|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$136.53 |
| Max. Negotiated Rate |
$407.72 |
| Rate for Payer: Aetna Commercial |
$283.91
|
| Rate for Payer: Aetna Medicare |
$211.87
|
| Rate for Payer: BCBS Complete |
$143.36
|
| Rate for Payer: BCBS MAPPO |
$211.87
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: BCN Medicare Advantage |
$211.87
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cofinity Commercial |
$305.09
|
| Rate for Payer: Cofinity Commercial |
$283.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.87
|
| Rate for Payer: Healthscope Commercial |
$254.24
|
| Rate for Payer: Healthscope Whirlpool |
$254.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.46
|
| Rate for Payer: Meridian Medicaid |
$143.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.06
|
| Rate for Payer: Nomi Health Commercial |
$254.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.00
|
| Rate for Payer: PACE SWMI |
$211.87
|
| Rate for Payer: PHP Medicare Advantage |
$211.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$339.83
|
| Rate for Payer: Priority Health Medicare |
$211.87
|
| Rate for Payer: Priority Health Narrow Network |
$339.83
|
| Rate for Payer: Railroad Medicare Medicare |
$211.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.87
|
| Rate for Payer: UHC Exchange |
$407.72
|
| Rate for Payer: UHC Medicaid |
$136.53
|
| Rate for Payer: UHCCP DNSP |
$211.87
|
| Rate for Payer: UHCCP Medicaid |
$136.53
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$285.14
|
| Rate for Payer: Aetna Medicare |
$212.79
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$212.79
|
| Rate for Payer: BCN Commercial |
$371.99
|
| Rate for Payer: BCN Medicare Advantage |
$212.79
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$306.42
|
| Rate for Payer: Cofinity Commercial |
$285.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.79
|
| Rate for Payer: Healthscope Commercial |
$255.35
|
| Rate for Payer: Healthscope Whirlpool |
$255.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.43
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$234.07
|
| Rate for Payer: Nomi Health Commercial |
$255.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.25
|
| Rate for Payer: PACE SWMI |
$212.79
|
| Rate for Payer: PHP Medicare Advantage |
$212.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$343.06
|
| Rate for Payer: Priority Health Medicare |
$212.79
|
| Rate for Payer: Priority Health Narrow Network |
$343.06
|
| Rate for Payer: Railroad Medicare Medicare |
$212.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.79
|
| Rate for Payer: UHC Exchange |
$414.96
|
| Rate for Payer: UHC Medicaid |
$137.17
|
| Rate for Payer: UHCCP DNSP |
$212.79
|
| Rate for Payer: UHCCP Medicaid |
$137.17
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$519.84 |
| Rate for Payer: Aetna Commercial |
$360.43
|
| Rate for Payer: Aetna Medicare |
$268.98
|
| Rate for Payer: BCBS Complete |
$182.05
|
| Rate for Payer: BCBS MAPPO |
$268.98
|
| Rate for Payer: BCN Commercial |
$467.60
|
| Rate for Payer: BCN Medicare Advantage |
$268.98
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$387.33
|
| Rate for Payer: Cofinity Commercial |
$360.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.98
|
| Rate for Payer: Healthscope Commercial |
$322.78
|
| Rate for Payer: Healthscope Whirlpool |
$322.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.43
|
| Rate for Payer: Meridian Medicaid |
$182.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$295.88
|
| Rate for Payer: Nomi Health Commercial |
$322.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: PACE SWMI |
$268.98
|
| Rate for Payer: PHP Medicare Advantage |
$268.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$431.23
|
| Rate for Payer: Priority Health Medicare |
$268.98
|
| Rate for Payer: Priority Health Narrow Network |
$431.23
|
| Rate for Payer: Railroad Medicare Medicare |
$268.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$268.98
|
| Rate for Payer: UHC Exchange |
$519.84
|
| Rate for Payer: UHC Medicaid |
$173.38
|
| Rate for Payer: UHCCP DNSP |
$268.98
|
| Rate for Payer: UHCCP Medicaid |
$173.38
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$157.41 |
| Max. Negotiated Rate |
$472.12 |
| Rate for Payer: Aetna Commercial |
$327.16
|
| Rate for Payer: Aetna Medicare |
$244.15
|
| Rate for Payer: BCBS Complete |
$165.28
|
| Rate for Payer: BCBS MAPPO |
$244.15
|
| Rate for Payer: BCN Commercial |
$426.28
|
| Rate for Payer: BCN Medicare Advantage |
$244.15
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$351.58
|
| Rate for Payer: Cofinity Commercial |
