|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 60687048411
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna American Axle |
$1.81
|
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.81
|
| Rate for Payer: UHC Core |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$131.13
|
|
|
Service Code
|
NDC 72205001290
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$118.02 |
| Rate for Payer: Aetna American Axle |
$85.23
|
| Rate for Payer: Aetna Commercial |
$111.46
|
| Rate for Payer: Aetna Medicare |
$65.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.23
|
| Rate for Payer: BCBS Complete |
$52.45
|
| Rate for Payer: Cash Price |
$104.90
|
| Rate for Payer: Cofinity Advantage |
$91.79
|
| Rate for Payer: Cofinity Commercial |
$112.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.90
|
| Rate for Payer: Healthscope Commercial |
$118.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.35
|
| Rate for Payer: PHP Commercial |
$111.46
|
| Rate for Payer: Priority Health SBD |
$82.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.23
|
| Rate for Payer: UHC Core |
$68.32
|
| Rate for Payer: UHC Exchange |
$51.53
|
| Rate for Payer: UMR Bronson Commercial |
$48.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.35
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$131.13
|
|
|
Service Code
|
NDC 72205001290
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$118.02 |
| Rate for Payer: Aetna American Axle |
$85.23
|
| Rate for Payer: Aetna Commercial |
$111.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.23
|
| Rate for Payer: Cash Price |
$104.90
|
| Rate for Payer: Cofinity Advantage |
$91.79
|
| Rate for Payer: Cofinity Commercial |
$112.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.90
|
| Rate for Payer: Healthscope Commercial |
$118.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.35
|
| Rate for Payer: PHP Commercial |
$111.46
|
| Rate for Payer: Priority Health SBD |
$82.61
|
| Rate for Payer: UMR Bronson Commercial |
$57.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.35
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
IP
|
$143.82
|
|
|
Service Code
|
NDC 69097067805
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Advantage |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UMR Bronson Commercial |
$63.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
PREGABALIN 50 MG CAPSULE
|
Facility
|
OP
|
$3,258.59
|
|
|
Service Code
|
NDC 00071101341
|
| Hospital Charge Code |
42163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,205.68 |
| Max. Negotiated Rate |
$2,932.73 |
| Rate for Payer: Aetna American Axle |
$2,118.08
|
| Rate for Payer: Aetna Commercial |
$2,769.80
|
| Rate for Payer: Aetna Medicare |
$1,629.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.08
|
| Rate for Payer: BCBS Complete |
$1,303.44
|
| Rate for Payer: Cash Price |
$2,606.87
|
| Rate for Payer: Cofinity Advantage |
$2,281.01
|
| Rate for Payer: Cofinity Commercial |
$2,802.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,606.87
|
| Rate for Payer: Healthscope Commercial |
$2,932.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,281.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,443.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,606.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,769.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,443.94
|
| Rate for Payer: PHP Commercial |
$2,769.80
|
| Rate for Payer: Priority Health SBD |
$2,052.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,118.08
|
| Rate for Payer: UHC Core |
$1,697.73
|
| Rate for Payer: UHC Exchange |
$1,280.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,205.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,443.94
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna American Axle |
$163.80
|
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Advantage |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.80
|
| Rate for Payer: UHC Core |
$131.29
|
| Rate for Payer: UHC Exchange |
$99.04
|
| Rate for Payer: UMR Bronson Commercial |
$93.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 64980041209
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna Medicare |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: BCBS Complete |
$71.91
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.86
|
| Rate for Payer: UHC Core |
$93.67
|
| Rate for Payer: UHC Exchange |
$70.65
|
| Rate for Payer: UMR Bronson Commercial |
$66.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$152.28
|
|
|
Service Code
|
NDC 69238131209
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$137.05 |
| Rate for Payer: Aetna American Axle |
$98.98
|
| Rate for Payer: Aetna Commercial |
$129.44
|
| Rate for Payer: Aetna Medicare |
$76.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.98
|
| Rate for Payer: BCBS Complete |
$60.91
|
| Rate for Payer: Cash Price |
$121.82
|
| Rate for Payer: Cofinity Advantage |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$130.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.82
|
| Rate for Payer: Healthscope Commercial |
$137.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.21
|
| Rate for Payer: PHP Commercial |
$129.44
|
| Rate for Payer: Priority Health SBD |
$95.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.98
|
| Rate for Payer: UHC Core |
$79.34
|
| Rate for Payer: UHC Exchange |
$59.85
|
| Rate for Payer: UMR Bronson Commercial |
$56.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.21
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna American Axle |
$163.80
|
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.80
