|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$427.98 |
| Max. Negotiated Rate |
$1,621.80 |
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna Medicare |
$468.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$563.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$563.12
|
| Rate for Payer: BCBS Complete |
$1,440.19
|
| Rate for Payer: BCBS MAPPO |
$450.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.42
|
| Rate for Payer: BCN Commercial |
$1,401.06
|
| Rate for Payer: BCN Medicare Advantage |
$450.50
|
| Rate for Payer: Cash Price |
$1,441.60
|
| 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: Health Alliance Plan Medicare Advantage |
$450.50
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,351.50
|
| Rate for Payer: Mclaren Medicaid |
$1,371.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$473.02
|
| Rate for Payer: Meridian Medicaid |
$1,440.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$518.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: Nomi Health Commercial |
$1,477.64
|
| Rate for Payer: PACE Senior Care Partners |
$427.98
|
| Rate for Payer: PACE SWMI |
$450.50
|
| Rate for Payer: PHP Commercial |
$1,531.70
|
| Rate for Payer: PHP Medicare Advantage |
$450.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,371.52
|
| 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 Medicare |
$455.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,207.34
|
| Rate for Payer: Railroad Medicare Medicare |
$450.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,585.76
|
| Rate for Payer: UHC Core |
$1,504.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.50
|
| Rate for Payer: UHC Exchange |
$450.50
|
| Rate for Payer: UHC Medicare Advantage |
$450.50
|
| Rate for Payer: UHCCP Medicaid |
$1,371.52
|
| Rate for Payer: VA VA |
$450.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,351.50
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Medicare |
$150.44
|
| Rate for Payer: BCBS Complete |
$720.80
|
| Rate for Payer: BCBS MAPPO |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$144.65
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$208.30
|
| Rate for Payer: Cofinity Commercial |
$193.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.88
|
| Rate for Payer: Nomi Health Commercial |
$173.58
|
| Rate for Payer: PACE SWMI |
$144.65
|
| Rate for Payer: PHP Medicare Advantage |
$144.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$146.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.65
|
| Rate for Payer: UHC Exchange |
$144.65
|
| Rate for Payer: UHC Medicare Advantage |
$144.65
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Medicare |
$150.44
|
| Rate for Payer: BCBS Complete |
$720.80
|
| Rate for Payer: BCBS MAPPO |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$144.65
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$208.30
|
| Rate for Payer: Cofinity Commercial |
$193.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.88
|
| Rate for Payer: Nomi Health Commercial |
$173.58
|
| Rate for Payer: PACE SWMI |
$144.65
|
| Rate for Payer: PHP Medicare Advantage |
$144.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$146.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.65
|
| Rate for Payer: UHC Exchange |
$144.65
|
| Rate for Payer: UHC Medicare Advantage |
$144.65
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$230.04 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$308.25
|
| Rate for Payer: Aetna Medicare |
$239.24
|
| Rate for Payer: BCBS Complete |
$454.80
|
| Rate for Payer: BCBS MAPPO |
$230.04
|
| Rate for Payer: BCN Medicare Advantage |
$230.04
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$308.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.54
|
| Rate for Payer: Nomi Health Commercial |
$276.05
|
| Rate for Payer: PACE SWMI |
$230.04
|
| Rate for Payer: PHP Medicare Advantage |
$230.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health Medicare |
$232.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.04
|
| Rate for Payer: UHC Exchange |
$230.04
|
| Rate for Payer: UHC Medicare Advantage |
$230.04
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$587.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$218.63 |
| Max. Negotiated Rate |
$381.55 |
| Rate for Payer: Aetna Commercial |
$292.96
|
| Rate for Payer: Aetna Medicare |
$227.38
|
| Rate for Payer: BCBS Complete |
$234.80
|
| Rate for Payer: BCBS MAPPO |
$218.63
|
| Rate for Payer: BCN Medicare Advantage |
$218.63
|
| Rate for Payer: Cash Price |
$469.60
|
| Rate for Payer: Cash Price |
$469.60
|
| Rate for Payer: Cofinity Commercial |
$314.83
|
| Rate for Payer: Cofinity Commercial |
$292.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.56
|
| Rate for Payer: Nomi Health Commercial |
$262.36
|
| Rate for Payer: PACE SWMI |
$218.63
|
| Rate for Payer: PHP Medicare Advantage |
$218.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.55
