|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$65.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.75
|
| Rate for Payer: BCBS Complete |
$46.65
|
| Rate for Payer: BCBS MAPPO |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$207.17
|
| Rate for Payer: BCN Commercial |
$207.17
|
| Rate for Payer: BCN Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Mclaren Medicaid |
$44.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.15
|
| Rate for Payer: Meridian Medicaid |
$46.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PACE Senior Care Partners |
$59.85
|
| Rate for Payer: PACE SWMI |
$63.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: PHP Medicare Advantage |
$63.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Medicare |
$63.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.39
|
| Rate for Payer: Railroad Medicare Medicare |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: UHC Exchange |
$63.00
|
| Rate for Payer: UHC Medicaid |
$44.43
|
| Rate for Payer: UHC Medicare Advantage |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$44.43
|
| Rate for Payer: VA VA |
$63.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.39 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$208.13
|
| Rate for Payer: BCN Commercial |
$208.13
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$65.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.75
|
| Rate for Payer: BCBS Complete |
$46.65
|
| Rate for Payer: BCBS MAPPO |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$207.17
|
| Rate for Payer: BCN Commercial |
$207.17
|
| Rate for Payer: BCN Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Mclaren Medicaid |
$44.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.15
|
| Rate for Payer: Meridian Medicaid |
$46.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PACE Senior Care Partners |
$59.85
|
| Rate for Payer: PACE SWMI |
$63.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: PHP Medicare Advantage |
$63.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Medicare |
$63.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.39
|
| Rate for Payer: Railroad Medicare Medicare |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: UHC Exchange |
$63.00
|
| Rate for Payer: UHC Medicaid |
$44.43
|
| Rate for Payer: UHC Medicare Advantage |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$44.43
|
| Rate for Payer: VA VA |
$63.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,830.24
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,665.85 |
| Max. Negotiated Rate |
$3,447.22 |
| Rate for Payer: Aetna Commercial |
$3,255.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,163.40
|
| Rate for Payer: BCN Commercial |
$3,163.40
|
| Rate for Payer: Cash Price |
$3,064.19
|
| Rate for Payer: Cofinity Commercial |
$3,294.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,064.19
|
| Rate for Payer: Healthscope Commercial |
$3,447.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,872.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,255.70
|
| Rate for Payer: Nomi Health Commercial |
$3,140.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,872.68
|
| Rate for Payer: PHP Commercial |
$3,255.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,332.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,665.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,370.61
|
| Rate for Payer: UHC Core |
$3,198.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,872.68
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$3,830.24
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$675.27 |
| Max. Negotiated Rate |
$3,447.22 |
| Rate for Payer: Aetna Commercial |
$3,255.70
|
| Rate for Payer: Aetna Medicare |
$995.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,196.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,196.95
|
| Rate for Payer: BCBS Complete |
$708.98
|
| Rate for Payer: BCBS MAPPO |
$957.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,148.84
|
| Rate for Payer: BCN Commercial |
$3,148.84
|
| Rate for Payer: BCN Medicare Advantage |
$957.56
|
| Rate for Payer: Cash Price |
$3,064.19
|
| Rate for Payer: Cofinity Commercial |
$3,294.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,064.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$957.56
|
| Rate for Payer: Healthscope Commercial |
$3,447.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,872.68
|
| Rate for Payer: Mclaren Medicaid |
$675.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,005.44
|
| Rate for Payer: Meridian Medicaid |
$708.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,101.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,053.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,255.70
|
| Rate for Payer: Nomi Health Commercial |
$3,140.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,872.68
|
| Rate for Payer: PACE Senior Care Partners |
$909.68
|
| Rate for Payer: PACE SWMI |
$957.56
|
| Rate for Payer: PHP Commercial |
$3,255.70
|
| Rate for Payer: PHP Medicare Advantage |
$957.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$675.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,332.31
|
| Rate for Payer: Priority Health Medicare |
$967.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,665.85
|
| Rate for Payer: Railroad Medicare Medicare |
$957.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,370.61
|
| Rate for Payer: UHC Core |
$3,198.25
|
| Rate for Payer: UHC Exchange |
$957.56
|
| Rate for Payer: UHC Medicaid |
$675.27
|
| Rate for Payer: UHC Medicare Advantage |
$957.56
|
| Rate for Payer: UHCCP Medicaid |
$675.27
|
| Rate for Payer: VA VA |
$957.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,872.68
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,455.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Aetna Commercial |
$298.44
|
| Rate for Payer: Aetna Medicare |
$727.50
|
| Rate for Payer: BCBS Complete |
$132.41
|
| Rate for Payer: BCN Commercial |
$331.16
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Mclaren Medicaid |
$126.10
|
| Rate for Payer: Meridian Medicaid |
$132.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,091.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$403.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$403.49
|
| Rate for Payer: UHC Medicaid |
$126.10
|
| Rate for Payer: UHCCP Medicaid |
$126.10
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$204.01
|
| Rate for Payer: Aetna Medicare |
$928.00
|
| Rate for Payer: BCBS Complete |
$91.25
|
| Rate for Payer: BCN Commercial |
$226.58
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Mclaren Medicaid |
$86.90
|
| Rate for Payer: Meridian Medicaid |
