|
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 Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| 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
|
$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 Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
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 Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| 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
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,425.40 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna American Axle |
$2,504.09
|
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: Aetna Medicare |
$1,926.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,504.09
|
| Rate for Payer: BCBS Complete |
$1,540.98
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$2,696.71
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,696.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,696.71
|
| 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: PHP Commercial |
$3,274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health SBD |
$2,427.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,425.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,889.33
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.47 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna American Axle |
$256.26
|
| Rate for Payer: Aetna Commercial |
$335.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.26
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$275.98
|
| Rate for Payer: Cofinity Commercial |
$339.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: PHP Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health SBD |
$248.38
|
| Rate for Payer: UMR Bronson Commercial |
$173.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.69
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$3,852.44
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,695.07 |
| Max. Negotiated Rate |
$3,467.20 |
| Rate for Payer: Aetna American Axle |
$2,504.09
|
| Rate for Payer: Aetna Commercial |
$3,274.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,504.09
|
| Rate for Payer: Cash Price |
$3,081.95
|
| Rate for Payer: Cofinity Commercial |
$2,696.71
|
| Rate for Payer: Cofinity Commercial |
$3,313.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,696.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,081.95
|
| Rate for Payer: Healthscope Commercial |
$3,467.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,696.71
|
| 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: PHP Commercial |
$3,274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,504.09
|
| Rate for Payer: Priority Health SBD |
$2,427.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,695.07
|
| 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 |
$141.65 |
| Max. Negotiated Rate |
$1,076.07 |
| Rate for Payer: Aetna Commercial |
$283.73
|
| Rate for Payer: Aetna Medicare |
$220.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.91
|
| Rate for Payer: BCBS Complete |
$148.73
|
| Rate for Payer: BCBS MAPPO |
$211.74
|
| Rate for Payer: BCBS Trust/PPO |
$724.83
|
| Rate for Payer: BCN Commercial |
$1,076.07
|
| 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 |
$283.73
|
| Rate for Payer: Cofinity Commercial |
$304.91
|
| 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: Meridian Medicaid |
$148.73
|
| Rate for Payer: Nomi Health Commercial |
$254.09
|
| Rate for Payer: PACE SWMI |
$211.74
|
| Rate for Payer: PHP Commercial |
$296.44
|
| Rate for Payer: PHP Medicare Advantage |
$211.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.35
|
| Rate for Payer: Priority Health Medicare |
$211.74
|
| Rate for Payer: Priority Health Narrow Network |
$394.35
|
| Rate for Payer: Priority Health SBD |
$394.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.74
|
| Rate for Payer: UHC Medicare Advantage |
$211.74
|
| Rate for Payer: UHCCP Medicaid |
$141.65
|
| Rate for Payer: UMR Bronson Commercial |
$649.98
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Medicare |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.30
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$144.65
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| 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 |
$193.83
|
| Rate for Payer: Cofinity Commercial |
$208.30
|
| 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: Meridian Medicaid |
$101.77
|
| Rate for Payer: Nomi Health Commercial |
$173.58
|
| Rate for Payer: PACE SWMI |
$144.65
|
| Rate for Payer: PHP Commercial |
$202.51
|
| Rate for Payer: PHP Medicare Advantage |
$144.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.86
|
| Rate for Payer: Priority Health Medicare |
$144.65
|
| Rate for Payer: Priority Health Narrow Network |
$270.86
|
| Rate for Payer: Priority Health SBD |
$270.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.65
|
| Rate for Payer: UHC Medicare Advantage |
$144.65
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
| Rate for Payer: UMR Bronson Commercial |
$828.92
|
|
|
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 |
$792.88 |
| Max. Negotiated Rate |
$1,621.80 |
| Rate for Payer: Aetna American Axle |
$1,171.30
|
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.30
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,261.40
|
| Rate for Payer: Cofinity Commercial |
$1,549.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,261.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,261.40
|
| 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: PHP Commercial |
$1,531.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health SBD |
$1,135.26
|
| Rate for Payer: UMR Bronson Commercial |