|
| Rate for Payer: Priority Health Medicare |
$220.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.63
|
| Rate for Payer: UHC Exchange |
$218.63
|
| Rate for Payer: UHC Medicare Advantage |
$218.63
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$167.26 |
| Max. Negotiated Rate |
$658.45 |
| Rate for Payer: Aetna Commercial |
$224.13
|
| Rate for Payer: Aetna Medicare |
$173.95
|
| Rate for Payer: BCBS Complete |
$405.20
|
| Rate for Payer: BCBS MAPPO |
$167.26
|
| Rate for Payer: BCN Medicare Advantage |
$167.26
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cofinity Commercial |
$240.85
|
| Rate for Payer: Cofinity Commercial |
$224.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.62
|
| Rate for Payer: Nomi Health Commercial |
$200.71
|
| Rate for Payer: PACE SWMI |
$167.26
|
| Rate for Payer: PHP Medicare Advantage |
$167.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.45
|
| Rate for Payer: Priority Health Medicare |
$168.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.26
|
| Rate for Payer: UHC Exchange |
$167.26
|
| Rate for Payer: UHC Medicare Advantage |
$167.26
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$205.46 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna Commercial |
$275.32
|
| Rate for Payer: Aetna Medicare |
$213.68
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$205.46
|
| Rate for Payer: BCN Medicare Advantage |
$205.46
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$295.86
|
| Rate for Payer: Cofinity Commercial |
$275.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$246.55
|
| Rate for Payer: PACE SWMI |
$205.46
|
| Rate for Payer: PHP Medicare Advantage |
$205.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$207.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.46
|
| Rate for Payer: UHC Exchange |
$205.46
|
| Rate for Payer: UHC Medicare Advantage |
$205.46
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$217.23 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$291.09
|
| Rate for Payer: Aetna Medicare |
$225.92
|
| Rate for Payer: BCBS Complete |
$415.60
|
| Rate for Payer: BCBS MAPPO |
$217.23
|
| Rate for Payer: BCN Medicare Advantage |
$217.23
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Cofinity Commercial |
$312.81
|
| Rate for Payer: Cofinity Commercial |
$291.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$228.09
|
| Rate for Payer: Nomi Health Commercial |
$260.68
|
| Rate for Payer: PACE SWMI |
$217.23
|
| Rate for Payer: PHP Medicare Advantage |
$217.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.35
|
| Rate for Payer: Priority Health Medicare |
$219.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.23
|
| Rate for Payer: UHC Exchange |
$217.23
|
| Rate for Payer: UHC Medicare Advantage |
$217.23
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$234.18 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Aetna Commercial |
$838.10
|
| Rate for Payer: Aetna Medicare |
$256.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$308.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$308.12
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$246.50
|
| Rate for Payer: BCBS Trust/PPO |
$810.59
|
| Rate for Payer: BCN Commercial |
$766.62
|
| Rate for Payer: BCN Medicare Advantage |
$246.50
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$847.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.50
|
| Rate for Payer: Healthscope Commercial |
$887.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.50
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.82
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: Nomi Health Commercial |
$808.52
|
| Rate for Payer: PACE Senior Care Partners |
$234.18
|
| Rate for Payer: PACE SWMI |
$246.50
|
| Rate for Payer: PHP Commercial |
$838.10
|
| Rate for Payer: PHP Medicare Advantage |
$246.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO |
$857.82
|
| Rate for Payer: Priority Health Medicare |
$248.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$660.62
|
| Rate for Payer: Railroad Medicare Medicare |
$246.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.68
|
| Rate for Payer: UHC Core |
$823.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.50
|
| Rate for Payer: UHC Exchange |
$246.50
|
| Rate for Payer: UHC Medicare Advantage |
$246.50
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$246.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.50
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Aetna Commercial |
$838.10
|
| Rate for Payer: BCBS Trust/PPO |
$804.87
|
| Rate for Payer: BCN Commercial |
$761.98
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$847.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Healthscope Commercial |
$887.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: Nomi Health Commercial |
$808.52
|
| Rate for Payer: PHP Commercial |