$91.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.08
|
| Rate for Payer: UHC Medicaid |
$86.90
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$327.21 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Aetna Commercial |
$1,577.60
|
| Rate for Payer: Aetna Medicare |
$482.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$580.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$580.00
|
| Rate for Payer: BCBS Complete |
$343.55
|
| Rate for Payer: BCBS MAPPO |
$464.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.82
|
| Rate for Payer: BCN Commercial |
$1,525.82
|
| Rate for Payer: BCN Medicare Advantage |
$464.00
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$1,596.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.00
|
| Rate for Payer: Healthscope Commercial |
$1,670.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,392.00
|
| Rate for Payer: Mclaren Medicaid |
$327.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.20
|
| Rate for Payer: Meridian Medicaid |
$343.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$533.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$510.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Nomi Health Commercial |
$1,521.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE Senior Care Partners |
$440.80
|
| Rate for Payer: PACE SWMI |
$464.00
|
| Rate for Payer: PHP Commercial |
$1,577.60
|
| Rate for Payer: PHP Medicare Advantage |
$464.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,614.72
|
| Rate for Payer: Priority Health Medicare |
$468.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,291.78
|
| Rate for Payer: Railroad Medicare Medicare |
$464.00
|
| Rate for Payer: UHC Core |
$1,549.76
|
| Rate for Payer: UHC Exchange |
$464.00
|
| Rate for Payer: UHC Medicaid |
$327.21
|
| Rate for Payer: UHC Medicare Advantage |
$464.00
|
| Rate for Payer: UHCCP Medicaid |
$327.21
|
| Rate for Payer: VA VA |
$464.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,392.00
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,291.78 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Aetna Commercial |
$1,577.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.87
|
| Rate for Payer: BCN Commercial |
$1,532.87
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$1,596.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Healthscope Commercial |
$1,670.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,392.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Nomi Health Commercial |
$1,521.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PHP Commercial |
$1,577.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,614.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,291.78
|
| Rate for Payer: UHC Core |
$1,549.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,392.00
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$204.01
|
| Rate for Payer: Aetna Medicare |
$928.00
|
| Rate for Payer: BCBS Complete |
$91.25
|
| Rate for Payer: BCN Commercial |
$226.58
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Mclaren Medicaid |
$86.90
|
| Rate for Payer: Meridian Medicaid |
$91.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.08
|
| Rate for Payer: UHC Medicaid |
$86.90
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$878.25 |
| Rate for Payer: Aetna Commercial |
$325.46
|
| Rate for Payer: Aetna Medicare |
$585.50
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCN Commercial |
$360.04
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$438.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.69
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$308.63
|
| Rate for Payer: Aetna Medicare |
$302.50
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Mclaren Medicaid |
$130.36
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$453.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$416.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.84
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$782.25 |
| Rate for Payer: Aetna Commercial |
$234.83
|
| Rate for Payer: Aetna Medicare |
$521.50
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Mclaren Medicaid |
$100.11
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.95
|
| Rate for Payer: UHC Medicaid |
$100.11
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$122.69 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna Commercial |
$289.61
|
| Rate for Payer: Aetna Medicare |
$356.00
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: BCN Commercial |
$320.70
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Mclaren Medicaid |
$122.69
|
| Rate for Payer: Meridian Medicaid |
$128.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$390.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$390.75
|
| Rate for Payer: UHC Medicaid |
$122.69
|
| Rate for Payer: UHCCP Medicaid |
$122.69
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Aetna Commercial |
$306.04
|
| Rate for Payer: Aetna Medicare |
$535.00
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCN Commercial |
$338.13
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Mclaren Medicaid |
$130.14
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$802.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$411.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.98
|
| Rate for Payer: UHC Medicaid |
$130.14
|
| Rate for Payer: UHCCP Medicaid |
$130.14
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$179.12 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Aetna Commercial |
$863.60
|
| Rate for Payer: Aetna Medicare |
$264.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$317.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$317.50
|
| Rate for Payer: BCBS Complete |
$188.06
|
| Rate for Payer: BCBS MAPPO |
$254.00
|
| Rate for Payer: BCBS Trust/PPO |
$835.25
|
| Rate for Payer: BCN Commercial |
$835.25
|
| Rate for Payer: BCN Medicare Advantage |
$254.00
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$873.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$812.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.00
|
| Rate for Payer: Healthscope Commercial |
$914.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.00
|
| Rate for Payer: Mclaren Medicaid |
$179.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.70
|
| Rate for Payer: Meridian Medicaid |
$188.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$279.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.60
|
| Rate for Payer: Nomi Health Commercial |
$833.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: PACE Senior Care Partners |
$241.30
|
| Rate for Payer: PACE SWMI |
$254.00
|