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Advantage |
$176.40
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UMR Bronson Commercial |
$110.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,830.24
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,685.31 |
| Max. Negotiated Rate |
$3,447.22 |
| Rate for Payer: Aetna American Axle |
$2,489.66
|
| Rate for Payer: Aetna Commercial |
$3,255.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,489.66
|
| Rate for Payer: Cash Price |
$3,064.19
|
| Rate for Payer: Cofinity Advantage |
$2,681.17
|
| Rate for Payer: Cofinity Commercial |
$3,294.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,064.19
|
| Rate for Payer: Healthscope Commercial |
$3,447.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,681.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,872.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,255.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,872.68
|
| Rate for Payer: PHP Commercial |
$3,255.70
|
| Rate for Payer: Priority Health SBD |
$2,413.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,685.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,872.68
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 67877046490
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$152.28
|
|
|
Service Code
|
NDC 69238131209
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$137.05 |
| Rate for Payer: Aetna American Axle |
$98.98
|
| Rate for Payer: Aetna Commercial |
$129.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.98
|
| Rate for Payer: Cash Price |
$121.82
|
| Rate for Payer: Cofinity Advantage |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$130.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.82
|
| Rate for Payer: Healthscope Commercial |
$137.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.21
|
| Rate for Payer: PHP Commercial |
$129.44
|
| Rate for Payer: Priority Health SBD |
$95.94
|
| Rate for Payer: UMR Bronson Commercial |
$67.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.21
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$3,830.24
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,417.19 |
| Max. Negotiated Rate |
$3,447.22 |
| Rate for Payer: Aetna American Axle |
$2,489.66
|
| Rate for Payer: Aetna Commercial |
$3,255.70
|
| Rate for Payer: Aetna Medicare |
$1,915.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,489.66
|
| Rate for Payer: BCBS Complete |
$1,532.10
|
| Rate for Payer: Cash Price |
$3,064.19
|
| Rate for Payer: Cofinity Advantage |
$2,681.17
|
| Rate for Payer: Cofinity Commercial |
$3,294.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,064.19
|
| Rate for Payer: Healthscope Commercial |
$3,447.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,681.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,872.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,064.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,255.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,872.68
|
| Rate for Payer: PHP Commercial |
$3,255.70
|
| Rate for Payer: Priority Health SBD |
$2,413.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,489.66
|
| Rate for Payer: UHC Core |
$1,995.56
|
| Rate for Payer: UHC Exchange |
$1,505.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,417.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,872.68
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 64980041209
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 67877046490
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna Medicare |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: BCBS Complete |
$71.91
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.86
|
| Rate for Payer: UHC Core |
$93.67
|
| Rate for Payer: UHC Exchange |
$70.65
|
| Rate for Payer: UMR Bronson Commercial |
$66.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,455.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Aetna Commercial |
$261.39
|
| Rate for Payer: Aetna Medicare |
$202.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.90
|
| Rate for Payer: BCBS Complete |
$132.41
|
| Rate for Payer: BCBS MAPPO |
$195.07
|
| Rate for Payer: BCN Commercial |
$331.16
|
| Rate for Payer: BCN Medicare Advantage |
$195.07
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cofinity Commercial |
$261.39
|
| Rate for Payer: Cofinity Commercial |
$280.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.82
|
| Rate for Payer: Meridian Medicaid |
$132.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.58
|
| Rate for Payer: Nomi Health Commercial |
$234.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,091.25
|
| Rate for Payer: PACE SWMI |
$195.07
|
| Rate for Payer: PHP Commercial |
$273.10
|
| Rate for Payer: PHP Medicare Advantage |
$195.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$403.49
|
| Rate for Payer: Priority Health Medicare |
$195.07
|
| Rate for Payer: Priority Health SBD |
$403.49
|
| Rate for Payer: Priority Health Tiered Network |
$403.49
|
| Rate for Payer: Railroad Medicare Medicare |
$195.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.06
|
| Rate for Payer: UHC Core |
$396.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$195.07
|
| Rate for Payer: UHC Exchange |
$396.06
|
| Rate for Payer: UHC Medicaid |
$126.10
|
| Rate for Payer: UHCCP Medicaid |
$126.10
|
| Rate for Payer: UMR Bronson Commercial |
$669.30
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$816.64 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Aetna American Axle |
$1,206.40
|
| Rate for Payer: Aetna Commercial |
