|
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 |
$440.75 |
| Max. Negotiated Rate |
$1,007.19 |
| Rate for Payer: Aetna Commercial |
$780.30
|
| 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 |
$840.99
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$672.19
|
| Rate for Payer: BCN Commercial |
$672.19
|
| 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 |
$814.98
|
| 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 |
$867.00
|
| Rate for Payer: Healthscope Whirlpool |
$840.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$805.75
|
| Rate for Payer: Mclaren Commercial |
$780.30
|
| 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 |
$736.95
|
| 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 |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$788.97
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$615.57
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$762.96
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
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 |
$607.43 |
| Rate for Payer: Aetna Commercial |
$215.85
|
| Rate for Payer: Aetna Medicare |
$161.08
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS MAPPO |
$161.08
|
| Rate for Payer: BCBS Trust/PPO |
$120.98
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: BCN Medicare Advantage |
$161.08
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$215.85
|
| Rate for Payer: Cofinity Commercial |
$231.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.08
|
| Rate for Payer: Healthscope Commercial |
$193.30
|
| Rate for Payer: Healthscope Whirlpool |
$193.30
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$169.13
|
| Rate for Payer: PACE SWMI |
$161.08
|
| Rate for Payer: PHP Medicare Advantage |
$161.08
|
| 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 Medicare |
$161.08
|
| Rate for Payer: Priority Health Narrow Network |
$286.34
|
| Rate for Payer: UHC Medicare Advantage |
$165.91
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 43248
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$607.43 |
| Rate for Payer: Aetna Commercial |
$215.85
|
| Rate for Payer: Aetna Medicare |
$161.08
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS MAPPO |
$161.08
|
| Rate for Payer: BCBS Trust/PPO |
$120.98
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: BCN Medicare Advantage |
$161.08
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$231.96
|
| Rate for Payer: Cofinity Commercial |
$215.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.08
|
| Rate for Payer: Healthscope Commercial |
$193.30
|
| Rate for Payer: Healthscope Whirlpool |
$193.30
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$169.13
|
| Rate for Payer: PACE SWMI |
$161.08
|
| Rate for Payer: PHP Medicare Advantage |
$161.08
|
| 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 Medicare |
$161.08
|
| Rate for Payer: Priority Health Narrow Network |
$286.34
|
| Rate for Payer: UHC Medicare Advantage |
$165.91
|
|
|
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 |
$606.90 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Aetna Commercial |
$780.30
|
| Rate for Payer: ASR ASR |
$840.99
|
| Rate for Payer: BCBS Trust/PPO |
$672.19
|
| Rate for Payer: BCN Commercial |
$672.19
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$814.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.60
|
| Rate for Payer: Healthscope Commercial |
$867.00
|
| Rate for Payer: Healthscope Whirlpool |
$840.99
|
| Rate for Payer: Mclaren Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$736.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$762.96
|
|
|
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 |
$184.40
|
| Rate for Payer: Aetna Medicare |
$137.61
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS MAPPO |
$137.61
|
| Rate for Payer: BCBS Trust/PPO |
$24.83
|
| Rate for Payer: BCN Commercial |
$203.29
|
| Rate for Payer: BCN Medicare Advantage |
$137.61
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cofinity Commercial |
$198.16
|
| Rate for Payer: Cofinity Commercial |
$184.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.61
|
| Rate for Payer: Healthscope Commercial |
$165.13
|
| Rate for Payer: Healthscope Whirlpool |
$165.13
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.49
|
| Rate for Payer: PACE SWMI |
$137.61
|
| Rate for Payer: PHP Medicare Advantage |
$137.61
|
| 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 Medicare |
$137.61
|
| Rate for Payer: Priority Health Narrow Network |
$244.60
|
| Rate for Payer: UHC Medicare Advantage |
$141.74
|
|
|
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 |
$342.18
|
| Rate for Payer: Aetna Medicare |
$255.36
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$255.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.77
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$255.36
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cofinity Commercial |
$342.18
|
| Rate for Payer: Cofinity Commercial |
$367.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$306.43
|
| Rate for Payer: Healthscope Whirlpool |
$306.43
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.13
|
| Rate for Payer: PACE SWMI |
$255.36
|
| Rate for Payer: PHP Medicare Advantage |
$255.36
|
| 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 Medicare |
$255.36
|
| Rate for Payer: Priority Health Narrow Network |
$453.33
|
| Rate for Payer: UHC Medicare Advantage |
$263.02
|
|
|
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 |
$301.63
|
| Rate for Payer: Aetna Medicare |
$225.10
|
| Rate for Payer: BCBS Complete |
$152.97
|
| Rate for Payer: BCBS MAPPO |
$225.10
|