$838.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO |
$857.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$660.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.68
|
| Rate for Payer: UHC Core |
$823.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.50
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 43247
|
| Min. Negotiated Rate |
$166.46 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$223.06
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: BCBS Complete |
$394.40
|
| Rate for Payer: BCBS MAPPO |
$166.46
|
| Rate for Payer: BCN Medicare Advantage |
$166.46
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Cofinity Commercial |
$223.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.78
|
| Rate for Payer: Nomi Health Commercial |
$199.75
|
| Rate for Payer: PACE SWMI |
$166.46
|
| Rate for Payer: PHP Medicare Advantage |
$166.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health Medicare |
$168.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.46
|
| Rate for Payer: UHC Exchange |
$166.46
|
| Rate for Payer: UHC Medicare Advantage |
$166.46
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$166.46 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$223.06
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: BCBS Complete |
$394.40
|
| Rate for Payer: BCBS MAPPO |
$166.46
|
| Rate for Payer: BCN Medicare Advantage |
$166.46
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Cofinity Commercial |
$223.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.78
|
| Rate for Payer: Nomi Health Commercial |
$199.75
|
| Rate for Payer: PACE SWMI |
$166.46
|
| Rate for Payer: PHP Medicare Advantage |
$166.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health Medicare |
$168.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.46
|
| Rate for Payer: UHC Exchange |
$166.46
|
| Rate for Payer: UHC Medicare Advantage |
$166.46
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
43250
|
| Min. Negotiated Rate |
$161.39 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$216.26
|
| Rate for Payer: Aetna Medicare |
$167.85
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$161.39
|
| Rate for Payer: BCN Medicare Advantage |
$161.39
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$232.40
|
| Rate for Payer: Cofinity Commercial |
$216.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.46
|
| Rate for Payer: Nomi Health Commercial |
$193.67
|
| Rate for Payer: PACE SWMI |
$161.39
|
| Rate for Payer: PHP Medicare Advantage |
$161.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$163.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.39
|
| Rate for Payer: UHC Exchange |
$161.39
|
| Rate for Payer: UHC Medicare Advantage |
$161.39
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$938.40
|
| Rate for Payer: Aetna Medicare |
$287.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$345.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$345.00
|
| Rate for Payer: BCBS Complete |
$1,440.19
|
| Rate for Payer: BCBS MAPPO |
$276.00
|
| Rate for Payer: BCBS Trust/PPO |
$907.60
|
| Rate for Payer: BCN Commercial |
$858.36
|
| Rate for Payer: BCN Medicare Advantage |
$276.00
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$949.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.00
|
| Rate for Payer: Healthscope Commercial |
$993.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.00
|
| Rate for Payer: Mclaren Medicaid |
$1,371.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.80
|
| Rate for Payer: Meridian Medicaid |
$1,440.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.40
|
| Rate for Payer: Nomi Health Commercial |
$905.28
|
| Rate for Payer: PACE Senior Care Partners |
$262.20
|
| Rate for Payer: PACE SWMI |
$276.00
|
| Rate for Payer: PHP Commercial |
$938.40
|
| Rate for Payer: PHP Medicare Advantage |
$276.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,371.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO |
$960.48
|
| Rate for Payer: Priority Health Medicare |
$278.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.68
|
| Rate for Payer: Railroad Medicare Medicare |
$276.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.52
|
| Rate for Payer: UHC Core |
$921.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.00
|
| Rate for Payer: UHC Exchange |
$276.00
|
| Rate for Payer: UHC Medicare Advantage |
$276.00
|
| Rate for Payer: UHCCP Medicaid |
$1,371.52
|
| Rate for Payer: VA VA |
$276.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.00
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43250
|
| Min. Negotiated Rate |
$161.39 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$216.26
|
| Rate for Payer: Aetna Medicare |
$167.85
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$161.39
|
| Rate for Payer: BCN Medicare Advantage |
$161.39
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$232.40
|
| Rate for Payer: Cofinity Commercial |