$1,577.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.40
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Advantage |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,596.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Healthscope Commercial |
$1,670.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,299.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,392.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PHP Commercial |
$1,577.60
|
| Rate for Payer: Priority Health SBD |
$1,169.28
|
| Rate for Payer: UMR Bronson Commercial |
$816.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,392.00
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$179.75
|
| Rate for Payer: Aetna Medicare |
$139.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.16
|
| Rate for Payer: BCBS Complete |
$91.25
|
| Rate for Payer: BCBS MAPPO |
$134.14
|
| Rate for Payer: BCN Commercial |
$226.58
|
| Rate for Payer: BCN Medicare Advantage |
$134.14
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$179.75
|
| Rate for Payer: Cofinity Commercial |
$193.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.85
|
| Rate for Payer: Meridian Medicaid |
$91.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.55
|
| Rate for Payer: Nomi Health Commercial |
$160.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$134.14
|
| Rate for Payer: PHP Commercial |
$187.80
|
| Rate for Payer: PHP Medicare Advantage |
$134.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$276.08
|
| Rate for Payer: Priority Health Medicare |
$134.14
|
| Rate for Payer: Priority Health SBD |
$276.08
|
| Rate for Payer: Priority Health Tiered Network |
$276.08
|
| Rate for Payer: Railroad Medicare Medicare |
$134.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.86
|
| Rate for Payer: UHC Core |
$269.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.14
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$86.90
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
| Rate for Payer: UMR Bronson Commercial |
$853.76
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$179.75
|
| Rate for Payer: Aetna Medicare |
$139.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.16
|
| Rate for Payer: BCBS Complete |
$91.25
|
| Rate for Payer: BCBS MAPPO |
$134.14
|
| Rate for Payer: BCN Commercial |
$226.58
|
| Rate for Payer: BCN Medicare Advantage |
$134.14
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$179.75
|
| Rate for Payer: Cofinity Commercial |
$193.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.85
|
| Rate for Payer: Meridian Medicaid |
$91.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.55
|
| Rate for Payer: Nomi Health Commercial |
$160.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$134.14
|
| Rate for Payer: PHP Commercial |
$187.80
|
| Rate for Payer: PHP Medicare Advantage |
$134.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$276.08
|
| Rate for Payer: Priority Health Medicare |
$134.14
|
| Rate for Payer: Priority Health SBD |
$276.08
|
| Rate for Payer: Priority Health Tiered Network |
$276.08
|
| Rate for Payer: Railroad Medicare Medicare |
$134.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.86
|
| Rate for Payer: UHC Core |
$269.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.14
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$86.90
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
| Rate for Payer: UMR Bronson Commercial |
$853.76
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$686.72 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna American Axle |
$1,206.40
|
| Rate for Payer: Aetna Commercial |
$1,577.60
|
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.14
|
| Rate for Payer: BCN Commercial |
$1,335.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Advantage |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$1,596.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Healthscope Commercial |
$1,670.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,299.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,392.00
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Commercial |
$1,577.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health SBD |
$1,169.28
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: UMR Bronson Commercial |
$686.72
|
| Rate for Payer: VA VA |
$1,912.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,392.00
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$878.25 |
| Rate for Payer: Aetna Commercial |
$284.82
|
| Rate for Payer: Aetna Medicare |
$221.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$212.55
|
| Rate for Payer: BCN Commercial |
$360.04
|
| Rate for Payer: BCN Medicare Advantage |
$212.55
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cofinity Commercial |
$284.82
|
| Rate for Payer: Cofinity Commercial |
$306.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.18
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.81
|
| Rate for Payer: Nomi Health Commercial |
$255.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.25
|
| Rate for Payer: PACE SWMI |
$212.55
|
| Rate for Payer: PHP Commercial |
$297.57
|
| Rate for Payer: PHP Medicare Advantage |
$212.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$438.69
|
| Rate for Payer: Priority Health Medicare |
$212.55
|
| Rate for Payer: Priority Health SBD |
$438.69
|
| Rate for Payer: Priority Health Tiered Network |
$438.69
|
| Rate for Payer: Railroad Medicare Medicare |
$212.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.77
|
| Rate for Payer: UHC Core |
$432.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.55
|
