|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
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
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$878.25 |
| Rate for Payer: Aetna Commercial |
$284.82
|
| Rate for Payer: Aetna Medicare |
$212.55
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$212.55
|
| Rate for Payer: BCN Commercial |
$360.04
|
| Rate for Payer: BCN Medicare Advantage |
$212.55
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cofinity Commercial |
$306.07
|
| Rate for Payer: Cofinity Commercial |
$284.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.55
|
| Rate for Payer: Healthscope Commercial |
$255.06
|
| Rate for Payer: Healthscope Whirlpool |
$255.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.18
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.81
|
| Rate for Payer: Nomi Health Commercial |
$255.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$878.25
|
| Rate for Payer: PACE SWMI |
$212.55
|
| Rate for Payer: PHP Medicare Advantage |
$212.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$438.69
|
| Rate for Payer: Priority Health Medicare |
$212.55
|
| Rate for Payer: Priority Health Narrow Network |
$438.69
|
| Rate for Payer: Railroad Medicare Medicare |
$212.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.55
|
| Rate for Payer: UHC Exchange |
$432.77
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP DNSP |
$212.55
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$270.20
|
| Rate for Payer: Aetna Medicare |
$201.64
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$201.64
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: BCN Medicare Advantage |
$201.64
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$290.36
|
| Rate for Payer: Cofinity Commercial |
$270.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.64
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Healthscope Whirlpool |
$241.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.72
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.80
|
| Rate for Payer: Nomi Health Commercial |
$241.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$453.75
|
| Rate for Payer: PACE SWMI |
$201.64
|
| Rate for Payer: PHP Medicare Advantage |
$201.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$416.84
|
| Rate for Payer: Priority Health Medicare |
$201.64
|
| Rate for Payer: Priority Health Narrow Network |
$416.84
|
| Rate for Payer: Railroad Medicare Medicare |
$201.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.64
|
| Rate for Payer: UHC Exchange |
$412.22
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP DNSP |
$201.64
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$782.25 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Medicare |
$155.07
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS MAPPO |
$155.07
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Medicare Advantage |
$155.07
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Cofinity Commercial |
$223.30
|
| Rate for Payer: Cofinity Commercial |
$207.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.07
|
| Rate for Payer: Healthscope Commercial |
$186.08
|
| Rate for Payer: Healthscope Whirlpool |
$186.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.82
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.58
|
| Rate for Payer: Nomi Health Commercial |
$186.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.25
|
| Rate for Payer: PACE SWMI |
$155.07
|
| Rate for Payer: PHP Medicare Advantage |
$155.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$317.95
|
| Rate for Payer: Priority Health Medicare |
$155.07
|
| Rate for Payer: Priority Health Narrow Network |
$317.95
|
| Rate for Payer: Railroad Medicare Medicare |
$155.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.07
|
| Rate for Payer: UHC Exchange |
$310.49
|
| Rate for Payer: UHC Medicaid |
$100.11
|
| Rate for Payer: UHCCP DNSP |
$155.07
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
|
|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$122.69 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna Commercial |
$254.88
|
| Rate for Payer: Aetna Medicare |
$190.21
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCN Commercial |
$320.70
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cofinity Commercial |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$254.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.21
|
| Rate for Payer: Healthscope Commercial |
$228.25
|
| Rate for Payer: Healthscope Whirlpool |
$228.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$128.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$209.23
|
| Rate for Payer: Nomi Health Commercial |
$228.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.00
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$390.75
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$390.75
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$190.21
|
| Rate for Payer: UHC Exchange |
$384.87
|
| Rate for Payer: UHC Medicaid |
$122.69
|
| Rate for Payer: UHCCP DNSP |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$122.69
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Aetna Commercial |
$271.12
|
| Rate for Payer: Aetna Medicare |
$202.33
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$202.33
|
| Rate for Payer: BCN Commercial |
$338.13
|
| Rate for Payer: BCN Medicare Advantage |
$202.33
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cofinity Commercial |
$291.36
|
| Rate for Payer: Cofinity Commercial |