$792.88
|
| 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
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$193.83
|
| Rate for Payer: Aetna Medicare |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.30
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$144.65
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| 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: Meridian Medicaid |
$101.77
|
| Rate for Payer: Nomi Health Commercial |
$173.58
|
| Rate for Payer: PACE SWMI |
$144.65
|
| Rate for Payer: PHP Commercial |
$202.51
|
| Rate for Payer: PHP Medicare Advantage |
$144.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.86
|
| Rate for Payer: Priority Health Medicare |
$144.65
|
| Rate for Payer: Priority Health Narrow Network |
$270.86
|
| Rate for Payer: Priority Health SBD |
$270.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.65
|
| Rate for Payer: UHC Medicare Advantage |
$144.65
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
| Rate for Payer: UMR Bronson Commercial |
$828.92
|
|
|
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 |
$146.13 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna American Axle |
$1,171.30
|
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,105.16
|
| Rate for Payer: BCN Commercial |
$1,105.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,261.40
|
| Rate for Payer: Cofinity Commercial |
$1,549.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,261.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Healthscope Commercial |
$1,621.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,261.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,351.50
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Commercial |
$1,531.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Priority Health SBD |
$1,135.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.74
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$146.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: UMR Bronson Commercial |
$666.74
|
| Rate for Payer: VA VA |
$1,858.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,351.50
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$308.25
|
| Rate for Payer: Aetna Medicare |
$239.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.26
|
| Rate for Payer: BCBS Complete |
$161.70
|
| Rate for Payer: BCBS MAPPO |
$230.04
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$350.87
|
| 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 |
$308.25
|
| Rate for Payer: Cofinity Commercial |
$331.26
|
| 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: Meridian Medicaid |
$161.70
|
| Rate for Payer: Nomi Health Commercial |
$276.05
|
| Rate for Payer: PACE SWMI |
$230.04
|
| Rate for Payer: PHP Commercial |
$322.06
|
| Rate for Payer: PHP Medicare Advantage |
$230.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.75
|
| Rate for Payer: Priority Health Medicare |
$230.04
|
| Rate for Payer: Priority Health Narrow Network |
$430.75
|
| Rate for Payer: Priority Health SBD |
$430.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.04
|
| Rate for Payer: UHC Medicare Advantage |
$230.04
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: UMR Bronson Commercial |
$523.02
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$587.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$850.03 |
| Rate for Payer: Aetna Commercial |
$292.96
|
| Rate for Payer: Aetna Medicare |
$227.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.83
|
| Rate for Payer: BCBS Complete |
$153.65
|
| Rate for Payer: BCBS MAPPO |
$218.63
|
| Rate for Payer: BCBS Trust/PPO |
$850.03
|
| Rate for Payer: BCN Commercial |
$332.79
|
| 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 |
$292.96
|
| Rate for Payer: Cofinity Commercial |
$314.83
|
| 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: Meridian Medicaid |
$153.65
|
| Rate for Payer: Nomi Health Commercial |
$262.36
|
| Rate for Payer: PACE SWMI |
$218.63
|
| Rate for Payer: PHP Commercial |
$306.08
|
| Rate for Payer: PHP Medicare Advantage |
$218.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.25
|
| Rate for Payer: Priority Health Medicare |
$218.63
|
| Rate for Payer: Priority Health Narrow Network |
$412.25
|
| Rate for Payer: Priority Health SBD |
$412.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.63
|
| Rate for Payer: UHC Medicare Advantage |
$218.63
|
| Rate for Payer: UHCCP Medicaid |
$146.33
|
| Rate for Payer: UMR Bronson Commercial |
$270.02
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$876.69 |
| Rate for Payer: Aetna Commercial |
$224.13
|
| Rate for Payer: Aetna Medicare |
$173.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.85
|
| Rate for Payer: BCBS Complete |
$117.19
|
| Rate for Payer: BCBS MAPPO |
$167.26
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$876.69
|
| 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 |
$224.13
|
| Rate for Payer: Cofinity Commercial |
$240.85
|
| 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: Meridian Medicaid |
$117.19
|
| Rate for Payer: Nomi Health Commercial |
$200.71
|
| Rate for Payer: PACE SWMI |
$167.26
|
| Rate for Payer: PHP Commercial |
$234.16
|
| Rate for Payer: PHP Medicare Advantage |
$167.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.63
|
| Rate for Payer: Priority Health Medicare |
$167.26
|
| Rate for Payer: Priority Health Narrow Network |
$309.63
|
| Rate for Payer: Priority Health SBD |
$309.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.26
|
| Rate for Payer: UHC Medicare Advantage |
$167.26
|
| Rate for Payer: UHCCP Medicaid |
$111.61
|
| Rate for Payer: UMR Bronson Commercial |
$465.98