$327.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.15
|
| Rate for Payer: Healthscope Commercial |
$292.98
|
| Rate for Payer: Healthscope Whirlpool |
$292.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.36
|
| Rate for Payer: Meridian Medicaid |
$165.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$268.56
|
| Rate for Payer: Nomi Health Commercial |
$292.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.75
|
| Rate for Payer: PACE SWMI |
$244.15
|
| Rate for Payer: PHP Medicare Advantage |
$244.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$393.12
|
| Rate for Payer: Priority Health Medicare |
$244.15
|
| Rate for Payer: Priority Health Narrow Network |
$393.12
|
| Rate for Payer: Railroad Medicare Medicare |
$244.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$244.15
|
| Rate for Payer: UHC Exchange |
$472.12
|
| Rate for Payer: UHC Medicaid |
$157.41
|
| Rate for Payer: UHCCP DNSP |
$244.15
|
| Rate for Payer: UHCCP Medicaid |
$157.41
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$656.90 |
| Rate for Payer: Aetna Commercial |
$458.25
|
| Rate for Payer: Aetna Medicare |
$341.98
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCBS MAPPO |
$341.98
|
| Rate for Payer: BCN Commercial |
$594.09
|
| Rate for Payer: BCN Medicare Advantage |
$341.98
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$492.45
|
| Rate for Payer: Cofinity Commercial |
$458.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.98
|
| Rate for Payer: Healthscope Commercial |
$410.38
|
| Rate for Payer: Healthscope Whirlpool |
$410.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.08
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$376.18
|
| Rate for Payer: Nomi Health Commercial |
$410.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.00
|
| Rate for Payer: PACE SWMI |
$341.98
|
| Rate for Payer: PHP Medicare Advantage |
$341.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$547.87
|
| Rate for Payer: Priority Health Medicare |
$341.98
|
| Rate for Payer: Priority Health Narrow Network |
$547.87
|
| Rate for Payer: Railroad Medicare Medicare |
$341.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$656.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$341.98
|
| Rate for Payer: UHC Exchange |
$656.90
|
| Rate for Payer: UHC Medicaid |
$220.46
|
| Rate for Payer: UHCCP DNSP |
$341.98
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$443.51 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Aetna Commercial |
$594.30
|
| Rate for Payer: Aetna Medicare |
$443.51
|
| Rate for Payer: BCBS MAPPO |
$443.51
|
| Rate for Payer: BCN Commercial |
$661.82
|
| Rate for Payer: BCN Medicare Advantage |
$443.51
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cofinity Commercial |
$638.65
|
| Rate for Payer: Cofinity Commercial |
$594.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.51
|
| Rate for Payer: Healthscope Commercial |
$532.21
|
| Rate for Payer: Healthscope Whirlpool |
$532.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$487.86
|
| Rate for Payer: Nomi Health Commercial |
$532.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.50
|
| Rate for Payer: PACE SWMI |
$443.51
|
| Rate for Payer: PHP Medicare Advantage |
$443.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$610.33
|
| Rate for Payer: Priority Health Medicare |
$443.51
|
| Rate for Payer: Priority Health Narrow Network |
$610.33
|
| Rate for Payer: Railroad Medicare Medicare |
$443.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$443.51
|
| Rate for Payer: UHC Exchange |
$622.75
|
| Rate for Payer: UHCCP DNSP |
$443.51
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,976.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: BCBS Complete |
$1,190.40
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,232.00
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$576.75 |
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.75
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$1,603.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$641.20 |
| Max. Negotiated Rate |
$1,202.25 |
| Rate for Payer: BCBS Complete |
$641.20
|
| Rate for Payer: BCBS Complete |
$1,278.00
|
| Rate for Payer: Cash Price |
$2,556.00
|
| Rate for Payer: Cash Price |
$1,282.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,202.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,396.25
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$164.64 |
| Rate for Payer: Aetna Commercial |
$118.24
|
| Rate for Payer: Aetna Medicare |
$88.24
|
| Rate for Payer: BCBS Complete |
$59.71
|
| Rate for Payer: BCBS MAPPO |
$88.24
|
