|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.92 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$628.55
|
| Rate for Payer: Aetna Commercial |
$821.95
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,536.26
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$676.90
|
| Rate for Payer: Cofinity Commercial |
$831.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$870.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$676.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.25
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$821.95
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$821.95
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$609.21
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$170.92
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$357.79
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.25
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 43247
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$676.90 |
| Rate for Payer: Aetna Commercial |
$235.23
|
| Rate for Payer: BCBS Complete |
$116.75
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Meridian Medicaid |
$116.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.15
|
| Rate for Payer: Priority Health Narrow Network |
$305.15
|
| Rate for Payer: Priority Health SBD |
$305.15
|
| Rate for Payer: UMR Bronson Commercial |
$444.82
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$425.48 |
| Max. Negotiated Rate |
$870.30 |
| Rate for Payer: Aetna American Axle |
$628.55
|
| Rate for Payer: Aetna Commercial |
$821.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.55
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$676.90
|
| Rate for Payer: Cofinity Commercial |
$831.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.60
|
| Rate for Payer: Healthscope Commercial |
$870.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$676.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$821.95
|
| Rate for Payer: PHP Commercial |
$821.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.90
|
| Rate for Payer: Priority Health SBD |
$609.21
|
| Rate for Payer: UMR Bronson Commercial |
$425.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.25
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$676.90 |
| Rate for Payer: Aetna Commercial |
$235.23
|
| Rate for Payer: BCBS Complete |
$116.75
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Meridian Medicaid |
$116.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.15
|
| Rate for Payer: Priority Health Narrow Network |
$305.15
|
| Rate for Payer: Priority Health SBD |
$305.15
|
| Rate for Payer: UMR Bronson Commercial |
$444.82
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$164.70 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna American Axle |
$703.30
|
| Rate for Payer: Aetna Commercial |
$919.70
|
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$757.40
|
| Rate for Payer: Cofinity Commercial |
$930.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$973.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$757.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.50
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.70
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$919.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Priority Health SBD |
$681.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$164.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: UMR Bronson Commercial |
$400.34
|
| Rate for Payer: VA VA |
$1,691.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.50
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
43250
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$940.37 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.99
|
| Rate for Payer: Priority Health Narrow Network |
$293.99
|
| Rate for Payer: Priority Health SBD |
$293.99
|
| Rate for Payer: UMR Bronson Commercial |
$497.72
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$476.08 |
| Max. Negotiated Rate |
$973.80 |
| Rate for Payer: Aetna American Axle |
$703.30
|
| Rate for Payer: Aetna Commercial |
$919.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.30
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$757.40
|
| Rate for Payer: Cofinity Commercial |
$930.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.60
|
| Rate for Payer: Healthscope Commercial |
$973.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$757.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.70
|
| Rate for Payer: PHP Commercial |
$919.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health SBD |
$681.66
|
| Rate for Payer: UMR Bronson Commercial |
$476.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.50
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 43250
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$940.37 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.99
|
| Rate for Payer: Priority Health Narrow Network |
$293.99
|
| Rate for Payer: Priority Health SBD |
$293.99
|
| Rate for Payer: UMR Bronson Commercial |
$497.72
|
|
|
PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 43243
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$826.00 |
| Rate for Payer: Aetna Commercial |
$315.11
|
| Rate for Payer: BCBS Complete |
$156.78
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Meridian Medicaid |
$156.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.22
|
| Rate for Payer: Priority Health Narrow Network |
$409.22
|
| Rate for Payer: Priority Health SBD |
$409.22
|
| Rate for Payer: UMR Bronson Commercial |
$542.80
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 43248
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$606.90 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS Trust/PPO |
$120.98
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.34
|
| Rate for Payer: Priority Health Narrow Network |
$286.34
|
| Rate for Payer: Priority Health SBD |
$286.34
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.77 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$563.55
|
| Rate for Payer: Aetna Commercial |
$736.95
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$655.17
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$606.90
|
| Rate for Payer: Cofinity Commercial |
$745.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$780.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$606.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.25
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$736.95
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$736.95
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$546.21
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$160.77
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$320.79
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.25
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$381.48 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Aetna American Axle |
$563.55
|
| Rate for Payer: Aetna Commercial |
$736.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.55
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$606.90
|
| Rate for Payer: Cofinity Commercial |
$745.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.60
|
| Rate for Payer: Healthscope Commercial |
$780.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$606.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$736.95
|
| Rate for Payer: PHP Commercial |
$736.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health SBD |
$546.21
|
| Rate for Payer: UMR Bronson Commercial |