$216.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.46
|
| Rate for Payer: Nomi Health Commercial |
$193.67
|
| Rate for Payer: PACE SWMI |
$161.39
|
| Rate for Payer: PHP Medicare Advantage |
$161.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$163.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.39
|
| Rate for Payer: UHC Exchange |
$161.39
|
| Rate for Payer: UHC Medicare Advantage |
$161.39
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$717.60 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna Commercial |
$938.40
|
| Rate for Payer: BCBS Trust/PPO |
$901.20
|
| Rate for Payer: BCN Commercial |
$853.17
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$949.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.20
|
| Rate for Payer: Healthscope Commercial |
$993.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.40
|
| Rate for Payer: Nomi Health Commercial |
$905.28
|
| Rate for Payer: PHP Commercial |
$938.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO |
$960.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.52
|
| Rate for Payer: UHC Core |
$921.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.00
|
|
|
PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 43243
|
| Min. Negotiated Rate |
$224.75 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$301.17
|
| Rate for Payer: Aetna Medicare |
$233.74
|
| Rate for Payer: BCBS Complete |
$481.60
|
| Rate for Payer: BCBS MAPPO |
$224.75
|
| Rate for Payer: BCN Medicare Advantage |
$224.75
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cofinity Commercial |
$323.64
|
| Rate for Payer: Cofinity Commercial |
$301.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.99
|
| Rate for Payer: Nomi Health Commercial |
$269.70
|
| Rate for Payer: PACE SWMI |
$224.75
|
| Rate for Payer: PHP Medicare Advantage |
$224.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health Medicare |
$227.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.75
|
| Rate for Payer: UHC Exchange |
$224.75
|
| Rate for Payer: UHC Medicare Advantage |
$224.75
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
43248
|
| Min. Negotiated Rate |
$156.41 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: Aetna Commercial |
$209.59
|
| Rate for Payer: Aetna Medicare |
$162.67
|
| Rate for Payer: BCBS Complete |
$353.60
|
| Rate for Payer: BCBS MAPPO |
$156.41
|
| Rate for Payer: BCN Medicare Advantage |
$156.41
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$225.23
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.23
|
| Rate for Payer: Nomi Health Commercial |
$187.69
|
| Rate for Payer: PACE SWMI |
$156.41
|
| Rate for Payer: PHP Medicare Advantage |
$156.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health Medicare |
$157.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.41
|
| Rate for Payer: UHC Exchange |
$156.41
|
| Rate for Payer: UHC Medicare Advantage |
$156.41
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Commercial |
$751.40
|
| Rate for Payer: Aetna Medicare |
$229.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.25
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$221.00
|
| Rate for Payer: BCBS Trust/PPO |
$726.74
|
| Rate for Payer: BCN Commercial |
$687.31
|
| Rate for Payer: BCN Medicare Advantage |
$221.00
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$760.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.00
|
| Rate for Payer: Healthscope Commercial |
$795.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$663.00
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.05
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.40
|
| Rate for Payer: Nomi Health Commercial |
$724.88
|
| Rate for Payer: PACE Senior Care Partners |
$209.95
|
| Rate for Payer: PACE SWMI |
$221.00
|
| Rate for Payer: PHP Commercial |
$751.40
|
| Rate for Payer: PHP Medicare Advantage |
$221.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO |
$769.08
|
| Rate for Payer: Priority Health Medicare |
$223.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.28
|
| Rate for Payer: Railroad Medicare Medicare |
$221.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$777.92
|
| Rate for Payer: UHC Core |
$738.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.00
|
| Rate for Payer: UHC Exchange |
$221.00
|
| Rate for Payer: UHC Medicare Advantage |
$221.00
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$221.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$663.00
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Commercial |
$751.40
|
| Rate for Payer: BCBS Trust/PPO |
$721.61
|
| Rate for Payer: BCN Commercial |
$683.16
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$760.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.20
|
| Rate for Payer: Healthscope Commercial |
$795.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$663.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.40