$271.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.33
|
| Rate for Payer: Healthscope Commercial |
$242.80
|
| Rate for Payer: Healthscope Whirlpool |
$242.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.45
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$222.56
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$802.50
|
| Rate for Payer: PACE SWMI |
$202.33
|
| Rate for Payer: PHP Medicare Advantage |
$202.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$411.98
|
| Rate for Payer: Priority Health Medicare |
$202.33
|
| Rate for Payer: Priority Health Narrow Network |
$411.98
|
| Rate for Payer: Railroad Medicare Medicare |
$202.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$202.33
|
| Rate for Payer: UHC Exchange |
$405.11
|
| Rate for Payer: UHC Medicaid |
$130.14
|
| Rate for Payer: UHCCP DNSP |
$202.33
|
| Rate for Payer: UHCCP Medicaid |
$130.14
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna Commercial |
$207.94
|
| Rate for Payer: Aetna Medicare |
$155.18
|
| Rate for Payer: BCBS Complete |
$105.34
|
| Rate for Payer: BCBS MAPPO |
$155.18
|
| Rate for Payer: BCN Commercial |
$260.44
|
| Rate for Payer: BCN Medicare Advantage |
$155.18
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$223.46
|
| Rate for Payer: Cofinity Commercial |
$207.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.18
|
| Rate for Payer: Healthscope Commercial |
$186.22
|
| Rate for Payer: Healthscope Whirlpool |
$186.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.94
|
| Rate for Payer: Meridian Medicaid |
$105.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.70
|
| Rate for Payer: Nomi Health Commercial |
$186.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: PACE SWMI |
$155.18
|
| Rate for Payer: PHP Medicare Advantage |
$155.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$317.33
|
| Rate for Payer: Priority Health Medicare |
$155.18
|
| Rate for Payer: Priority Health Narrow Network |
$317.33
|
| Rate for Payer: Railroad Medicare Medicare |
$155.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.18
|
| Rate for Payer: UHC Exchange |
$312.21
|
| Rate for Payer: UHC Medicaid |
$100.32
|
| Rate for Payer: UHCCP DNSP |
$155.18
|
| Rate for Payer: UHCCP Medicaid |
$100.32
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$1,129.65 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Medicare |
$903.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: ASR ASR |
$985.52
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$837.69
|
| Rate for Payer: BCN Commercial |
$837.69
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$955.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$812.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$985.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$903.72
|
| Rate for Payer: Mclaren Commercial |
$914.40
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$496.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.60
|
| Rate for Payer: Nomi Health Commercial |
$833.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$994.09
|
| Rate for Payer: PHP Medicaid |
$484.39
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$890.22
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Narrow Network |
$712.22
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP DNSP |
$903.72
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$762.00 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: ASR ASR |
$985.52
|
| Rate for Payer: BCBS Trust/PPO |
$834.34
|
| Rate for Payer: BCN Commercial |
$834.34
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$955.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$812.80
|
| Rate for Payer: Healthscope Commercial |
$985.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.00
|
| Rate for Payer: Mclaren Commercial |
$914.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.60
|
| Rate for Payer: Nomi Health Commercial |
$833.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 43247
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna Commercial |
$207.94
|
| Rate for Payer: Aetna Medicare |
$155.18
|
| Rate for Payer: BCBS Complete |
$105.34
|
| Rate for Payer: BCBS MAPPO |
$155.18
|
| Rate for Payer: BCN Commercial |
$260.44
|
| Rate for Payer: BCN Medicare Advantage |
$155.18
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$207.94
|
| Rate for Payer: Cofinity Commercial |
$223.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.18
|
| Rate for Payer: Healthscope Commercial |
$186.22
|
| Rate for Payer: Healthscope Whirlpool |
$186.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.94
|
| Rate for Payer: Meridian Medicaid |
$105.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.70
|
| Rate for Payer: Nomi Health Commercial |
$186.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: PACE SWMI |
$155.18
|
| Rate for Payer: PHP Medicare Advantage |
$155.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$317.33
|
| Rate for Payer: Priority Health Medicare |
$155.18
|
| Rate for Payer: Priority Health Narrow Network |
$317.33
|
| Rate for Payer: Railroad Medicare Medicare |
$155.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.18
|
| Rate for Payer: UHC Exchange |
$312.21
|
| Rate for Payer: UHC Medicaid |
$100.32
|
| Rate for Payer: UHCCP DNSP |
$155.18
|
| Rate for Payer: UHCCP Medicaid |
$100.32
|
|
|
PR EGD FLEXIBLE TRANSNASAL W/INSJ INTRAL TUBE/CATH
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 0654T
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$249.13 |
| Rate for Payer: Aetna Commercial |
$143.60