| Rate for Payer: BCN Commercial |
$157.36
|
| Rate for Payer: BCN Medicare Advantage |
$88.24
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$127.07
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.24
|
| Rate for Payer: Healthscope Commercial |
$105.89
|
| Rate for Payer: Healthscope Whirlpool |
$105.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.65
|
| Rate for Payer: Meridian Medicaid |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.06
|
| Rate for Payer: Nomi Health Commercial |
$105.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$88.24
|
| Rate for Payer: PHP Medicare Advantage |
$88.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$145.11
|
| Rate for Payer: Priority Health Medicare |
$88.24
|
| Rate for Payer: Priority Health Narrow Network |
$145.11
|
| Rate for Payer: Railroad Medicare Medicare |
$88.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$88.24
|
| Rate for Payer: UHC Exchange |
$164.64
|
| Rate for Payer: UHC Medicaid |
$56.87
|
| Rate for Payer: UHCCP DNSP |
$88.24
|
| Rate for Payer: UHCCP Medicaid |
$56.87
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$215.79 |
| Rate for Payer: Aetna Commercial |
$147.92
|
| Rate for Payer: Aetna Medicare |
$110.39
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS MAPPO |
$110.39
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$110.39
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$158.96
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.39
|
| Rate for Payer: Healthscope Commercial |
$132.47
|
| Rate for Payer: Healthscope Whirlpool |
$132.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.91
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.43
|
| Rate for Payer: Nomi Health Commercial |
$132.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PACE SWMI |
$110.39
|
| Rate for Payer: PHP Medicare Advantage |
$110.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.33
|
| Rate for Payer: Priority Health Medicare |
$110.39
|
| Rate for Payer: Priority Health Narrow Network |
$182.33
|
| Rate for Payer: Railroad Medicare Medicare |
$110.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.39
|
| Rate for Payer: UHC Exchange |
$215.79
|
| Rate for Payer: UHC Medicaid |
$71.14
|
| Rate for Payer: UHCCP DNSP |
$110.39
|
| Rate for Payer: UHCCP Medicaid |
$71.14
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$255.09 |
| Rate for Payer: Aetna Commercial |
$177.50
|
| Rate for Payer: Aetna Medicare |
$132.46
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCBS MAPPO |
$132.46
|
| Rate for Payer: BCN Commercial |
$236.55
|
| Rate for Payer: BCN Medicare Advantage |
$132.46
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Cofinity Commercial |
$177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$158.95
|
| Rate for Payer: Healthscope Whirlpool |
$158.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.08
|
| Rate for Payer: Meridian Medicaid |
$89.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.71
|
| Rate for Payer: Nomi Health Commercial |
$158.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.75
|
| Rate for Payer: PACE SWMI |
$132.46
|
| Rate for Payer: PHP Medicare Advantage |
$132.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$218.15
|
| Rate for Payer: Priority Health Medicare |
$132.46
|
| Rate for Payer: Priority Health Narrow Network |
$218.15
|
| Rate for Payer: Railroad Medicare Medicare |
$132.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.46
|
| Rate for Payer: UHC Exchange |
$255.09
|
| Rate for Payer: UHC Medicaid |
$85.41
|
| Rate for Payer: UHCCP DNSP |
$132.46
|
| Rate for Payer: UHCCP Medicaid |
$85.41
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$334.11 |
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Medicare |
$169.83
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCBS MAPPO |
$169.83
|
| Rate for Payer: BCN Commercial |
$303.77
|
| Rate for Payer: BCN Medicare Advantage |
$169.83
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$244.56
|
| Rate for Payer: Cofinity Commercial |
$227.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.83
|
| Rate for Payer: Healthscope Commercial |
$203.80
|
| Rate for Payer: Healthscope Whirlpool |
$203.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.32
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.81
|
| Rate for Payer: Nomi Health Commercial |
$203.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.50
|
| Rate for Payer: PACE SWMI |
$169.83
|
| Rate for Payer: PHP Medicare Advantage |
$169.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$280.13
|
| Rate for Payer: Priority Health Medicare |
$169.83
|
