|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$493.43 |
| Rate for Payer: Aetna Commercial |
$204.07
|
| Rate for Payer: Aetna Medicare |
$152.29
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS MAPPO |
$152.29
|
| Rate for Payer: BCBS Trust/PPO |
$493.43
|
| Rate for Payer: BCN Commercial |
$227.73
|
| Rate for Payer: BCN Medicare Advantage |
$152.29
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$204.07
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.29
|
| Rate for Payer: Healthscope Commercial |
$182.75
|
| Rate for Payer: Healthscope Whirlpool |
$182.75
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.90
|
| Rate for Payer: PACE SWMI |
$152.29
|
| Rate for Payer: PHP Medicare Advantage |
$152.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.60
|
| Rate for Payer: Priority Health Medicare |
$152.29
|
| Rate for Payer: Priority Health Narrow Network |
$206.60
|
| Rate for Payer: UHC Medicare Advantage |
$156.86
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$267.29
|
| Rate for Payer: Aetna Medicare |
$199.47
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$199.47
|
| Rate for Payer: BCBS Trust/PPO |
$399.39
|
| Rate for Payer: BCN Commercial |
$300.05
|
| Rate for Payer: BCN Medicare Advantage |
$199.47
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cofinity Commercial |
$287.24
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.47
|
| Rate for Payer: Healthscope Commercial |
$239.36
|
| Rate for Payer: Healthscope Whirlpool |
$239.36
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$209.44
|
| Rate for Payer: PACE SWMI |
$199.47
|
| Rate for Payer: PHP Medicare Advantage |
$199.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.83
|
| Rate for Payer: Priority Health Medicare |
$199.47
|
| Rate for Payer: Priority Health Narrow Network |
$270.83
|
| Rate for Payer: UHC Medicare Advantage |
$205.45
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$422.75
|
|
|
Service Code
|
NDC 0904-7001-61
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.92 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$380.48
|
| Rate for Payer: ASR ASR |
$410.07
|
| Rate for Payer: BCBS Trust/PPO |
$327.76
|
| Rate for Payer: BCN Commercial |
$327.76
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$422.75
|
| Rate for Payer: Healthscope Whirlpool |
$410.07
|
| Rate for Payer: Mclaren Commercial |
$380.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.02
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$507.36
|
|
|
Service Code
|
NDC 60687-495-01
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.15 |
| Max. Negotiated Rate |
$507.36 |
| Rate for Payer: Aetna Commercial |
$456.62
|
| Rate for Payer: ASR ASR |
$492.14
|
| Rate for Payer: BCBS Trust/PPO |
$393.36
|
| Rate for Payer: BCN Commercial |
$393.36
|
| Rate for Payer: Cash Price |
$405.89
|
| Rate for Payer: Cofinity Commercial |
$476.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.89
|
| Rate for Payer: Healthscope Commercial |
$507.36
|
| Rate for Payer: Healthscope Whirlpool |
$492.14
|
| Rate for Payer: Mclaren Commercial |
$456.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.48
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$5.07
|
|
|
Service Code
|
NDC 60687-495-11
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: ASR ASR |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.93
|
| Rate for Payer: BCN Commercial |
$3.93
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$5.07
|
| Rate for Payer: Healthscope Whirlpool |
$4.92
|
| Rate for Payer: Mclaren Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.46
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 0904-7000-61
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.32 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: ASR ASR |
$375.97
|
| Rate for Payer: BCBS Trust/PPO |
$300.51
|
| Rate for Payer: BCN Commercial |
$300.51
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$364.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$387.60
|
| Rate for Payer: Healthscope Whirlpool |
$375.97
|
| Rate for Payer: Mclaren Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.09
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,385.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$1,076.07 |
| Rate for Payer: Aetna Commercial |
$291.44
|
| Rate for Payer: Aetna Medicare |
$217.49
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS MAPPO |
$217.49
|
| Rate for Payer: BCBS Trust/PPO |
$724.83
|
| Rate for Payer: BCN Commercial |
$1,076.07
|
| Rate for Payer: BCN Medicare Advantage |
$217.49
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cofinity Commercial |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$291.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.49
|
| Rate for Payer: Healthscope Commercial |
$260.99
|
| Rate for Payer: Healthscope Whirlpool |
$260.99
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.36
|
| Rate for Payer: PACE SWMI |
$217.49
|
| Rate for Payer: PHP Medicare Advantage |
$217.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.30
|
| Rate for Payer: Priority Health Medicare |
$217.49
|
| Rate for Payer: Priority Health Narrow Network |
$386.30
|
| Rate for Payer: UHC Medicare Advantage |
$224.01
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$199.90
|
| Rate for Payer: Aetna Medicare |
$149.18
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$149.18
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: BCN Medicare Advantage |
$149.18