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.13
|
| Rate for Payer: UHC Exchange |
$249.13
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43250
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$202.10
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$150.82
|
| Rate for Payer: BCN Commercial |
$251.98
|
| Rate for Payer: BCN Medicare Advantage |
$150.82
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$217.18
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.82
|
| Rate for Payer: Healthscope Commercial |
$180.98
|
| Rate for Payer: Healthscope Whirlpool |
$180.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.36
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$165.90
|
| Rate for Payer: Nomi Health Commercial |
$180.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: PACE SWMI |
$150.82
|
| Rate for Payer: PHP Medicare Advantage |
$150.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$307.01
|
| Rate for Payer: Priority Health Medicare |
$150.82
|
| Rate for Payer: Priority Health Narrow Network |
$307.01
|
| Rate for Payer: Railroad Medicare Medicare |
$150.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$150.82
|
| Rate for Payer: UHC Exchange |
$302.01
|
| Rate for Payer: UHC Medicaid |
$97.34
|
| Rate for Payer: UHCCP DNSP |
$150.82
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$797.04 |
| Max. Negotiated Rate |
$2,390.01 |
| Rate for Payer: Aetna Commercial |
$1,023.30
|
| 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 |
$1,102.89
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$937.46
|
| Rate for Payer: BCN Commercial |
$937.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$1,068.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Healthscope Commercial |
$1,102.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,137.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,912.01
|
| Rate for Payer: Mclaren Commercial |
$1,023.30
|
| 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 |
$966.45
|
| Rate for Payer: Nomi Health Commercial |
$932.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| 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 |
$996.24
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Narrow Network |
$797.04
|
| 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 FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$852.75 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Aetna Commercial |
$1,023.30
|
| Rate for Payer: ASR ASR |
$1,102.89
|
| Rate for Payer: BCBS Trust/PPO |
$933.70
|
| Rate for Payer: BCN Commercial |
$933.70
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$1,068.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$909.60
|
| Rate for Payer: Healthscope Commercial |
$1,102.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,137.00
|
| Rate for Payer: Mclaren Commercial |
$1,023.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$966.45
|
| Rate for Payer: Nomi Health Commercial |
$932.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
43250
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$202.10
|
| Rate for Payer: Aetna Medicare |
$150.82
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$150.82
|
| Rate for Payer: BCN Commercial |
$251.98
|
| Rate for Payer: BCN Medicare Advantage |
$150.82
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$217.18
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.82
|
| Rate for Payer: Healthscope Commercial |
$180.98
|
| Rate for Payer: Healthscope Whirlpool |
$180.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.36
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$165.90
|
| Rate for Payer: Nomi Health Commercial |
$180.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: PACE SWMI |
$150.82
|
| Rate for Payer: PHP Medicare Advantage |
$150.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$307.01
|
| Rate for Payer: Priority Health Medicare |
$150.82
|
| Rate for Payer: Priority Health Narrow Network |
$307.01
|
| Rate for Payer: Railroad Medicare Medicare |
$150.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$150.82
|
| Rate for Payer: UHC Exchange |
$302.01
|
| Rate for Payer: UHC Medicaid |
$97.34
|
| Rate for Payer: UHCCP DNSP |
$150.82
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 43243
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna Commercial |
$277.13
|
| Rate for Payer: Aetna Medicare |
$206.81
|
| Rate for Payer: BCBS Complete |
$140.01
|
| Rate for Payer: BCBS MAPPO |
$206.81
|
| Rate for Payer: BCN Commercial |
$350.58
|
| Rate for Payer: BCN Medicare Advantage |
$206.81
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cofinity Commercial |
$297.81
|
| Rate for Payer: Cofinity Commercial |
$277.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.81
|
| Rate for Payer: Healthscope Commercial |
$248.17
|
| Rate for Payer: Healthscope Whirlpool |
$248.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.15
|
| Rate for Payer: Meridian Medicaid |
$140.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$227.49
|
| Rate for Payer: Nomi Health Commercial |
$248.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$930.00
|
| Rate for Payer: PACE SWMI |
$206.81
|
| Rate for Payer: PHP Medicare Advantage |
$206.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$427.16
|
| Rate for Payer: Priority Health Medicare |
$206.81
|
| Rate for Payer: Priority Health Narrow Network |
$427.16
|
| Rate for Payer: Railroad Medicare Medicare |
$206.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$206.81
|
| Rate for Payer: UHC Exchange |