| Rate for Payer: Priority Health Narrow Network |
$280.13
|
| Rate for Payer: Railroad Medicare Medicare |
$169.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.83
|
| Rate for Payer: UHC Exchange |
$334.11
|
| Rate for Payer: UHC Medicaid |
$109.48
|
| Rate for Payer: UHCCP DNSP |
$169.83
|
| Rate for Payer: UHCCP Medicaid |
$109.48
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$272.64
|
|
|
Service Code
|
NDC 904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$245.38
|
| Rate for Payer: Aetna Medicare |
$100.88
|
| Rate for Payer: ASR ASR |
$264.46
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: BCBS Trust/PPO |
$224.79
|
| Rate for Payer: BCN Commercial |
$224.79
|
| Rate for Payer: Cash Price |
$218.11
|
| Rate for Payer: Cofinity Commercial |
$256.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.11
|
| Rate for Payer: Healthscope Commercial |
$264.46
|
| Rate for Payer: Healthscope Whirlpool |
$272.64
|
| Rate for Payer: Mclaren Commercial |
$245.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.74
|
| Rate for Payer: Nomi Health Commercial |
$223.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$238.89
|
| Rate for Payer: Priority Health Narrow Network |
$191.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.92
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$272.64
|
|
|
Service Code
|
NDC 904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$245.38
|
| Rate for Payer: ASR ASR |
$264.46
|
| Rate for Payer: BCBS Trust/PPO |
$223.89
|
| Rate for Payer: BCN Commercial |
$223.89
|
| Rate for Payer: Cash Price |
$218.11
|
| Rate for Payer: Cofinity Commercial |
$256.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.11
|
| Rate for Payer: Healthscope Commercial |
$264.46
|
| Rate for Payer: Healthscope Whirlpool |
$272.64
|
| Rate for Payer: Mclaren Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.74
|
| Rate for Payer: Nomi Health Commercial |
$223.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.92
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.28
|
| Rate for Payer: BCN Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: BCBS Trust/PPO |
$206.94
|
| Rate for Payer: BCN Commercial |
$206.94
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$244.44
|
| Rate for Payer: Healthscope Whirlpool |
$252.00
|
| Rate for Payer: Mclaren Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.76
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$277.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$102.65
|
| Rate for Payer: ASR ASR |
$269.12
|
| Rate for Payer: BCBS Complete |
$110.98
|
| Rate for Payer: BCBS Trust/PPO |
$228.75
|
| Rate for Payer: BCN Commercial |
$228.75
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Commercial |
$260.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$269.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.44
|
| Rate for Payer: Mclaren Commercial |
$249.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Nomi Health Commercial |
$227.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$243.09
|
| Rate for Payer: Priority Health Narrow Network |
$194.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.15
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$277.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.08 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: ASR ASR |
$269.12
|
| Rate for Payer: BCBS Trust/PPO |
$227.83
|
| Rate for Payer: BCN Commercial |
$227.83
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Commercial |
$260.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$269.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.44
|
| Rate for Payer: Mclaren Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: Nomi Health Commercial |
$227.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.15
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: ASR ASR |
$2.69
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.77
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.43
|
| Rate for Payer: Priority Health Narrow Network |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.44
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
NDC 904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Medicare |
$93.24
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS Trust/PPO |
$207.77
|
| Rate for Payer: BCN Commercial |
$207.77
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$244.44
|
| Rate for Payer: Healthscope Whirlpool |
$252.00
|
| Rate for Payer: Mclaren Commercial |
$226.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.20
|
| Rate for Payer: Nomi Health Commercial |
