|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 43248
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$455.50
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCN Commercial |
$245.01
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Mclaren Medicaid |
$94.36
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.52
|
| Rate for Payer: UHC Medicaid |
$94.36
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.61 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Aetna Commercial |
$774.35
|
| Rate for Payer: Aetna Medicare |
$236.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.69
|
| Rate for Payer: BCBS Complete |
$168.63
|
| Rate for Payer: BCBS MAPPO |
$227.75
|
| Rate for Payer: BCBS Trust/PPO |
$748.93
|
| Rate for Payer: BCN Commercial |
$748.93
|
| Rate for Payer: BCN Medicare Advantage |
$227.75
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$783.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.75
|
| Rate for Payer: Healthscope Commercial |
$819.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.25
|
| Rate for Payer: Mclaren Medicaid |
$160.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$239.14
|
| Rate for Payer: Meridian Medicaid |
$168.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$250.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.35
|
| Rate for Payer: Nomi Health Commercial |
$747.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: PACE Senior Care Partners |
$216.36
|
| Rate for Payer: PACE SWMI |
$227.75
|
| Rate for Payer: PHP Commercial |
$774.35
|
| Rate for Payer: PHP Medicare Advantage |
$227.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$792.57
|
| Rate for Payer: Priority Health Medicare |
$230.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$634.06
|
| Rate for Payer: Railroad Medicare Medicare |
$227.75
|
| Rate for Payer: UHC Core |
$760.68
|
| Rate for Payer: UHC Exchange |
$227.75
|
| Rate for Payer: UHC Medicaid |
$160.61
|
| Rate for Payer: UHC Medicare Advantage |
$227.75
|
| Rate for Payer: UHCCP Medicaid |
$160.61
|
| Rate for Payer: VA VA |
$227.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.25
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$634.06 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Aetna Commercial |
$774.35
|
| Rate for Payer: BCBS Trust/PPO |
$752.39
|
| Rate for Payer: BCN Commercial |
$752.39
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$783.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.80
|
| Rate for Payer: Healthscope Commercial |
$819.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.35
|
| Rate for Payer: Nomi Health Commercial |
$747.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: PHP Commercial |
$774.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$792.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$634.06
|
| Rate for Payer: UHC Core |
$760.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.25
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
43248
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$455.50
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCN Commercial |
$245.01
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Mclaren Medicaid |
$94.36
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.52
|
| Rate for Payer: UHC Medicaid |
$94.36
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
PR EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 43241
|
| Min. Negotiated Rate |
$80.94 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Aetna Commercial |
$188.57
|
| Rate for Payer: Aetna Medicare |
$449.50
|
| Rate for Payer: BCBS Complete |
$84.99
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Mclaren Medicaid |
$80.94
|
| Rate for Payer: Meridian Medicaid |
$84.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$256.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.67
|
| Rate for Payer: UHC Medicaid |
$80.94
|
| Rate for Payer: UHCCP Medicaid |
$80.94
|
|
|
PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY
|
Professional
|
Both
|
$1,064.00
|
|
|
Service Code
|
HCPCS 43242
|
| Min. Negotiated Rate |
$146.54 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna Commercial |
$348.83
|
| Rate for Payer: Aetna Medicare |
$532.00
|
| Rate for Payer: BCBS Complete |
$153.87
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Mclaren Medicaid |
$146.54
|
| Rate for Payer: Meridian Medicaid |
$153.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$470.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.25
|
| Rate for Payer: UHC Medicaid |
$146.54
|
| Rate for Payer: UHCCP Medicaid |
$146.54
|
|
|
PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 43238
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: Aetna Commercial |
$308.98
|
| Rate for Payer: Aetna Medicare |
$533.50
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCN Commercial |
$342.61
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Mclaren Medicaid |
$130.36
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$800.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$417.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$417.44
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
43246
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,036.34 |
| Max. Negotiated Rate |
$1,340.10 |
| Rate for Payer: Aetna Commercial |
$1,265.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.77
|
| Rate for Payer: BCN Commercial |
$1,229.77
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cofinity Commercial |
$1,280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,191.20
|
| Rate for Payer: Healthscope Commercial |
$1,340.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,116.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,265.65
|
| Rate for Payer: Nomi Health Commercial |
$1,220.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,116.75
|
| Rate for Payer: PHP Commercial |
$1,265.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,295.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.34
|
| Rate for Payer: UHC Core |
$1,243.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,116.75
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
43246
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$1,116.75 |
| Rate for Payer: Aetna Commercial |
$266.68
|
| Rate for Payer: Aetna Medicare |
$744.50
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCN Commercial |