$418.91
|
| Rate for Payer: UHC Medicaid |
$133.34
|
| Rate for Payer: UHCCP DNSP |
$206.81
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$683.25 |
| Max. Negotiated Rate |
$911.00 |
| Rate for Payer: Aetna Commercial |
$819.90
|
| Rate for Payer: ASR ASR |
$883.67
|
| Rate for Payer: BCBS Trust/PPO |
$748.11
|
| Rate for Payer: BCN Commercial |
$748.11
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$856.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.80
|
| Rate for Payer: Healthscope Commercial |
$883.67
|
| Rate for Payer: Healthscope Whirlpool |
$911.00
|
| Rate for Payer: Mclaren Commercial |
$819.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.35
|
| Rate for Payer: Nomi Health Commercial |
$747.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 43248
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Aetna Commercial |
$195.37
|
| Rate for Payer: Aetna Medicare |
$145.80
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCBS MAPPO |
$145.80
|
| Rate for Payer: BCN Commercial |
$245.01
|
| Rate for Payer: BCN Medicare Advantage |
$145.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$209.95
|
| Rate for Payer: Cofinity Commercial |
$195.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.80
|
| Rate for Payer: Healthscope Commercial |
$174.96
|
| Rate for Payer: Healthscope Whirlpool |
$174.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.09
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.38
|
| Rate for Payer: Nomi Health Commercial |
$174.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: PACE SWMI |
$145.80
|
| Rate for Payer: PHP Medicare Advantage |
$145.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$298.52
|
| Rate for Payer: Priority Health Medicare |
$145.80
|
| Rate for Payer: Priority Health Narrow Network |
$298.52
|
| Rate for Payer: Railroad Medicare Medicare |
$145.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.80
|
| Rate for Payer: UHC Exchange |
$291.87
|
| Rate for Payer: UHC Medicaid |
$94.36
|
| Rate for Payer: UHCCP DNSP |
$145.80
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
43248
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Aetna Commercial |
$195.37
|
| Rate for Payer: Aetna Medicare |
$145.80
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCBS MAPPO |
$145.80
|
| Rate for Payer: BCN Commercial |
$245.01
|
| Rate for Payer: BCN Medicare Advantage |
$145.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$209.95
|
| Rate for Payer: Cofinity Commercial |
$195.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.80
|
| Rate for Payer: Healthscope Commercial |
$174.96
|
| Rate for Payer: Healthscope Whirlpool |
$174.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.09
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.38
|
| Rate for Payer: Nomi Health Commercial |
$174.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: PACE SWMI |
$145.80
|
| Rate for Payer: PHP Medicare Advantage |
$145.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$298.52
|
| Rate for Payer: Priority Health Medicare |
$145.80
|
| Rate for Payer: Priority Health Narrow Network |
$298.52
|
| Rate for Payer: Railroad Medicare Medicare |
$145.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.80
|
| Rate for Payer: UHC Exchange |
$291.87
|
| Rate for Payer: UHC Medicaid |
$94.36
|
| Rate for Payer: UHCCP DNSP |
$145.80
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$1,129.65 |
| Rate for Payer: Aetna Commercial |
$819.90
|
| Rate for Payer: Aetna Medicare |
$903.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: ASR ASR |
$883.67
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$751.12
|
| Rate for Payer: BCN Commercial |
$751.12
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$856.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$883.67
|
| Rate for Payer: Healthscope Whirlpool |
$911.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$903.72
|
| Rate for Payer: Mclaren Commercial |
$819.90
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$496.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.35
|
| Rate for Payer: Nomi Health Commercial |
$747.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$994.09
|
| Rate for Payer: PHP Medicaid |
$484.39
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$798.22
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health Narrow Network |
$638.61
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP DNSP |
$903.72
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
PR EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 43241
|
| Min. Negotiated Rate |
$80.94 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Aetna Commercial |
$167.65
|
| Rate for Payer: Aetna Medicare |
$125.11
|
| Rate for Payer: BCBS Complete |
$84.99
|
| Rate for Payer: BCBS MAPPO |
$125.11
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: BCN Medicare Advantage |
$125.11
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$180.16
|
| Rate for Payer: Cofinity Commercial |
$167.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$150.13
|
| Rate for Payer: Healthscope Whirlpool |
$150.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.37
|
| Rate for Payer: Meridian Medicaid |
$84.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$137.62
|
| Rate for Payer: Nomi Health Commercial |
$150.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.25
|
| Rate for Payer: PACE SWMI |
$125.11
|
| Rate for Payer: PHP Medicare Advantage |
$125.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$256.67
