|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$622.40 |
| Max. Negotiated Rate |
$1,011.40 |
| Rate for Payer: Aetna Medicare |
$778.00
|
| Rate for Payer: Aetna Medicare |
$1,551.00
|
| Rate for Payer: BCBS Complete |
$622.40
|
| Rate for Payer: BCBS Complete |
$1,240.80
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$144.33 |
| Rate for Payer: Aetna Commercial |
$134.31
|
| Rate for Payer: Aetna Medicare |
$104.24
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$100.23
|
| Rate for Payer: BCN Medicare Advantage |
$100.23
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$134.31
|
| Rate for Payer: Cofinity Commercial |
$144.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.24
|
| Rate for Payer: Nomi Health Commercial |
$120.28
|
| Rate for Payer: PACE SWMI |
$100.23
|
| Rate for Payer: PHP Medicare Advantage |
$100.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$101.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.23
|
| Rate for Payer: UHC Exchange |
$100.23
|
| Rate for Payer: UHC Medicare Advantage |
$100.23
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$181.38 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna Medicare |
$131.00
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS MAPPO |
$125.96
|
| Rate for Payer: BCN Medicare Advantage |
$125.96
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$181.38
|
| Rate for Payer: Cofinity Commercial |
$168.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.26
|
| Rate for Payer: Nomi Health Commercial |
$151.15
|
| Rate for Payer: PACE SWMI |
$125.96
|
| Rate for Payer: PHP Medicare Advantage |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$127.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.96
|
| Rate for Payer: UHC Exchange |
$125.96
|
| Rate for Payer: UHC Medicare Advantage |
$125.96
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$216.92 |
| Rate for Payer: Aetna Commercial |
$201.86
|
| Rate for Payer: Aetna Medicare |
$156.67
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: BCBS MAPPO |
$150.64
|
| Rate for Payer: BCN Medicare Advantage |
$150.64
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$216.92
|
| Rate for Payer: Cofinity Commercial |
$201.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.17
|
| Rate for Payer: Nomi Health Commercial |
$180.77
|
| Rate for Payer: PACE SWMI |
$150.64
|
| Rate for Payer: PHP Medicare Advantage |
$150.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health Medicare |
$152.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.64
|
| Rate for Payer: UHC Exchange |
$150.64
|
| Rate for Payer: UHC Medicare Advantage |
$150.64
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$278.51 |
| Rate for Payer: Aetna Commercial |
$259.17
|
| Rate for Payer: Aetna Medicare |
$201.15
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS MAPPO |
$193.41
|
| Rate for Payer: BCN Medicare Advantage |
$193.41
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$278.51
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.08
|
| Rate for Payer: Nomi Health Commercial |
$232.09
|
| Rate for Payer: PACE SWMI |
$193.41
|
| Rate for Payer: PHP Medicare Advantage |
$193.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health Medicare |
$195.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.41
|
| Rate for Payer: UHC Exchange |
$193.41
|
| Rate for Payer: UHC Medicare Advantage |
$193.41
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$3,260.81
|
|
|
Service Code
|
NDC 00071101641
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$774.44 |
| Max. Negotiated Rate |
$2,934.73 |
| Rate for Payer: Aetna Commercial |
$2,771.69
|
| Rate for Payer: Aetna Medicare |
$847.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,019.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,019.00
|
| Rate for Payer: BCBS Complete |
$1,304.32
|
| Rate for Payer: BCBS MAPPO |
$815.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,680.71
|
| Rate for Payer: BCN Commercial |
$2,535.28
|
| Rate for Payer: BCN Medicare Advantage |
$815.20
|
| 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: Health Alliance Plan Medicare Advantage |
$815.20
|
| Rate for Payer: Healthscope Commercial |
$2,934.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,445.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$855.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$937.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,771.69
|
| Rate for Payer: Nomi Health Commercial |
$2,673.86
|
| Rate for Payer: PACE Senior Care Partners |
$774.44
|
| Rate for Payer: PACE SWMI |
$815.20
|
| Rate for Payer: PHP Commercial |
$2,771.69
|
| Rate for Payer: PHP Medicare Advantage |
$815.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,119.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,836.90
|
| Rate for Payer: Priority Health Medicare |
$823.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,184.74
|
| Rate for Payer: Railroad Medicare Medicare |
$815.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,869.51
|
| Rate for Payer: UHC Core |
$2,722.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$815.20
|
| Rate for Payer: UHC Exchange |
$815.20
|
| Rate for Payer: UHC Medicare Advantage |
$815.20
|
| Rate for Payer: VA VA |
$815.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,445.61
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$458.85
|
|
|
Service Code
|
NDC 00904700261