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$1,452.30 |
| Rate for Payer: Aetna Commercial |
$275.32
|
| Rate for Payer: Aetna Medicare |
$213.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.86
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$205.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.30
|
| Rate for Payer: BCN Commercial |
$311.78
|
| 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 |
$275.32
|
| Rate for Payer: Cofinity Commercial |
$295.86
|
| 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: Meridian Medicaid |
$144.03
|
| Rate for Payer: Nomi Health Commercial |
$246.55
|
| Rate for Payer: PACE SWMI |
$205.46
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Medicare Advantage |
$205.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.02
|
| Rate for Payer: Priority Health Medicare |
$205.46
|
| Rate for Payer: Priority Health Narrow Network |
$383.02
|
| Rate for Payer: Priority Health SBD |
$383.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.46
|
| Rate for Payer: UHC Medicare Advantage |
$205.46
|
| Rate for Payer: UHCCP Medicaid |
$137.17
|
| Rate for Payer: UMR Bronson Commercial |
$317.86
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$291.09
|
| Rate for Payer: Aetna Medicare |
$225.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.81
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS MAPPO |
$217.23
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$327.90
|
| 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 |
$291.09
|
| Rate for Payer: Cofinity Commercial |
$312.81
|
| 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: Meridian Medicaid |
$151.86
|
| Rate for Payer: Nomi Health Commercial |
$260.68
|
| Rate for Payer: PACE SWMI |
$217.23
|
| Rate for Payer: PHP Commercial |
$304.12
|
| Rate for Payer: PHP Medicare Advantage |
$217.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.90
|
| Rate for Payer: Priority Health Medicare |
$217.23
|
| Rate for Payer: Priority Health Narrow Network |
$403.90
|
| Rate for Payer: Priority Health SBD |
$403.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.23
|
| Rate for Payer: UHC Medicare Advantage |
$217.23
|
| Rate for Payer: UHCCP Medicaid |
$144.63
|
| Rate for Payer: UMR Bronson Commercial |
$477.94
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 43247
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$223.06
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.70
|
| Rate for Payer: BCBS Complete |
$116.97
|
| Rate for Payer: BCBS MAPPO |
$166.46
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$563.45
|
| 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 |
$223.06
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| 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: Meridian Medicaid |
$116.97
|
| Rate for Payer: Nomi Health Commercial |
$199.75
|
| Rate for Payer: PACE SWMI |
$166.46
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: PHP Medicare Advantage |
$166.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.42
|
| Rate for Payer: Priority Health Medicare |
$166.46
|
| Rate for Payer: Priority Health Narrow Network |
$311.42
|
| Rate for Payer: Priority Health SBD |
$311.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.46
|
| Rate for Payer: UHC Medicare Advantage |
$166.46
|
| Rate for Payer: UHCCP Medicaid |
$111.40
|
| Rate for Payer: UMR Bronson Commercial |
$453.56
|
|
|
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 |
$168.21 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna American Axle |
$640.90
|
| Rate for Payer: Aetna Commercial |
$838.10
|
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.25
|
| Rate for Payer: BCN Commercial |
$1,611.25
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$847.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$887.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$690.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.50
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$838.10
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Priority Health SBD |
$621.18
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.03
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$168.21
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: UMR Bronson Commercial |
$364.82
|
| Rate for Payer: VA VA |
$918.60
|
| 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
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$223.06
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.70
|
| Rate for Payer: BCBS Complete |
$116.97
|
| Rate for Payer: BCBS MAPPO |
$166.46
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$563.45
|
| 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: Meridian Medicaid |
$116.97
|
| Rate for Payer: Nomi Health Commercial |
$199.75
|
| Rate for Payer: PACE SWMI |
$166.46
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: PHP Medicare Advantage |
$166.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.42
|
| Rate for Payer: Priority Health Medicare |
$166.46
|
| Rate for Payer: Priority Health Narrow Network |
$311.42
|
| Rate for Payer: Priority Health SBD |
$311.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.46
|
| Rate for Payer: UHC Medicare Advantage |
$166.46
|
| Rate for Payer: UHCCP Medicaid |
$111.40
|
| Rate for Payer: UMR Bronson Commercial |
$453.56
|
|
|
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 |
$433.84 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Aetna American Axle |
$640.90
|
| Rate for Payer: Aetna Commercial |
$838.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.90
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$847.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$690.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Healthscope Commercial |