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$214.82
|
| Rate for Payer: Cofinity Commercial |
$199.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.18
|
| Rate for Payer: Healthscope Commercial |
$179.02
|
| Rate for Payer: Healthscope Whirlpool |
$179.02
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.64
|
| Rate for Payer: PACE SWMI |
$149.18
|
| Rate for Payer: PHP Medicare Advantage |
$149.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.17
|
| Rate for Payer: Priority Health Medicare |
$149.18
|
| Rate for Payer: Priority Health Narrow Network |
$265.17
|
| Rate for Payer: UHC Medicare Advantage |
$153.66
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$199.90
|
| Rate for Payer: Aetna Medicare |
$149.18
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$149.18
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: BCN Medicare Advantage |
$149.18
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$214.82
|
| Rate for Payer: Cofinity Commercial |
$199.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.18
|
| Rate for Payer: Healthscope Commercial |
$179.02
|
| Rate for Payer: Healthscope Whirlpool |
$179.02
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.64
|
| Rate for Payer: PACE SWMI |
$149.18
|
| Rate for Payer: PHP Medicare Advantage |
$149.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.17
|
| Rate for Payer: Priority Health Medicare |
$149.18
|
| Rate for Payer: Priority Health Narrow Network |
$265.17
|
| Rate for Payer: UHC Medicare Advantage |
$153.66
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,767.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,236.90 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Aetna Commercial |
$1,590.30
|
| Rate for Payer: ASR ASR |
$1,713.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.96
|
| Rate for Payer: BCN Commercial |
$1,369.96
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,660.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.60
|
| Rate for Payer: Healthscope Commercial |
$1,767.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,713.99
|
| Rate for Payer: Mclaren Commercial |
$1,590.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,501.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,554.96
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,767.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$925.18 |
| Max. Negotiated Rate |
$2,114.21 |
| Rate for Payer: Aetna Commercial |
$1,590.30
|
| Rate for Payer: Aetna Medicare |
$1,691.37
|
| 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: ASR ASR |
$1,713.99
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.96
|
| Rate for Payer: BCN Commercial |
$1,369.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,660.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$1,767.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,713.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,691.37
|
| Rate for Payer: Mclaren Commercial |
$1,590.30
|
| 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 |
$1,501.95
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$1,860.51
|
| Rate for Payer: PHP Medicaid |
$925.18
|
| 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 |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,607.97
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,554.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$780.50 |
| Rate for Payer: Aetna Commercial |
$318.54
|
| Rate for Payer: Aetna Medicare |
$237.72
|
| Rate for Payer: BCBS Complete |
$161.48
|
| Rate for Payer: BCBS MAPPO |
$237.72
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$237.72
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$318.54
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.72
|
| Rate for Payer: Healthscope Commercial |
$285.26
|
| Rate for Payer: Healthscope Whirlpool |
$285.26
|
| Rate for Payer: Meridian Medicaid |
$161.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.61
|
| Rate for Payer: PACE SWMI |
$237.72
|
| Rate for Payer: PHP Medicare Advantage |
$237.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.16
|
| Rate for Payer: Priority Health Medicare |
$237.72
|
| Rate for Payer: Priority Health Narrow Network |
$422.16
|
| Rate for Payer: UHC Medicare Advantage |
$244.85
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$147.18 |
| Max. Negotiated Rate |
$850.03 |
| Rate for Payer: Aetna Commercial |
$302.60
|
| Rate for Payer: Aetna Medicare |
$225.82
|
| Rate for Payer: BCBS Complete |
$154.54
|
| Rate for Payer: BCBS MAPPO |
$225.82
|
| Rate for Payer: BCBS Trust/PPO |
$850.03
|
| Rate for Payer: BCN Commercial |
$332.79
|
| Rate for Payer: BCN Medicare Advantage |
$225.82
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$325.18
|
| Rate for Payer: Cofinity Commercial |
$302.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.82
|
| Rate for Payer: Healthscope Commercial |
$270.98
|
| Rate for Payer: Healthscope Whirlpool |
$270.98
|
| Rate for Payer: Meridian Medicaid |
$154.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.11
|
| Rate for Payer: PACE SWMI |
$225.82
|
| Rate for Payer: PHP Medicare Advantage |
$225.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.41
|
| Rate for Payer: Priority Health Medicare |
$225.82
|
| Rate for Payer: Priority Health Narrow Network |
$400.41
|
| Rate for Payer: UHC Medicare Advantage |
$232.59
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$876.69 |
| Rate for Payer: Aetna Commercial |
$229.13
|
| Rate for Payer: Aetna Medicare |