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.25 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: BCBS Trust/PPO |
$374.56
|
| Rate for Payer: BCN Commercial |
$354.60
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: Priority Health HMO/PPO |
$399.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.79
|
| Rate for Payer: UHC Core |
$383.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$458.85
|
|
|
Service Code
|
NDC 00904700261
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.39
|
| Rate for Payer: BCBS Complete |
$183.54
|
| Rate for Payer: BCBS MAPPO |
$114.71
|
| Rate for Payer: BCBS Trust/PPO |
$377.22
|
| Rate for Payer: BCN Commercial |
$356.76
|
| Rate for Payer: BCN Medicare Advantage |
$114.71
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.71
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: PACE Senior Care Partners |
$108.98
|
| Rate for Payer: PACE SWMI |
$114.71
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: PHP Medicare Advantage |
$114.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.25
|
| Rate for Payer: Priority Health HMO/PPO |
$399.20
|
| Rate for Payer: Priority Health Medicare |
$115.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.43
|
| Rate for Payer: Railroad Medicare Medicare |
$114.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.79
|
| Rate for Payer: UHC Core |
$383.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.71
|
| Rate for Payer: UHC Exchange |
$114.71
|
| Rate for Payer: UHC Medicare Advantage |
$114.71
|
| Rate for Payer: VA VA |
$114.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
IP
|
$3,260.81
|
|
|
Service Code
|
NDC 00071101641
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,119.53 |
| Max. Negotiated Rate |
$2,934.73 |
| Rate for Payer: Aetna Commercial |
$2,771.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,661.80
|
| 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 Commercial |
$2,771.69
|
| Rate for Payer: Nomi Health Commercial |
$2,673.86
|
| Rate for Payer: PHP Commercial |
$2,771.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,119.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,836.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,184.74
|
| 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
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101668
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,041.12 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.34
|
| Rate for Payer: BCN Commercial |
$2,426.74
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 150 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101668
|
| Hospital Charge Code |
42166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.80 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$816.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$981.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$981.31
|
| Rate for Payer: BCBS Complete |
$1,256.08
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,441.50
|
| Rate for Payer: BCN Medicare Advantage |
$785.05
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.05
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: PACE Senior Care Partners |
$745.80
|
| Rate for Payer: PACE SWMI |
$785.05
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: PHP Medicare Advantage |
$785.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| Rate for Payer: Railroad Medicare Medicare |
$785.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$785.05
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| Rate for Payer: VA VA |
$785.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.80 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$816.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$981.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$981.31
|
| Rate for Payer: BCBS Complete |
$1,256.08
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,441.50
|
| Rate for Payer: BCN Medicare Advantage |
$785.05
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.05
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: PACE Senior Care Partners |
$745.80
|
| Rate for Payer: PACE SWMI |
$785.05
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: PHP Medicare Advantage |
$785.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| Rate for Payer: Railroad Medicare Medicare |
$785.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$785.05
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| Rate for Payer: VA VA |
$785.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101268
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,041.12 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.34
|
| Rate for Payer: BCN Commercial |
$2,426.74
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.97 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: BCBS Trust/PPO |
$220.99
|
| Rate for Payer: BCN Commercial |
$209.21
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health HMO/PPO |
$235.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.23
|
| Rate for Payer: UHC Core |
$226.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$270.72
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.30 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna Medicare |
$70.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.60
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: BCBS MAPPO |
$67.68
|
| Rate for Payer: BCBS Trust/PPO |
$222.56
|
| Rate for Payer: BCN Commercial |
$210.48
|
| Rate for Payer: BCN Medicare Advantage |