| Rate for Payer: PHP Commercial |
$863.60
|
| Rate for Payer: PHP Medicare Advantage |
$254.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$883.92
|
| Rate for Payer: Priority Health Medicare |
$256.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$707.14
|
| Rate for Payer: Railroad Medicare Medicare |
$254.00
|
| Rate for Payer: UHC Core |
$848.36
|
| Rate for Payer: UHC Exchange |
$254.00
|
| Rate for Payer: UHC Medicaid |
$179.12
|
| Rate for Payer: UHC Medicare Advantage |
$254.00
|
| Rate for Payer: UHCCP Medicaid |
$179.12
|
| Rate for Payer: VA VA |
$254.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.00
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 43247
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna Commercial |
$235.23
|
| Rate for Payer: Aetna Medicare |
$508.00
|
| Rate for Payer: BCBS Complete |
$105.34
|
| Rate for Payer: BCN Commercial |
$260.44
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Mclaren Medicaid |
$100.32
|
| Rate for Payer: Meridian Medicaid |
$105.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.33
|
| Rate for Payer: UHC Medicaid |
$100.32
|
| Rate for Payer: UHCCP Medicaid |
$100.32
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$707.14 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Aetna Commercial |
$863.60
|
| Rate for Payer: BCBS Trust/PPO |
$839.11
|
| Rate for Payer: BCN Commercial |
$839.11
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$873.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$812.80
|
| Rate for Payer: Healthscope Commercial |
$914.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.60
|
| Rate for Payer: Nomi Health Commercial |
$833.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: PHP Commercial |
$863.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$883.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$707.14
|
| Rate for Payer: UHC Core |
$848.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.00
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna Commercial |
$235.23
|
| Rate for Payer: Aetna Medicare |
$508.00
|
| Rate for Payer: BCBS Complete |
$105.34
|
| Rate for Payer: BCN Commercial |
$260.44
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Mclaren Medicaid |
$100.32
|
| Rate for Payer: Meridian Medicaid |
$105.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.33
|
| Rate for Payer: UHC Medicaid |
$100.32
|
| Rate for Payer: UHCCP Medicaid |
$100.32
|
|
|
PR EGD FLEXIBLE TRANSNASAL W/INSJ INTRAL TUBE/CATH
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 0654T
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$210.65 |
| Rate for Payer: Aetna Commercial |
$143.60
|
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.50
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$200.45 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Aetna Commercial |
$966.45
|
| Rate for Payer: Aetna Medicare |
$295.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$355.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$355.31
|
| Rate for Payer: BCBS Complete |
$210.46
|
| Rate for Payer: BCBS MAPPO |
$284.25
|
| Rate for Payer: BCBS Trust/PPO |
$934.73
|
| Rate for Payer: BCN Commercial |
$934.73
|
| Rate for Payer: BCN Medicare Advantage |
$284.25
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$977.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$1,023.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$852.75
|
| Rate for Payer: Mclaren Medicaid |
$200.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.46
|
| Rate for Payer: Meridian Medicaid |
$210.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$312.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.45
|
| Rate for Payer: Nomi Health Commercial |
$932.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: PACE Senior Care Partners |
$270.04
|
| Rate for Payer: PACE SWMI |
$284.25
|
| Rate for Payer: PHP Commercial |
$966.45
|
| Rate for Payer: PHP Medicare Advantage |
$284.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$989.19
|
| Rate for Payer: Priority Health Medicare |
$287.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$791.35
|
| Rate for Payer: Railroad Medicare Medicare |
$284.25
|
| Rate for Payer: UHC Core |
$949.39
|
| Rate for Payer: UHC Exchange |
$284.25
|
| Rate for Payer: UHC Medicaid |
$200.45
|
| Rate for Payer: UHC Medicare Advantage |
$284.25
|
| Rate for Payer: UHCCP Medicaid |
$200.45
|
| Rate for Payer: VA VA |
$284.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$852.75
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$791.35 |
| Max. Negotiated Rate |
$1,023.30 |
| Rate for Payer: Aetna Commercial |
$966.45
|
| Rate for Payer: BCBS Trust/PPO |
$939.05
|
| Rate for Payer: BCN Commercial |
$939.05
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$977.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.60
|
| Rate for Payer: Healthscope Commercial |
$1,023.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$852.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.45
|
| Rate for Payer: Nomi Health Commercial |
$932.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: PHP Commercial |
$966.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$989.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$791.35
|
| Rate for Payer: UHC Core |
$949.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$852.75
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43250
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: Aetna Medicare |
$568.50
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCN Commercial |
$251.98
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.01
|
| Rate for Payer: UHC Medicaid |
$97.34
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
43250
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: Aetna Medicare |
$568.50
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCN Commercial |
$251.98
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.01
|
| Rate for Payer: UHC Medicaid |
$97.34
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 43243
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna Commercial |
$315.11
|
| Rate for Payer: Aetna Medicare |
$620.00
|
| Rate for Payer: BCBS Complete |
$140.01
|
| Rate for Payer: BCN Commercial |
$350.58
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Mclaren Medicaid |
$133.34
|
| Rate for Payer: Meridian Medicaid |
$140.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$930.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$427.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.16
|
| Rate for Payer: UHC Medicaid |
$133.34
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
|