$170.99
|
| Rate for Payer: BCBS Complete |
$116.08
|
| Rate for Payer: BCBS MAPPO |
$170.99
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$876.69
|
| Rate for Payer: BCN Medicare Advantage |
$170.99
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$246.23
|
| Rate for Payer: Cofinity Commercial |
$229.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.99
|
| Rate for Payer: Healthscope Commercial |
$205.19
|
| Rate for Payer: Healthscope Whirlpool |
$205.19
|
| Rate for Payer: Meridian Medicaid |
$116.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.54
|
| Rate for Payer: PACE SWMI |
$170.99
|
| Rate for Payer: PHP Medicare Advantage |
$170.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.40
|
| Rate for Payer: Priority Health Medicare |
$170.99
|
| Rate for Payer: Priority Health Narrow Network |
$303.40
|
| Rate for Payer: UHC Medicare Advantage |
$176.12
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$1,452.30 |
| Rate for Payer: Aetna Commercial |
$283.58
|
| Rate for Payer: Aetna Medicare |
$211.63
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$211.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.30
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: BCN Medicare Advantage |
$211.63
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$304.75
|
| Rate for Payer: Cofinity Commercial |
$283.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.63
|
| Rate for Payer: Healthscope Commercial |
$253.96
|
| Rate for Payer: Healthscope Whirlpool |
$253.96
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.21
|
| Rate for Payer: PACE SWMI |
$211.63
|
| Rate for Payer: PHP Medicare Advantage |
$211.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.13
|
| Rate for Payer: Priority Health Medicare |
$211.63
|
| Rate for Payer: Priority Health Narrow Network |
$375.13
|
| Rate for Payer: UHC Medicare Advantage |
$217.98
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,019.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$713.30 |
| Rate for Payer: Aetna Commercial |
$298.44
|
| Rate for Payer: Aetna Medicare |
$222.72
|
| Rate for Payer: BCBS Complete |
$151.41
|
| Rate for Payer: BCBS MAPPO |
$222.72
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$327.90
|
| Rate for Payer: BCN Medicare Advantage |
$222.72
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cofinity Commercial |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$298.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.72
|
| Rate for Payer: Healthscope Commercial |
$267.26
|
| Rate for Payer: Healthscope Whirlpool |
$267.26
|
| Rate for Payer: Meridian Medicaid |
$151.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$233.86
|
| Rate for Payer: PACE SWMI |
$222.72
|
| Rate for Payer: PHP Medicare Advantage |
$222.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.52
|
| Rate for Payer: Priority Health Medicare |
$222.72
|
| Rate for Payer: Priority Health Narrow Network |
$394.52
|
| Rate for Payer: UHC Medicare Advantage |
$229.40
|
|
|
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 |
$230.27
|
| Rate for Payer: Aetna Medicare |
$171.84
|
| Rate for Payer: BCBS Complete |
$116.75
|
| Rate for Payer: BCBS MAPPO |
$171.84
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$563.45
|
| Rate for Payer: BCN Medicare Advantage |
$171.84
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$247.45
|
| Rate for Payer: Cofinity Commercial |
$230.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.84
|
| Rate for Payer: Healthscope Commercial |
$206.21
|
| Rate for Payer: Healthscope Whirlpool |
$206.21
|
| Rate for Payer: Meridian Medicaid |
$116.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$180.43
|
| Rate for Payer: PACE SWMI |
$171.84
|
| Rate for Payer: PHP Medicare Advantage |
$171.84
|
| 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 Medicare |
$171.84
|
| Rate for Payer: Priority Health Narrow Network |
$305.15
|
| Rate for Payer: UHC Medicare Advantage |
$177.00
|
|
|
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 |
$440.75 |
| Max. Negotiated Rate |
$1,007.19 |
| Rate for Payer: Aetna Commercial |
$870.30
|
| Rate for Payer: Aetna Medicare |
$805.75
|
| 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: ASR ASR |
$937.99
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$749.72
|
| Rate for Payer: BCN Commercial |
$749.72
|
| 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 |
$908.98
|
| 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 |
$967.00
|
| Rate for Payer: Healthscope Whirlpool |
$937.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$805.75
|
| Rate for Payer: Mclaren Commercial |
$870.30
|
| 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 |
$886.32
|
| Rate for Payer: PHP Medicaid |
$440.75
|
| 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 |
$879.97
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$686.57
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.96
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
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 |
$230.27
|
| Rate for Payer: Aetna Medicare |
$171.84
|
| Rate for Payer: BCBS Complete |
$116.75
|
| Rate for Payer: BCBS MAPPO |
$171.84
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$563.45
|
| Rate for Payer: BCN Medicare Advantage |
$171.84
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$230.27
|
| Rate for Payer: Cofinity Commercial |
$247.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.84
|