$67.68
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: PACE Senior Care Partners |
$64.30
|
| Rate for Payer: PACE SWMI |
$67.68
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: PHP Medicare Advantage |
$67.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: Priority Health HMO/PPO |
$235.53
|
| Rate for Payer: Priority Health Medicare |
$68.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.38
|
| Rate for Payer: Railroad Medicare Medicare |
$67.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.23
|
| Rate for Payer: UHC Core |
$226.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.68
|
| Rate for Payer: UHC Exchange |
$67.68
|
| Rate for Payer: UHC Medicare Advantage |
$67.68
|
| Rate for Payer: VA VA |
$67.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.09 |
| Max. Negotiated Rate |
$346.27 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: BCBS Trust/PPO |
$314.07
|
| Rate for Payer: BCN Commercial |
$297.33
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Nomi Health Commercial |
$315.50
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health HMO/PPO |
$334.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.58
|
| Rate for Payer: UHC Core |
$321.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.56
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101368
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.80 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: Aetna Medicare |
$816.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$981.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$981.31
|
| Rate for Payer: BCBS Complete |
$1,256.08
|
| Rate for Payer: BCBS MAPPO |
$785.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,581.55
|
| Rate for Payer: BCN Commercial |
$2,441.50
|
| Rate for Payer: BCN Medicare Advantage |
$785.05
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.05
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$902.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: PACE Senior Care Partners |
$745.80
|
| Rate for Payer: PACE SWMI |
$785.05
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: PHP Medicare Advantage |
$785.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Medicare |
$792.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| Rate for Payer: Railroad Medicare Medicare |
$785.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$785.05
|
| Rate for Payer: UHC Exchange |
$785.05
|
| Rate for Payer: UHC Medicare Advantage |
$785.05
|
| Rate for Payer: VA VA |
$785.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 00904699261
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$346.27 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna Medicare |
$100.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.23
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: BCBS MAPPO |
$96.19
|
| Rate for Payer: BCBS Trust/PPO |
$316.30
|
| Rate for Payer: BCN Commercial |
$299.14
|
| Rate for Payer: BCN Medicare Advantage |
$96.19
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.19
|
| Rate for Payer: Healthscope Commercial |
$346.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Nomi Health Commercial |
$315.50
|
| Rate for Payer: PACE Senior Care Partners |
$91.38
|
| Rate for Payer: PACE SWMI |
$96.19
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: PHP Medicare Advantage |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health HMO/PPO |
$334.73
|
| Rate for Payer: Priority Health Medicare |
$97.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.78
|
| Rate for Payer: Railroad Medicare Medicare |
$96.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.58
|
| Rate for Payer: UHC Core |
$321.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.19
|
| Rate for Payer: UHC Exchange |
$96.19
|
| Rate for Payer: UHC Medicare Advantage |
$96.19
|
| Rate for Payer: VA VA |
$96.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.56
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$3,140.19
|
|
|
Service Code
|
NDC 00071101368
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,041.12 |
| Max. Negotiated Rate |
$2,826.17 |
| Rate for Payer: Aetna Commercial |
$2,669.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.34
|
| Rate for Payer: BCN Commercial |
$2,426.74
|
| Rate for Payer: Cash Price |
$2,512.15
|
| Rate for Payer: Cofinity Commercial |
$2,700.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,512.15
|
| Rate for Payer: Healthscope Commercial |
$2,826.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,355.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,669.16
|
| Rate for Payer: Nomi Health Commercial |
$2,574.96
|
| Rate for Payer: PHP Commercial |
$2,669.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,041.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,731.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,103.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.37
|
| Rate for Payer: UHC Core |
$2,622.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,355.14
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.26 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: BCBS Trust/PPO |
$321.83
|
| Rate for Payer: BCN Commercial |
$304.68
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$339.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: Nomi Health Commercial |
$323.29
|
| Rate for Payer: PHP Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health HMO/PPO |