$295.80
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Mclaren Medicaid |
$113.74
|
| Rate for Payer: Meridian Medicaid |
$119.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,116.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$360.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.42
|
| Rate for Payer: UHC Medicaid |
$113.74
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$1,116.75 |
| Rate for Payer: Aetna Commercial |
$266.68
|
| Rate for Payer: Aetna Medicare |
$744.50
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCN Commercial |
$295.80
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Mclaren Medicaid |
$113.74
|
| Rate for Payer: Meridian Medicaid |
$119.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,116.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$360.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.42
|
| Rate for Payer: UHC Medicaid |
$113.74
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
43246
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$262.51 |
| Max. Negotiated Rate |
$1,340.10 |
| Rate for Payer: Aetna Commercial |
$1,265.65
|
| Rate for Payer: Aetna Medicare |
$387.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$465.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$465.31
|
| Rate for Payer: BCBS Complete |
$275.61
|
| Rate for Payer: BCBS MAPPO |
$372.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,224.11
|
| Rate for Payer: BCN Commercial |
$1,224.11
|
| Rate for Payer: BCN Medicare Advantage |
$372.25
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cofinity Commercial |
$1,280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,191.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.25
|
| Rate for Payer: Healthscope Commercial |
$1,340.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,116.75
|
| Rate for Payer: Mclaren Medicaid |
$262.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.86
|
| Rate for Payer: Meridian Medicaid |
$275.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$428.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,265.65
|
| Rate for Payer: Nomi Health Commercial |
$1,220.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,116.75
|
| Rate for Payer: PACE Senior Care Partners |
$353.64
|
| Rate for Payer: PACE SWMI |
$372.25
|
| Rate for Payer: PHP Commercial |
$1,265.65
|
| Rate for Payer: PHP Medicare Advantage |
$372.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,295.43
|
| Rate for Payer: Priority Health Medicare |
$375.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.34
|
| Rate for Payer: Railroad Medicare Medicare |
$372.25
|
| Rate for Payer: UHC Core |
$1,243.32
|
| Rate for Payer: UHC Exchange |
$372.25
|
| Rate for Payer: UHC Medicaid |
$262.51
|
| Rate for Payer: UHC Medicare Advantage |
$372.25
|
| Rate for Payer: UHCCP Medicaid |
$262.51
|
| Rate for Payer: VA VA |
$372.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,116.75
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
43251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$855.38 |
| Max. Negotiated Rate |
$1,106.10 |
| Rate for Payer: Aetna Commercial |
$1,044.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.03
|
| Rate for Payer: BCN Commercial |
$1,015.03
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,056.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.20
|
| Rate for Payer: Healthscope Commercial |
$1,106.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.65
|
| Rate for Payer: Nomi Health Commercial |
$1,007.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.75
|
| Rate for Payer: PHP Commercial |
$1,044.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,069.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.38
|
| Rate for Payer: UHC Core |
$1,026.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.75
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
43251
|
| Min. Negotiated Rate |
$110.33 |
| Max. Negotiated Rate |
$921.75 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: Aetna Medicare |
$614.50
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCN Commercial |
$288.83
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Mclaren Medicaid |
$110.33
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.92
|
| Rate for Payer: UHC Medicaid |
$110.33
|
| Rate for Payer: UHCCP Medicaid |
$110.33
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 43251
|
| Min. Negotiated Rate |
$110.33 |
| Max. Negotiated Rate |
$921.75 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: Aetna Medicare |
$614.50
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCN Commercial |
$288.83
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Mclaren Medicaid |
$110.33
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.92
|
| Rate for Payer: UHC Medicaid |
$110.33
|
| Rate for Payer: UHCCP Medicaid |
$110.33
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
43251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$216.67 |
| Max. Negotiated Rate |
$1,106.10 |
| Rate for Payer: Aetna Commercial |
$1,044.65
|
| Rate for Payer: Aetna Medicare |
$319.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$384.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$384.06
|
| Rate for Payer: BCBS Complete |
$227.49
|
| Rate for Payer: BCBS MAPPO |
$307.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.36
|
| Rate for Payer: BCN Commercial |
$1,010.36
|
| Rate for Payer: BCN Medicare Advantage |
$307.25
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,056.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.25
|
| Rate for Payer: Healthscope Commercial |
$1,106.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.75
|
| Rate for Payer: Mclaren Medicaid |
$216.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.61
|
| Rate for Payer: Meridian Medicaid |
$227.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$337.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.65
|
| Rate for Payer: Nomi Health Commercial |
$1,007.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.75
|
| Rate for Payer: PACE Senior Care Partners |
$291.89
|
| Rate for Payer: PACE SWMI |
$307.25
|
| Rate for Payer: PHP Commercial |
$1,044.65
|
| Rate for Payer: PHP Medicare Advantage |
$307.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,069.23
|
| Rate for Payer: Priority Health Medicare |
$310.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.38
