |
$318.54
|
| Rate for Payer: Aetna Medicare |
$247.23
|
| Rate for Payer: BCBS Complete |
$161.48
|
| Rate for Payer: BCBS MAPPO |
$237.72
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$237.72
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$318.54
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.72
|
| Rate for Payer: Mclaren Medicaid |
$153.79
|
| Rate for Payer: Meridian Medicaid |
$161.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.61
|
| Rate for Payer: PACE SWMI |
$237.72
|
| Rate for Payer: PHP Medicare Advantage |
$237.72
|
| 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 Medicare |
$237.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$422.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.72
|
| Rate for Payer: UHC Medicare Advantage |
$244.85
|
|
|
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 |
$302.60
|
| Rate for Payer: Aetna Medicare |
$234.85
|
| Rate for Payer: BCBS Complete |
$154.54
|
| Rate for Payer: BCBS MAPPO |
$225.82
|
| Rate for Payer: BCBS Trust/PPO |
$850.03
|
| Rate for Payer: BCN Commercial |
$332.79
|
| Rate for Payer: BCN Medicare Advantage |
$225.82
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$325.18
|
| Rate for Payer: Cofinity Commercial |
$302.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.82
|
| Rate for Payer: Mclaren Medicaid |
$147.18
|
| Rate for Payer: Meridian Medicaid |
$154.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.11
|
| Rate for Payer: PACE SWMI |
$225.82
|
| Rate for Payer: PHP Medicare Advantage |
$225.82
|
| 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 Medicare |
$225.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$400.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.82
|
| Rate for Payer: UHC Medicare Advantage |
$232.59
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$876.69 |
| Rate for Payer: Aetna Commercial |
$229.13
|
| Rate for Payer: Aetna Medicare |
$177.83
|
| Rate for Payer: BCBS Complete |
$116.08
|
| Rate for Payer: BCBS MAPPO |
$170.99
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$876.69
|
| Rate for Payer: BCN Medicare Advantage |
$170.99
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$229.13
|
| Rate for Payer: Cofinity Commercial |
$246.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.99
|
| Rate for Payer: Mclaren Medicaid |
$110.55
|
| Rate for Payer: Meridian Medicaid |
$116.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.54
|
| Rate for Payer: PACE SWMI |
$170.99
|
| Rate for Payer: PHP Medicare Advantage |
$170.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.40
|
| Rate for Payer: Priority Health Medicare |
$170.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.99
|
| Rate for Payer: UHC Medicare Advantage |
$176.12
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$1,452.30 |
| Rate for Payer: Aetna Commercial |
$283.58
|
| Rate for Payer: Aetna Medicare |
$220.10
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$211.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.30
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: BCN Medicare Advantage |
$211.63
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$283.58
|
| Rate for Payer: Cofinity Commercial |
$304.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.63
|
| Rate for Payer: Mclaren Medicaid |
$136.75
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.21
|
| Rate for Payer: PACE SWMI |
$211.63
|
| Rate for Payer: PHP Medicare Advantage |
$211.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.13
|
| Rate for Payer: Priority Health Medicare |
$211.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$375.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.63
|
| Rate for Payer: UHC Medicare Advantage |
$217.98
|
|