$343.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.94
|
| Rate for Payer: UHC Core |
$329.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.69
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna Medicare |
$102.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.20
|
| Rate for Payer: BCBS Complete |
$157.70
|
| Rate for Payer: BCBS MAPPO |
$98.56
|
| Rate for Payer: BCBS Trust/PPO |
$324.11
|
| Rate for Payer: BCN Commercial |
$306.53
|
| Rate for Payer: BCN Medicare Advantage |
$98.56
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$339.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.56
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: Nomi Health Commercial |
$323.29
|
| Rate for Payer: PACE Senior Care Partners |
$93.63
|
| Rate for Payer: PACE SWMI |
$98.56
|
| Rate for Payer: PHP Commercial |
$335.11
|
| Rate for Payer: PHP Medicare Advantage |
$98.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health HMO/PPO |
$343.00
|
| Rate for Payer: Priority Health Medicare |
$99.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.15
|
| Rate for Payer: Railroad Medicare Medicare |
$98.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.94
|
| Rate for Payer: UHC Core |
$329.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.56
|
| Rate for Payer: UHC Exchange |
$98.56
|
| Rate for Payer: UHC Medicare Advantage |
$98.56
|
| Rate for Payer: VA VA |
$98.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.69
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$914.95 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: Aetna Medicare |
$1,001.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,203.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,203.89
|
| Rate for Payer: BCBS Complete |
$1,540.98
|
| Rate for Payer: BCBS MAPPO |
$963.11
|
| Rate for Payer: BCBS Trust/PPO |
$3,167.09
|
| Rate for Payer: BCN Commercial |
$2,995.27
|
| Rate for Payer: BCN Medicare Advantage |
$963.11
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$963.11
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,889.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,011.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,107.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,274.57
|
| Rate for Payer: Nomi Health Commercial |
$3,159.00
|
| Rate for Payer: PACE Senior Care Partners |
$914.95
|
| Rate for Payer: PACE SWMI |
$963.11
|
| Rate for Payer: PHP Commercial |
$3,274.57
|
| Rate for Payer: PHP Medicare Advantage |
$963.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health HMO/PPO |
$3,351.62
|
| Rate for Payer: Priority Health Medicare |
$972.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,581.13
|
| Rate for Payer: Railroad Medicare Medicare |
$963.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,390.15
|
| Rate for Payer: UHC Core |
$3,216.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$963.11
|
| Rate for Payer: UHC Exchange |
$963.11
|
| Rate for Payer: UHC Medicare Advantage |
$963.11
|
| Rate for Payer: VA VA |
$963.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,889.33
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,504.09 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,144.75
|
| Rate for Payer: BCN Commercial |
$2,977.17
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,889.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,274.57
|
| Rate for Payer: Nomi Health Commercial |
$3,159.00
|
| Rate for Payer: PHP Commercial |
$3,274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health HMO/PPO |
$3,351.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,581.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,390.15
|
| Rate for Payer: UHC Core |
$3,216.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,889.33
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,413.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$211.74 |
| Max. Negotiated Rate |
$918.45 |
| Rate for Payer: Aetna Commercial |
$283.73
|
| Rate for Payer: Aetna Medicare |
$220.21
|
| Rate for Payer: BCBS Complete |
$565.20
|
| Rate for Payer: BCBS MAPPO |
$211.74
|
| Rate for Payer: BCN Medicare Advantage |
$211.74
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cofinity Commercial |
$304.91
|
| Rate for Payer: Cofinity Commercial |
$283.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.33
|
| Rate for Payer: Nomi Health Commercial |
$254.09
|
| Rate for Payer: PACE SWMI |
$211.74
|
| Rate for Payer: PHP Medicare Advantage |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.45
|
| Rate for Payer: Priority Health Medicare |
$213.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.74
|
| Rate for Payer: UHC Exchange |
$211.74
|
| Rate for Payer: UHC Medicare Advantage |
$211.74
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,171.30 |
| Max. Negotiated Rate |
$1,621.80 |
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,470.97
|
| Rate for Payer: BCN Commercial |
$1,392.59
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,549.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,351.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: Nomi Health Commercial |
$1,477.64
|
| Rate for Payer: PHP Commercial |
$1,531.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,567.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,207.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,585.76
|
| Rate for Payer: UHC Core |
$1,504.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,351.50
|
|