|
| Rate for Payer: Priority Health Medicare |
$125.11
|
| Rate for Payer: Priority Health Narrow Network |
$256.67
|
| Rate for Payer: Railroad Medicare Medicare |
$125.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.11
|
| Rate for Payer: UHC Exchange |
$249.78
|
| Rate for Payer: UHC Medicaid |
$80.94
|
| Rate for Payer: UHCCP DNSP |
$125.11
|
| Rate for Payer: UHCCP Medicaid |
$80.94
|
|
|
PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY
|
Professional
|
Both
|
$1,064.00
|
|
|
Service Code
|
HCPCS 43242
|
| Min. Negotiated Rate |
$146.54 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna Commercial |
$303.83
|
| Rate for Payer: Aetna Medicare |
$226.74
|
| Rate for Payer: BCBS Complete |
$153.87
|
| Rate for Payer: BCBS MAPPO |
$226.74
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: BCN Medicare Advantage |
$226.74
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cofinity Commercial |
$326.51
|
| Rate for Payer: Cofinity Commercial |
$303.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.74
|
| Rate for Payer: Healthscope Commercial |
$272.09
|
| Rate for Payer: Healthscope Whirlpool |
$272.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.08
|
| Rate for Payer: Meridian Medicaid |
$153.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$249.41
|
| Rate for Payer: Nomi Health Commercial |
$272.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.00
|
| Rate for Payer: PACE SWMI |
$226.74
|
| Rate for Payer: PHP Medicare Advantage |
$226.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$470.25
|
| Rate for Payer: Priority Health Medicare |
$226.74
|
| Rate for Payer: Priority Health Narrow Network |
$470.25
|
| Rate for Payer: Railroad Medicare Medicare |
$226.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$226.74
|
| Rate for Payer: UHC Exchange |
$463.36
|
| Rate for Payer: UHC Medicaid |
$146.54
|
| Rate for Payer: UHCCP DNSP |
$226.74
|
| Rate for Payer: UHCCP Medicaid |
$146.54
|
|
|
PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 43238
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: Aetna Commercial |
$270.14
|
| Rate for Payer: Aetna Medicare |
$201.60
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$201.60
|
| Rate for Payer: BCN Commercial |
$342.61
|
| Rate for Payer: BCN Medicare Advantage |
$201.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$290.30
|
| Rate for Payer: Cofinity Commercial |
$270.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$241.92
|
| Rate for Payer: Healthscope Whirlpool |
$241.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.68
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.76
|
| Rate for Payer: Nomi Health Commercial |
$241.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$800.25
|
| Rate for Payer: PACE SWMI |
$201.60
|
| Rate for Payer: PHP Medicare Advantage |
$201.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$417.44
|
| Rate for Payer: Priority Health Medicare |
$201.60
|
| Rate for Payer: Priority Health Narrow Network |
$417.44
|
| Rate for Payer: Railroad Medicare Medicare |
$201.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.60
|
| Rate for Payer: UHC Exchange |
$409.49
|
| Rate for Payer: UHC Medicaid |
$130.36
|
| Rate for Payer: UHCCP DNSP |
$201.60
|
| Rate for Payer: UHCCP Medicaid |
$130.36
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
43246
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,116.75 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$1,340.10
|
| Rate for Payer: ASR ASR |
$1,444.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.77
|
| Rate for Payer: BCN Commercial |
$1,222.77
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cofinity Commercial |
$1,399.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,191.20
|
| Rate for Payer: Healthscope Commercial |
$1,444.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,489.00
|
| Rate for Payer: Mclaren Commercial |
$1,340.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,265.65
|
| Rate for Payer: Nomi Health Commercial |
$1,220.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,116.75
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$1,116.75 |
| Rate for Payer: Aetna Commercial |
$236.84
|
| Rate for Payer: Aetna Medicare |
$176.75
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCBS MAPPO |
$176.75
|
| Rate for Payer: BCN Commercial |
$295.80
|
| Rate for Payer: BCN Medicare Advantage |
$176.75
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cofinity Commercial |
$254.52
|
| Rate for Payer: Cofinity Commercial |
$236.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.75
|
| Rate for Payer: Healthscope Commercial |
$212.10
|
| Rate for Payer: Healthscope Whirlpool |
$212.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.59
|
| Rate for Payer: Meridian Medicaid |
$119.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.43
|
| Rate for Payer: Nomi Health Commercial |
$212.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,116.75
|
| Rate for Payer: PACE SWMI |
$176.75
|
| Rate for Payer: PHP Medicare Advantage |
$176.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$360.42
|
| Rate for Payer: Priority Health Medicare |
$176.75
|
| Rate for Payer: Priority Health Narrow Network |
$360.42
|
| Rate for Payer: Railroad Medicare Medicare |
$176.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.75
|
| Rate for Payer: UHC Exchange |
$354.94
|
| Rate for Payer: UHC Medicaid |
$113.74
|
| Rate for Payer: UHCCP DNSP |
$176.75
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
|