| Rate for Payer: Healthscope Commercial |
$206.21
|
| Rate for Payer: Healthscope Whirlpool |
$206.21
|
| Rate for Payer: Meridian Medicaid |
$116.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$180.43
|
| Rate for Payer: PACE SWMI |
$171.84
|
| Rate for Payer: PHP Medicare Advantage |
$171.84
|
| 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 Medicare |
$171.84
|
| Rate for Payer: Priority Health Narrow Network |
$305.15
|
| Rate for Payer: UHC Medicare Advantage |
$177.00
|
|
|
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 |
$676.90 |
| Max. Negotiated Rate |
$967.00 |
| Rate for Payer: Aetna Commercial |
$870.30
|
| Rate for Payer: ASR ASR |
$937.99
|
| Rate for Payer: BCBS Trust/PPO |
$749.72
|
| Rate for Payer: BCN Commercial |
$749.72
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$908.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.60
|
| Rate for Payer: Healthscope Commercial |
$967.00
|
| Rate for Payer: Healthscope Whirlpool |
$937.99
|
| Rate for Payer: Mclaren Commercial |
$870.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$821.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.96
|
|
|
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 |
$222.06
|
| Rate for Payer: Aetna Medicare |
$165.72
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$165.72
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: BCN Commercial |
$664.11
|
| Rate for Payer: BCN Medicare Advantage |
$165.72
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$222.06
|
| Rate for Payer: Cofinity Commercial |
$238.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.72
|
| Rate for Payer: Healthscope Commercial |
$198.86
|
| Rate for Payer: Healthscope Whirlpool |
$198.86
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.01
|
| Rate for Payer: PACE SWMI |
$165.72
|
| Rate for Payer: PHP Medicare Advantage |
$165.72
|
| 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 Medicare |
$165.72
|
| Rate for Payer: Priority Health Narrow Network |
$293.99
|
| Rate for Payer: UHC Medicare Advantage |
$170.69
|
|
|
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 |
$757.40 |
| Max. Negotiated Rate |
$1,082.00 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: ASR ASR |
$1,049.54
|
| Rate for Payer: BCBS Trust/PPO |
$838.87
|
| Rate for Payer: BCN Commercial |
$838.87
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$1,017.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.60
|
| Rate for Payer: Healthscope Commercial |
$1,082.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.54
|
| Rate for Payer: Mclaren Commercial |
$973.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.16
|
|
|
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 |
$757.40 |
| Max. Negotiated Rate |
$2,114.21 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: Aetna Medicare |
$1,691.37
|
| 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: ASR ASR |
$1,049.54
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$838.87
|
| Rate for Payer: BCN Commercial |
$838.87
|
| 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 |
$1,017.08
|
| 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 |
$1,082.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,691.37
|
| Rate for Payer: Mclaren Commercial |
$973.80
|
| 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 |
$1,860.51
|
| Rate for Payer: PHP Medicaid |
$925.18
|
| 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 |
$984.62
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$768.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
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 |
$222.06
|
| Rate for Payer: Aetna Medicare |
$165.72
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$165.72
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: BCN Commercial |
$664.11
|
| Rate for Payer: BCN Medicare Advantage |
$165.72
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$222.06
|
| Rate for Payer: Cofinity Commercial |
$238.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.72
|
| Rate for Payer: Healthscope Commercial |
$198.86
|
| Rate for Payer: Healthscope Whirlpool |
$198.86
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.01
|
| Rate for Payer: PACE SWMI |
$165.72
|
| Rate for Payer: PHP Medicare Advantage |
$165.72
|
| 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 Medicare |
$165.72
|
| Rate for Payer: Priority Health Narrow Network |
$293.99
|
| Rate for Payer: UHC Medicare Advantage |
$170.69
|
|
|
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 |
$309.22
|
| Rate for Payer: Aetna Medicare |
$230.76
|
| Rate for Payer: BCBS Complete |
$156.78
|
| Rate for Payer: BCBS MAPPO |
$230.76
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$340.12
|
| Rate for Payer: BCN Medicare Advantage |
$230.76
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cash Price |
$944.00
|
| Rate for Payer: Cofinity Commercial |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$332.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.76
|
| Rate for Payer: Healthscope Commercial |
$276.91
|
| Rate for Payer: Healthscope Whirlpool |
$276.91
|
| Rate for Payer: Meridian Medicaid |
$156.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.30
|
| Rate for Payer: PACE SWMI |
$230.76
|
| Rate for Payer: PHP Medicare Advantage |
$230.76
|
| 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 Medicare |
$230.76
|
| Rate for Payer: Priority Health Narrow Network |
$409.22
|
| Rate for Payer: UHC Medicare Advantage |
$237.68
|
|