| Rate for Payer: BCBS Trust/PPO |
$14.01
|
| Rate for Payer: BCN Commercial |
$332.30
|
| Rate for Payer: BCN Medicare Advantage |
$225.10
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$324.14
|
| Rate for Payer: Cofinity Commercial |
$301.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.10
|
| Rate for Payer: Healthscope Commercial |
$270.12
|
| Rate for Payer: Healthscope Whirlpool |
$270.12
|
| Rate for Payer: Meridian Medicaid |
$152.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.36
|
| Rate for Payer: PACE SWMI |
$225.10
|
| Rate for Payer: PHP Medicare Advantage |
$225.10
|
| 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 Medicare |
$225.10
|
| Rate for Payer: Priority Health Narrow Network |
$399.82
|
| Rate for Payer: UHC Medicare Advantage |
$231.85
|
|
|
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 |
$992.60 |
| Max. Negotiated Rate |
$1,418.00 |
| Rate for Payer: Aetna Commercial |
$1,276.20
|
| Rate for Payer: ASR ASR |
$1,375.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.38
|
| Rate for Payer: BCN Commercial |
$1,099.38
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$1,332.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.40
|
| Rate for Payer: Healthscope Commercial |
$1,418.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,375.46
|
| Rate for Payer: Mclaren Commercial |
$1,276.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,205.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,247.84
|
|
|
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 |
$262.09
|
| Rate for Payer: Aetna Medicare |
$195.59
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS MAPPO |
$195.59
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$195.59
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$281.65
|
| Rate for Payer: Cofinity Commercial |
$262.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.59
|
| Rate for Payer: Healthscope Commercial |
$234.71
|
| Rate for Payer: Healthscope Whirlpool |
$234.71
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$205.37
|
| Rate for Payer: PACE SWMI |
$195.59
|
| Rate for Payer: PHP Medicare Advantage |
$195.59
|
| 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 Medicare |
$195.59
|
| Rate for Payer: Priority Health Narrow Network |
$346.32
|
| Rate for Payer: UHC Medicare Advantage |
$201.46
|
|
|
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 |
$925.18 |
| Max. Negotiated Rate |
$2,114.21 |
| Rate for Payer: Aetna Commercial |
$1,276.20
|
| 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 |
$1,375.46
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.38
|
| Rate for Payer: BCN Commercial |
$1,099.38
|
| 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 |
$1,332.92
|
| 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 |
$1,418.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,375.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,691.37
|
| Rate for Payer: Mclaren Commercial |
$1,276.20
|
| 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 |
$1,860.51
|
| 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 |
$992.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,290.38
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,006.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,247.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
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 |
$262.09
|
| Rate for Payer: Aetna Medicare |
$195.59
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS MAPPO |
$195.59
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$195.59
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$262.09
|
| Rate for Payer: Cofinity Commercial |
$281.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.59
|
| Rate for Payer: Healthscope Commercial |
$234.71
|
| Rate for Payer: Healthscope Whirlpool |
$234.71
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$205.37
|
| Rate for Payer: PACE SWMI |
$195.59
|
| Rate for Payer: PHP Medicare Advantage |
$195.59
|
| 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 Medicare |
$195.59
|
| Rate for Payer: Priority Health Narrow Network |
$346.32
|
| Rate for Payer: UHC Medicare Advantage |
$201.46
|
|
|
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 |
$819.00 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| Rate for Payer: ASR ASR |
$1,134.90
|
| Rate for Payer: BCBS Trust/PPO |
$907.10
|
| Rate for Payer: BCN Commercial |
$907.10
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$1,099.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.00
|
| Rate for Payer: Healthscope Commercial |
$1,170.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.90
|
| Rate for Payer: Mclaren Commercial |
$1,053.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,029.60
|
|
|
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 |
$819.00 |
| Max. Negotiated Rate |
$2,114.21 |
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| 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 |
$1,134.90
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$907.10
|
| Rate for Payer: BCN Commercial |
$907.10
|
| 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 |
$1,099.80
|
| 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 |
$1,170.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,691.37
|
| Rate for Payer: Mclaren Commercial |
$1,053.00
|
| 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 |
$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 |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,064.70
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$830.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,029.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