$381.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.25
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
43248
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$606.90 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS Trust/PPO |
$120.98
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.34
|
| Rate for Payer: Priority Health Narrow Network |
$286.34
|
| Rate for Payer: Priority Health SBD |
$286.34
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$856.00
|
|
|
Service Code
|
HCPCS 43241
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$599.20 |
| Rate for Payer: Aetna Commercial |
$188.57
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS Trust/PPO |
$24.83
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.60
|
| Rate for Payer: Priority Health Narrow Network |
$244.60
|
| Rate for Payer: Priority Health SBD |
$244.60
|
| Rate for Payer: UMR Bronson Commercial |
$393.76
|
|
|
PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 43242
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$709.10 |
| Rate for Payer: Aetna Commercial |
$348.83
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS Trust/PPO |
$51.77
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$453.33
|
| Rate for Payer: Priority Health Narrow Network |
$453.33
|
| Rate for Payer: Priority Health SBD |
$453.33
|
| Rate for Payer: UMR Bronson Commercial |
$465.98
|
|
|
PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 43238
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$711.20 |
| Rate for Payer: Aetna Commercial |
$308.98
|
| Rate for Payer: BCBS Complete |
$152.97
|
| Rate for Payer: BCBS Trust/PPO |
$14.01
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Meridian Medicaid |
$152.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$399.82
|
| Rate for Payer: Priority Health Narrow Network |
$399.82
|
| Rate for Payer: Priority Health SBD |
$399.82
|
| Rate for Payer: UMR Bronson Commercial |
$467.36
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
43246
|
| Min. Negotiated Rate |
$69.74 |
| Max. Negotiated Rate |
$992.60 |
| Rate for Payer: Aetna Commercial |
$266.68
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.32
|
| Rate for Payer: Priority Health Narrow Network |
$346.32
|
| Rate for Payer: Priority Health SBD |
$346.32
|
| Rate for Payer: UMR Bronson Commercial |
$652.28
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$69.74 |
| Max. Negotiated Rate |
$992.60 |
| Rate for Payer: Aetna Commercial |
$266.68
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.32
|
| Rate for Payer: Priority Health Narrow Network |
$346.32
|
| Rate for Payer: Priority Health SBD |
$346.32
|
| Rate for Payer: UMR Bronson Commercial |
$652.28
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
43246
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$623.92 |
| Max. Negotiated Rate |
$1,276.20 |
| Rate for Payer: Aetna American Axle |
$921.70
|
| Rate for Payer: Aetna Commercial |
$1,205.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.70
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$1,219.48
|
| Rate for Payer: Cofinity Commercial |
$992.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.40
|
| Rate for Payer: Healthscope Commercial |
$1,276.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,205.30
|
| Rate for Payer: PHP Commercial |
$1,205.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.60
|
| Rate for Payer: Priority Health SBD |
$893.34
|
| Rate for Payer: UMR Bronson Commercial |
$623.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.50
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
43246
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna American Axle |
$921.70
|
| Rate for Payer: Aetna Commercial |
$1,205.30
|
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,497.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$1,219.48
|
| Rate for Payer: Cofinity Commercial |
$992.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$1,276.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.50
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,205.30
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$1,205.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Priority Health SBD |
$893.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: UMR Bronson Commercial |
$524.66
|
| Rate for Payer: VA VA |
$1,691.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.50
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
43251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$189.26 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna American Axle |
$760.50
|
| Rate for Payer: Aetna Commercial |
$994.50
|
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,389.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$1,006.20
|
| Rate for Payer: Cofinity Commercial |
$819.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.50
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$994.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Priority Health SBD |
$737.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$189.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: UMR Bronson Commercial |
$432.90
|
| Rate for Payer: VA VA |
$1,691.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.50
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43251
|
| Min. Negotiated Rate |
$123.11 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS Trust/PPO |
$748.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.08
|
| Rate for Payer: Priority Health Narrow Network |
$338.08
|
| Rate for Payer: Priority Health SBD |
$338.08
|
| Rate for Payer: UMR Bronson Commercial |
$538.20
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
43251
|
| Min. Negotiated Rate |
$123.11 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS Trust/PPO |
$748.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.08
|
| Rate for Payer: Priority Health Narrow Network |
$338.08
|
| Rate for Payer: Priority Health SBD |
$338.08
|
| Rate for Payer: UMR Bronson Commercial |
$538.20
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
43251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$514.80 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna American Axle |
$760.50
|
| Rate for Payer: Aetna Commercial |
$994.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.50
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$1,006.20
|
| Rate for Payer: Cofinity Commercial |
$819.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.00
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: PHP Commercial |
$994.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health SBD |
$737.10
|
| Rate for Payer: UMR Bronson Commercial |
$514.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.50
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$534.30
|
| Rate for Payer: Aetna Commercial |
$698.70
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$661.04
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$575.40
|
| Rate for Payer: Cofinity Commercial |
$706.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$739.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.50
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.70
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$698.70
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Priority Health SBD |
$517.86
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$134.25
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$304.14
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.50
|
|