$206.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.80
|
| Rate for Payer: Priority Health Narrow Network |
$176.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.76
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,455.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Aetna Commercial |
$261.39
|
| Rate for Payer: Aetna Medicare |
$195.07
|
| Rate for Payer: BCBS Complete |
$132.41
|
| Rate for Payer: BCBS MAPPO |
$195.07
|
| Rate for Payer: BCN Commercial |
$331.16
|
| Rate for Payer: BCN Medicare Advantage |
$195.07
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cofinity Commercial |
$280.90
|
| Rate for Payer: Cofinity Commercial |
$261.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$234.08
|
| Rate for Payer: Healthscope Whirlpool |
$234.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.82
|
| Rate for Payer: Meridian Medicaid |
$132.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.58
|
| Rate for Payer: Nomi Health Commercial |
$234.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,091.25
|
| Rate for Payer: PACE SWMI |
$195.07
|
| Rate for Payer: PHP Medicare Advantage |
$195.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$403.49
|
| Rate for Payer: Priority Health Medicare |
$195.07
|
| Rate for Payer: Priority Health Narrow Network |
$403.49
|
| Rate for Payer: Railroad Medicare Medicare |
$195.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$195.07
|
| Rate for Payer: UHC Exchange |
$396.06
|
| Rate for Payer: UHC Medicaid |
$126.10
|
| Rate for Payer: UHCCP DNSP |
$195.07
|
| Rate for Payer: UHCCP Medicaid |
$126.10
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,392.00 |
| Max. Negotiated Rate |
$1,856.00 |
| Rate for Payer: Aetna Commercial |
$1,670.40
|
| Rate for Payer: ASR ASR |
$1,800.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,524.15
|
| Rate for Payer: BCN Commercial |
$1,524.15
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$1,744.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Healthscope Commercial |
$1,800.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,856.00
|
| Rate for Payer: Mclaren Commercial |
$1,670.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Nomi Health Commercial |
$1,521.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$2,390.01 |
| Rate for Payer: Aetna Commercial |
$1,670.40
|
| Rate for Payer: Aetna Medicare |
$1,912.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: ASR ASR |
$1,800.32
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,530.27
|
| Rate for Payer: BCN Commercial |
$1,530.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$1,744.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Healthscope Commercial |
$1,800.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,856.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,912.01
|
| Rate for Payer: Mclaren Commercial |
$1,670.40
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$1,050.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.60
|
| Rate for Payer: Nomi Health Commercial |
$1,521.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Commercial |
$2,103.21
|
| Rate for Payer: PHP Medicaid |
$1,024.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,626.23
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,301.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP DNSP |
$1,912.01
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$179.75
|
| Rate for Payer: Aetna Medicare |
$134.14
|
| Rate for Payer: BCBS Complete |
$91.25
|
| Rate for Payer: BCBS MAPPO |
$134.14
|
| Rate for Payer: BCN Commercial |
$226.58
|
| Rate for Payer: BCN Medicare Advantage |
$134.14
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$193.16
|
| Rate for Payer: Cofinity Commercial |
$179.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.14
|
| Rate for Payer: Healthscope Commercial |
$160.97
|
| Rate for Payer: Healthscope Whirlpool |
$160.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.85
|
| Rate for Payer: Meridian Medicaid |
$91.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.55
|
| Rate for Payer: Nomi Health Commercial |
$160.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$134.14
|
| Rate for Payer: PHP Medicare Advantage |
$134.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$276.08
|
| Rate for Payer: Priority Health Medicare |
$134.14
|
| Rate for Payer: Priority Health Narrow Network |
$276.08
|
| Rate for Payer: Railroad Medicare Medicare |
$134.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.14
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$86.90
|
| Rate for Payer: UHCCP DNSP |
$134.14
|
| Rate for Payer: UHCCP Medicaid |
$86.90
|
|