|
| Rate for Payer: Railroad Medicare Medicare |
$307.25
|
| Rate for Payer: UHC Core |
$1,026.21
|
| Rate for Payer: UHC Exchange |
$307.25
|
| Rate for Payer: UHC Medicaid |
$216.67
|
| Rate for Payer: UHC Medicare Advantage |
$307.25
|
| Rate for Payer: UHCCP Medicaid |
$216.67
|
| Rate for Payer: VA VA |
$307.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.75
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$600.65 |
| Max. Negotiated Rate |
$776.70 |
| Rate for Payer: Aetna Commercial |
$733.55
|
| Rate for Payer: BCBS Trust/PPO |
$712.75
|
| Rate for Payer: BCN Commercial |
$712.75
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cofinity Commercial |
$742.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.40
|
| Rate for Payer: Healthscope Commercial |
$776.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.55
|
| Rate for Payer: Nomi Health Commercial |
$707.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.25
|
| Rate for Payer: PHP Commercial |
$733.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$750.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$600.65
|
| Rate for Payer: UHC Core |
$720.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.25
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$776.70 |
| Rate for Payer: Aetna Commercial |
$733.55
|
| Rate for Payer: Aetna Medicare |
$224.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$269.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$269.69
|
| Rate for Payer: BCBS Complete |
$159.74
|
| Rate for Payer: BCBS MAPPO |
$215.75
|
| Rate for Payer: BCBS Trust/PPO |
$709.47
|
| Rate for Payer: BCN Commercial |
$709.47
|
| Rate for Payer: BCN Medicare Advantage |
$215.75
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cofinity Commercial |
$742.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.75
|
| Rate for Payer: Healthscope Commercial |
$776.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.25
|
| Rate for Payer: Mclaren Medicaid |
$152.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.54
|
| Rate for Payer: Meridian Medicaid |
$159.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.55
|
| Rate for Payer: Nomi Health Commercial |
$707.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.25
|
| Rate for Payer: PACE Senior Care Partners |
$204.96
|
| Rate for Payer: PACE SWMI |
$215.75
|
| Rate for Payer: PHP Commercial |
$733.55
|
| Rate for Payer: PHP Medicare Advantage |
$215.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$750.81
|
| Rate for Payer: Priority Health Medicare |
$217.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$600.65
|
| Rate for Payer: Railroad Medicare Medicare |
$215.75
|
| Rate for Payer: UHC Core |
$720.61
|
| Rate for Payer: UHC Exchange |
$215.75
|
| Rate for Payer: UHC Medicaid |
$152.15
|
| Rate for Payer: UHC Medicare Advantage |
$215.75
|
| Rate for Payer: UHCCP Medicaid |
$152.15
|
| Rate for Payer: VA VA |
$215.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.25
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
43239
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$647.25 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: Aetna Medicare |
$431.50
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Mclaren Medicaid |
$78.81
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.77
|
| Rate for Payer: UHC Medicaid |
$78.81
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$647.25 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: Aetna Medicare |
$431.50
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Mclaren Medicaid |
$78.81
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.77
|
| Rate for Payer: UHC Medicaid |
$78.81
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$112.89 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Aetna Commercial |
$266.36
|
| Rate for Payer: Aetna Medicare |
$594.00
|
| Rate for Payer: BCBS Complete |
$118.53
|
| Rate for Payer: BCN Commercial |
$295.30
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Mclaren Medicaid |
$112.89
|
| Rate for Payer: Meridian Medicaid |
$118.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$891.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$359.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$359.80
|
| Rate for Payer: UHC Medicaid |
$112.89
|
| Rate for Payer: UHCCP Medicaid |
$112.89
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$151.02 |
| Max. Negotiated Rate |
$644.25 |
| Rate for Payer: Aetna Commercial |
$358.95
|
| Rate for Payer: Aetna Medicare |
$429.50
|
| Rate for Payer: BCBS Complete |
$158.57
|
| Rate for Payer: BCN Commercial |
$397.38
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Mclaren Medicaid |
$151.02
|
| Rate for Payer: Meridian Medicaid |
$158.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$644.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$484.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.20
|
| Rate for Payer: UHC Medicaid |
$151.02
|
| Rate for Payer: UHCCP Medicaid |
$151.02
|
|
|
PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 43240
|
| Min. Negotiated Rate |
$218.11 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Aetna Commercial |
$521.19
|
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: BCBS Complete |
$229.02
|
| Rate for Payer: BCN Commercial |
$574.67
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Mclaren Medicaid |
$218.11
|
| Rate for Payer: Meridian Medicaid |
$229.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$918.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$700.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$700.20
|
| Rate for Payer: UHC Medicaid |
$218.11
|
| Rate for Payer: UHCCP Medicaid |
$218.11
|
|
|
PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 43253
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$348.83
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCN Commercial |
$386.44
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Mclaren Medicaid |
$146.76
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$470.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.85
|
| Rate for Payer: UHC Medicaid |
$146.76
|
| Rate for Payer: UHCCP Medicaid |
$146.76
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.35
|
|
|
PR EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCN Commercial |
$11.95
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.35
|
|