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 |
$255.03
|
| Rate for Payer: Aetna Medicare |
$190.32
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS MAPPO |
$190.32
|
| Rate for Payer: BCBS Trust/PPO |
$748.60
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: BCN Medicare Advantage |
$190.32
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$274.06
|
| Rate for Payer: Cofinity Commercial |
$255.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.32
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Healthscope Whirlpool |
$228.38
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.84
|
| Rate for Payer: PACE SWMI |
$190.32
|
| Rate for Payer: PHP Medicare Advantage |
$190.32
|
| 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 Medicare |
$190.32
|
| Rate for Payer: Priority Health Narrow Network |
$338.08
|
| Rate for Payer: UHC Medicare Advantage |
$196.03
|
|
|
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 |
$255.03
|
| Rate for Payer: Aetna Medicare |
$190.32
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS MAPPO |
$190.32
|
| Rate for Payer: BCBS Trust/PPO |
$748.60
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: BCN Medicare Advantage |
$190.32
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$274.06
|
| Rate for Payer: Cofinity Commercial |
$255.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.32
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Healthscope Whirlpool |
$228.38
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.84
|
| Rate for Payer: PACE SWMI |
$190.32
|
| Rate for Payer: PHP Medicare Advantage |
$190.32
|
| 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 Medicare |
$190.32
|
| Rate for Payer: Priority Health Narrow Network |
$338.08
|
| Rate for Payer: UHC Medicare Advantage |
$196.03
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$179.79
|
| Rate for Payer: Aetna Medicare |
$134.17
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$134.17
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: BCN Commercial |
$554.16
|
| Rate for Payer: BCN Medicare Advantage |
$134.17
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$179.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.17
|
| Rate for Payer: Healthscope Commercial |
$161.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.00
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.88
|
| Rate for Payer: PACE SWMI |
$134.17
|
| Rate for Payer: PHP Medicare Advantage |
$134.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.71
|
| Rate for Payer: Priority Health Medicare |
$134.17
|
| Rate for Payer: Priority Health Narrow Network |
$238.71
|
| Rate for Payer: UHC Medicare Advantage |
$138.20
|
|
|
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 |
$440.75 |
| Max. Negotiated Rate |
$1,007.19 |
| Rate for Payer: Aetna Commercial |
$739.80
|
| 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 |
$797.34
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$637.30
|
| Rate for Payer: BCN Commercial |
$637.30
|
| 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 |
$772.68
|
| 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 |
$822.00
|
| Rate for Payer: Healthscope Whirlpool |
$797.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$805.75
|
| Rate for Payer: Mclaren Commercial |
$739.80
|
| 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 |
$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 |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.02
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$583.62
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$723.36
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$575.40 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: Aetna Commercial |
$739.80
|
| Rate for Payer: ASR ASR |
$797.34
|
| Rate for Payer: BCBS Trust/PPO |
$637.30
|
| Rate for Payer: BCN Commercial |
$637.30
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$772.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.60
|
| Rate for Payer: Healthscope Commercial |
$822.00
|
| Rate for Payer: Healthscope Whirlpool |
$797.34
|
| Rate for Payer: Mclaren Commercial |
$739.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$723.36
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$179.79
|
| Rate for Payer: Aetna Medicare |
$134.17
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$134.17
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: BCN Commercial |
$554.16
|
| Rate for Payer: BCN Medicare Advantage |
$134.17
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$179.79
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.17
|
| Rate for Payer: Healthscope Commercial |
$161.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.00
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.88
|
| Rate for Payer: PACE SWMI |
$134.17
|
| Rate for Payer: PHP Medicare Advantage |
$134.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.71
|
| Rate for Payer: Priority Health Medicare |
$134.17
|
| Rate for Payer: Priority Health Narrow Network |
$238.71
|
| Rate for Payer: UHC Medicare Advantage |
$138.20
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$260.28
|
| Rate for Payer: Aetna Medicare |
$194.24
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCBS MAPPO |
$194.24
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$923.11
|
| Rate for Payer: BCN Medicare Advantage |
$194.24
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cofinity Commercial |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$260.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.24
|