$887.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$690.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$739.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: PHP Commercial |
$838.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health SBD |
$621.18
|
| Rate for Payer: UMR Bronson Commercial |
$433.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$739.50
|
|
|
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 |
$107.78 |
| Max. Negotiated Rate |
$940.37 |
| Rate for Payer: Aetna Commercial |
$216.26
|
| Rate for Payer: Aetna Medicare |
$167.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.40
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS MAPPO |
$161.39
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: BCN Commercial |
$664.11
|
| 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: Meridian Medicaid |
$113.17
|
| Rate for Payer: Nomi Health Commercial |
$193.67
|
| Rate for Payer: PACE SWMI |
$161.39
|
| Rate for Payer: PHP Commercial |
$225.95
|
| Rate for Payer: PHP Medicare Advantage |
$161.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.09
|
| Rate for Payer: Priority Health Medicare |
$161.39
|
| Rate for Payer: Priority Health Narrow Network |
$300.09
|
| Rate for Payer: Priority Health SBD |
$300.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.39
|
| Rate for Payer: UHC Medicare Advantage |
$161.39
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
| Rate for Payer: UMR Bronson Commercial |
$507.84
|
|
|
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 |
$485.76 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna American Axle |
$717.60
|
| Rate for Payer: Aetna Commercial |
$938.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.60
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$772.80
|
| Rate for Payer: Cofinity Commercial |
$949.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.20
|
| Rate for Payer: Healthscope Commercial |
$993.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.40
|
| Rate for Payer: PHP Commercial |
$938.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health SBD |
$695.52
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.00
|
|
|
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 |
$162.39 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna American Axle |
$717.60
|
| Rate for Payer: Aetna Commercial |
$938.40
|
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$947.27
|
| Rate for Payer: BCN Commercial |
$947.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$772.80
|
| Rate for Payer: Cofinity Commercial |
$949.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Healthscope Commercial |
$993.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.00
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.40
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Commercial |
$938.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Priority Health SBD |
$695.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.63
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$162.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: UMR Bronson Commercial |
$408.48
|
| Rate for Payer: VA VA |
$1,858.63
|
| 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 |
$107.78 |
| Max. Negotiated Rate |
$940.37 |
| Rate for Payer: Aetna Commercial |
$216.26
|
| Rate for Payer: Aetna Medicare |
$167.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.40
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS MAPPO |
$161.39
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: BCN Commercial |
$664.11
|
| 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 |
$216.26
|
| Rate for Payer: Cofinity Commercial |
$232.40
|
| 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: Meridian Medicaid |
$113.17
|
| Rate for Payer: Nomi Health Commercial |
$193.67
|
| Rate for Payer: PACE SWMI |
$161.39
|
| Rate for Payer: PHP Commercial |
$225.95
|
| Rate for Payer: PHP Medicare Advantage |
$161.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.09
|
| Rate for Payer: Priority Health Medicare |
$161.39
|
| Rate for Payer: Priority Health Narrow Network |
$300.09
|
| Rate for Payer: Priority Health SBD |
$300.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.39
|
| Rate for Payer: UHC Medicare Advantage |
$161.39
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
| Rate for Payer: UMR Bronson Commercial |
$507.84
|
|
|
PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 43243
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$301.16
|
| Rate for Payer: Aetna Medicare |
$233.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.64
|
| Rate for Payer: BCBS Complete |
$157.45
|
| Rate for Payer: BCBS MAPPO |
$224.75
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$340.12
|
| 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 |
$301.16
|
| Rate for Payer: Cofinity Commercial |
$323.64
|
| 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: Meridian Medicaid |
$157.45
|
| Rate for Payer: Nomi Health Commercial |
$269.70
|
| Rate for Payer: PACE SWMI |
$224.75
|
| Rate for Payer: PHP Commercial |
$314.65
|
| Rate for Payer: PHP Medicare Advantage |
$224.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.22
|
| Rate for Payer: Priority Health Medicare |
$224.75
|
| Rate for Payer: Priority Health Narrow Network |
$418.22
|
| Rate for Payer: Priority Health SBD |
$418.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.75
|
| Rate for Payer: UHC Medicare Advantage |
$224.75
|
| Rate for Payer: UHCCP Medicaid |
$149.95
|
| Rate for Payer: UMR Bronson Commercial |
$553.84
|
|