|
| Rate for Payer: Nomi Health Commercial |
$724.88
|
| Rate for Payer: PHP Commercial |
$751.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO |
$769.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$777.92
|
| Rate for Payer: UHC Core |
$738.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$663.00
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 43248
|
| Min. Negotiated Rate |
$156.41 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: Aetna Commercial |
$209.59
|
| Rate for Payer: Aetna Medicare |
$162.67
|
| Rate for Payer: BCBS Complete |
$353.60
|
| Rate for Payer: BCBS MAPPO |
$156.41
|
| Rate for Payer: BCN Medicare Advantage |
$156.41
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$225.23
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.23
|
| Rate for Payer: Nomi Health Commercial |
$187.69
|
| Rate for Payer: PACE SWMI |
$156.41
|
| Rate for Payer: PHP Medicare Advantage |
$156.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health Medicare |
$157.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.41
|
| Rate for Payer: UHC Exchange |
$156.41
|
| Rate for Payer: UHC Medicare Advantage |
$156.41
|
|
|
PR EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 43241
|
| Min. Negotiated Rate |
$134.61 |
| Max. Negotiated Rate |
$567.45 |
| Rate for Payer: Aetna Commercial |
$180.38
|
| Rate for Payer: Aetna Medicare |
$139.99
|
| Rate for Payer: BCBS Complete |
$349.20
|
| Rate for Payer: BCBS MAPPO |
$134.61
|
| Rate for Payer: BCN Medicare Advantage |
$134.61
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$193.84
|
| Rate for Payer: Cofinity Commercial |
$180.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.34
|
| Rate for Payer: Nomi Health Commercial |
$161.53
|
| Rate for Payer: PACE SWMI |
$134.61
|
| Rate for Payer: PHP Medicare Advantage |
$134.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health Medicare |
$135.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.61
|
| Rate for Payer: UHC Exchange |
$134.61
|
| Rate for Payer: UHC Medicare Advantage |
$134.61
|
|
|
PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY
|
Professional
|
Both
|
$1,033.00
|
|
|
Service Code
|
HCPCS 43242
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$671.45 |
| Rate for Payer: Aetna Commercial |
$330.51
|
| Rate for Payer: Aetna Medicare |
$256.52
|
| Rate for Payer: BCBS Complete |
$413.20
|
| Rate for Payer: BCBS MAPPO |
$246.65
|
| Rate for Payer: BCN Medicare Advantage |
$246.65
|
| Rate for Payer: Cash Price |
$826.40
|
| Rate for Payer: Cash Price |
$826.40
|
| Rate for Payer: Cofinity Commercial |
$355.18
|
| Rate for Payer: Cofinity Commercial |
$330.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.98
|
| Rate for Payer: Nomi Health Commercial |
$295.98
|
| Rate for Payer: PACE SWMI |
$246.65
|
| Rate for Payer: PHP Medicare Advantage |
$246.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.45
|
| Rate for Payer: Priority Health Medicare |
$249.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.65
|
| Rate for Payer: UHC Exchange |
$246.65
|
| Rate for Payer: UHC Medicare Advantage |
$246.65
|
|
|
PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 43238
|
| Min. Negotiated Rate |
$218.95 |
| Max. Negotiated Rate |
$673.40 |
| Rate for Payer: Aetna Commercial |
$293.39
|
| Rate for Payer: Aetna Medicare |
$227.71
|
| Rate for Payer: BCBS Complete |
$414.40
|
| Rate for Payer: BCBS MAPPO |
$218.95
|
| Rate for Payer: BCN Medicare Advantage |
$218.95
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cofinity Commercial |
$315.29
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.90
|
| Rate for Payer: Nomi Health Commercial |
$262.74
|
| Rate for Payer: PACE SWMI |
$218.95
|
| Rate for Payer: PHP Medicare Advantage |
$218.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health Medicare |
$221.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.95
|
| Rate for Payer: UHC Exchange |
$218.95
|
| Rate for Payer: UHC Medicare Advantage |
$218.95
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
43246
|
| Min. Negotiated Rate |
$189.95 |
| Max. Negotiated Rate |
$939.90 |
| Rate for Payer: Aetna Commercial |
$254.53
|
| Rate for Payer: Aetna Medicare |
$197.55
|
| Rate for Payer: BCBS Complete |
$578.40
|
| Rate for Payer: BCBS MAPPO |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$189.95
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cofinity Commercial |
$273.53
|
| Rate for Payer: Cofinity Commercial |
$254.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$227.94
|
| Rate for Payer: PACE SWMI |
$189.95
|
| Rate for Payer: PHP Medicare Advantage |
$189.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.90
|
| Rate for Payer: Priority Health Medicare |
$191.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.95
|
| Rate for Payer: UHC Exchange |
$189.95
|
| Rate for Payer: UHC Medicare Advantage |
$189.95
|
|