| Rate for Payer: Healthscope Commercial |
$233.09
|
| Rate for Payer: Healthscope Whirlpool |
$233.09
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.95
|
| Rate for Payer: PACE SWMI |
$194.24
|
| Rate for Payer: PHP Medicare Advantage |
$194.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.14
|
| Rate for Payer: Priority Health Medicare |
$194.24
|
| Rate for Payer: Priority Health Narrow Network |
$345.14
|
| Rate for Payer: UHC Medicare Advantage |
$200.07
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$169.34 |
| Max. Negotiated Rate |
$1,640.37 |
| Rate for Payer: Aetna Commercial |
$351.09
|
| Rate for Payer: Aetna Medicare |
$262.01
|
| Rate for Payer: BCBS Complete |
$177.81
|
| Rate for Payer: BCBS MAPPO |
$262.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.37
|
| Rate for Payer: BCN Commercial |
$386.55
|
| Rate for Payer: BCN Medicare Advantage |
$262.01
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$351.09
|
| Rate for Payer: Cofinity Commercial |
$377.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.01
|
| Rate for Payer: Healthscope Commercial |
$314.41
|
| Rate for Payer: Healthscope Whirlpool |
$314.41
|
| Rate for Payer: Meridian Medicaid |
$177.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$275.11
|
| Rate for Payer: PACE SWMI |
$262.01
|
| Rate for Payer: PHP Medicare Advantage |
$262.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.09
|
| Rate for Payer: Priority Health Medicare |
$262.01
|
| Rate for Payer: Priority Health Narrow Network |
$465.09
|
| Rate for Payer: UHC Medicare Advantage |
$269.87
|
|
|
PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 43240
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$815.50 |
| Rate for Payer: Aetna Commercial |
$509.11
|
| Rate for Payer: Aetna Medicare |
$379.93
|
| Rate for Payer: BCBS Complete |
$258.09
|
| Rate for Payer: BCBS MAPPO |
$379.93
|
| Rate for Payer: BCBS Trust/PPO |
$41.74
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: BCN Medicare Advantage |
$379.93
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$547.10
|
| Rate for Payer: Cofinity Commercial |
$509.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.93
|
| Rate for Payer: Healthscope Commercial |
$455.92
|
| Rate for Payer: Healthscope Whirlpool |
$455.92
|
| Rate for Payer: Meridian Medicaid |
$258.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$398.93
|
| Rate for Payer: PACE SWMI |
$379.93
|
| Rate for Payer: PHP Medicare Advantage |
$379.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$673.82
|
| Rate for Payer: Priority Health Medicare |
$379.93
|
| Rate for Payer: Priority Health Narrow Network |
$673.82
|
| Rate for Payer: UHC Medicare Advantage |
$391.33
|
|
|
PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 43253
|
| Min. Negotiated Rate |
$164.65 |
| Max. Negotiated Rate |
$1,676.30 |
| Rate for Payer: Aetna Commercial |
$341.77
|
| Rate for Payer: Aetna Medicare |
$255.05
|
| Rate for Payer: BCBS Complete |
$172.88
|
| Rate for Payer: BCBS MAPPO |
$255.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.30
|
| Rate for Payer: BCN Commercial |
$376.28
|
| Rate for Payer: BCN Medicare Advantage |
$255.05
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$367.27
|
| Rate for Payer: Cofinity Commercial |
$341.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.05
|
| Rate for Payer: Healthscope Commercial |
$306.06
|
| Rate for Payer: Healthscope Whirlpool |
$306.06
|
| Rate for Payer: Meridian Medicaid |
$172.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$267.80
|
| Rate for Payer: PACE SWMI |
$255.05
|
| Rate for Payer: PHP Medicare Advantage |
$255.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.74
|
| Rate for Payer: Priority Health Medicare |
$255.05
|
| Rate for Payer: Priority Health Narrow Network |
$452.74
|
| Rate for Payer: UHC Medicare Advantage |
$262.70
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$1,763.47 |
| Rate for Payer: Aetna Commercial |
$18.63
|
| Rate for Payer: Aetna Medicare |
$13.90
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$13.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,763.47
|
| Rate for Payer: BCN Commercial |
$21.02
|
| Rate for Payer: BCN Medicare Advantage |
$13.90
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$20.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.90
|
| Rate for Payer: Healthscope Commercial |
$16.68
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.60
|
| Rate for Payer: PACE SWMI |
$13.90
|
| Rate for Payer: PHP Medicare Advantage |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.33
|
| Rate for Payer: Priority Health Medicare |
$13.90
|
| Rate for Payer: Priority Health Narrow Network |
$20.33
|
| Rate for Payer: UHC Medicare Advantage |
$14.32
|
|
|
PR EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$1,397.35 |
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Medicare |
$7.98
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,397.35
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: BCN Medicare Advantage |
$7.98
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$11.49
|
| Rate for Payer: Cofinity Commercial |
$10.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.98
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Healthscope Whirlpool |
$9.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.38
|
| Rate for Payer: PACE SWMI |
$7.98
|
| Rate for Payer: PHP Medicare Advantage |
$7.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.34
|
| Rate for Payer: Priority Health Medicare |
$7.98
|
| Rate for Payer: Priority Health Narrow Network |
$11.34
|
| Rate for Payer: UHC Medicare Advantage |
$8.22
|
|