| Rate for Payer: UHC Exchange |
$432.77
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
| Rate for Payer: UMR Bronson Commercial |
$538.66
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$270.20
|
| Rate for Payer: Aetna Medicare |
$209.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.36
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$201.64
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: BCN Medicare Advantage |
$201.64
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$270.20
|
| Rate for Payer: Cofinity Commercial |
$290.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.72
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.80
|
| Rate for Payer: Nomi Health Commercial |
$241.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$453.75
|
| Rate for Payer: PACE SWMI |
$201.64
|
| Rate for Payer: PHP Commercial |
$282.30
|
| Rate for Payer: PHP Medicare Advantage |
$201.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$416.84
|
| Rate for Payer: Priority Health Medicare |
$201.64
|
| Rate for Payer: Priority Health SBD |
$416.84
|
| Rate for Payer: Priority Health Tiered Network |
$416.84
|
| Rate for Payer: Railroad Medicare Medicare |
$201.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.22
|
| Rate for Payer: UHC Core |
$412.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.64
|
| Rate for Payer: UHC Exchange |
$412.22
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
| Rate for Payer: UMR Bronson Commercial |
$278.30
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$782.25 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Medicare |
$161.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.30
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS MAPPO |
$155.07
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Medicare Advantage |
$155.07
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Cofinity Commercial |
$207.79
|
| Rate for Payer: Cofinity Commercial |
$223.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.82
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.58
|
| Rate for Payer: Nomi Health Commercial |
$186.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.25
|
| Rate for Payer: PACE SWMI |
$155.07
|
| Rate for Payer: PHP Commercial |
$217.10
|
| Rate for Payer: PHP Medicare Advantage |
$155.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$317.95
|
| Rate for Payer: Priority Health Medicare |
$155.07
|
| Rate for Payer: Priority Health SBD |
$317.95
|
| Rate for Payer: Priority Health Tiered Network |
$317.95
|
| Rate for Payer: Railroad Medicare Medicare |
$155.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.49
|
| Rate for Payer: UHC Core |
$310.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.07
|
| Rate for Payer: UHC Exchange |
$310.49
|
| Rate for Payer: UHC Medicaid |
$100.11
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
| Rate for Payer: UMR Bronson Commercial |
$479.78
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$122.69 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna Commercial |
$254.88
|
| Rate for Payer: Aetna Medicare |
$197.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.90
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCN Commercial |
$320.70
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cofinity Commercial |
$254.88
|
| Rate for Payer: Cofinity Commercial |
$273.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$128.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$209.23
|
| Rate for Payer: Nomi Health Commercial |
$228.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.00
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Commercial |
$266.29
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$390.75
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health SBD |
$390.75
|
| Rate for Payer: Priority Health Tiered Network |
$390.75
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.87
|
| Rate for Payer: UHC Core |
$384.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$190.21
|
| Rate for Payer: UHC Exchange |
$384.87
|
| Rate for Payer: UHC Medicaid |
$122.69
|
| Rate for Payer: UHCCP Medicaid |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$327.52
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Aetna Commercial |
$271.12
|
| Rate for Payer: Aetna Medicare |
$210.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.36
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$202.33
|
| Rate for Payer: BCN Commercial |
$338.13
|
| Rate for Payer: BCN Medicare Advantage |
$202.33
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cofinity Commercial |
$271.12
|
| Rate for Payer: Cofinity Commercial |
$291.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.45
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$222.56
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$802.50
|
| Rate for Payer: PACE SWMI |
$202.33
|
| Rate for Payer: PHP Commercial |
$283.26
|
| Rate for Payer: PHP Medicare Advantage |
$202.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$411.98
|
| Rate for Payer: Priority Health Medicare |
$202.33
|
| Rate for Payer: Priority Health SBD |
$411.98
|
| Rate for Payer: Priority Health Tiered Network |
$411.98
|
| Rate for Payer: Railroad Medicare Medicare |
$202.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.11
|
| Rate for Payer: UHC Core |
$405.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$202.33
|
| Rate for Payer: UHC Exchange |
$405.11
|
| Rate for Payer: UHC Medicaid |
$130.14
|
| Rate for Payer: UHCCP Medicaid |
$130.14
|
| Rate for Payer: UMR Bronson Commercial |
$492.20
|
|
