|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,889.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,155.60 |
| Max. Negotiated Rate |
$1,877.85 |
| Rate for Payer: Aetna Medicare |
$1,444.50
|
| Rate for Payer: BCBS Complete |
$1,155.60
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,877.85
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$298.80 |
| Max. Negotiated Rate |
$485.55 |
| Rate for Payer: Aetna Medicare |
$373.50
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$3,102.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$1,240.80 |
| Max. Negotiated Rate |
$2,016.30 |
| Rate for Payer: Aetna Medicare |
$1,551.00
|
| Rate for Payer: Aetna Medicare |
$778.00
|
| Rate for Payer: BCBS Complete |
$622.40
|
| Rate for Payer: BCBS Complete |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Cash Price |
$2,481.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$729.05 |
| Rate for Payer: Aetna Commercial |
$111.64
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS Trust/PPO |
$729.05
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.57
|
| Rate for Payer: Priority Health Narrow Network |
$141.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.52
|
| Rate for Payer: UHC Exchange |
$111.52
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$379.32 |
| Rate for Payer: Aetna Commercial |
$147.36
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: BCN Commercial |
$194.01
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.57
|
| Rate for Payer: Priority Health Narrow Network |
$179.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.42
|
| Rate for Payer: UHC Exchange |
$146.42
|
| Rate for Payer: UHCCP Medicaid |
$84.56
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$493.43 |
| Rate for Payer: Aetna Commercial |
$172.27
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: BCBS Complete |
$106.24
|
| Rate for Payer: BCBS Trust/PPO |
$493.43
|
| Rate for Payer: BCN Commercial |
$227.73
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Meridian Medicaid |
$106.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.39
|
| Rate for Payer: Priority Health Narrow Network |
$214.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.00
|
| Rate for Payer: UHC Exchange |
$173.00
|
| Rate for Payer: UHCCP Medicaid |
$101.18
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$226.36
|
| Rate for Payer: Aetna Medicare |
$212.50
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS Trust/PPO |
$399.39
|
| Rate for Payer: BCN Commercial |
$300.05
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.37
|
| Rate for Payer: Priority Health Narrow Network |
$276.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.74
|
| Rate for Payer: UHC Exchange |
$226.74
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 00904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.49 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.60
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: ASR Commercial |
$415.60
|
| Rate for Payer: BCBS Trust/PPO |
$349.14
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$428.45
|
| Rate for Payer: Healthscope Whirlpool |
$415.60
|
| Rate for Payer: Mclaren Commercial |
$385.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 00904700161
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.60
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: ASR Commercial |
$415.60
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Trust/PPO |
$350.86
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$428.45
|
| Rate for Payer: Healthscope Whirlpool |
$415.60
|
| Rate for Payer: Mclaren Commercial |
$385.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.41
|
| Rate for Payer: Priority Health Narrow Network |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
OP
|
$160.74
|
|
|
Service Code
|
NDC 69238131009
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.30 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$144.67
|
| Rate for Payer: Aetna Medicare |
$80.37
|
| Rate for Payer: ASR ASR |
$155.92
|
| Rate for Payer: ASR Commercial |
$155.92
|
| Rate for Payer: BCBS Complete |
$64.30
|
| Rate for Payer: BCBS Trust/PPO |
$131.63
|
| Rate for Payer: BCN Commercial |
$124.62
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Commercial |
$151.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Healthscope Whirlpool |
$155.92
|
| Rate for Payer: Mclaren Commercial |
$144.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.84
|
| Rate for Payer: Priority Health Narrow Network |
$112.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.45
|
|
|
PREGABALIN 25 MG CAPSULE
|
Facility
|
IP
|
$160.74
|
|
|
Service Code
|
NDC 69238131009
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.48 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$144.67
|
| Rate for Payer: ASR ASR |
$155.92
|
| Rate for Payer: ASR Commercial |
$155.92
|
| Rate for Payer: BCBS Trust/PPO |
$130.99
|
| Rate for Payer: BCN Commercial |
$124.62
|
| Rate for Payer: Cash Price |
$128.59
|
| Rate for Payer: Cofinity Commercial |
$151.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.59
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Healthscope Whirlpool |
$155.92
|
| Rate for Payer: Mclaren Commercial |
$144.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.63
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.45
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$265.44 |
| Rate for Payer: Aetna Commercial |
$238.90
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: ASR ASR |
$257.48
|
| Rate for Payer: ASR Commercial |
$257.48
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: BCBS Trust/PPO |
$217.37
|
| Rate for Payer: BCN Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$249.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$265.44
|
| Rate for Payer: Healthscope Whirlpool |
$257.48
|
| Rate for Payer: Mclaren Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Nomi Health Commercial |
$217.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.58
|
| Rate for Payer: Priority Health Narrow Network |
$186.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.59
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$265.44 |
| Rate for Payer: Aetna Commercial |
$238.90
|
| Rate for Payer: ASR ASR |
$257.48
|
| Rate for Payer: ASR Commercial |
$257.48
|
| Rate for Payer: BCBS Trust/PPO |
$216.31
|
| Rate for Payer: BCN Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$249.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$265.44
|
| Rate for Payer: Healthscope Whirlpool |
$257.48
|
| Rate for Payer: Mclaren Commercial |
$238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Nomi Health Commercial |
$217.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.59
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna Commercial |
$354.82
|
| Rate for Payer: Aetna Medicare |
$197.12
|
| Rate for Payer: ASR ASR |
$382.42
|
| Rate for Payer: ASR Commercial |
$382.42
|
| Rate for Payer: BCBS Complete |
$157.70
|
| Rate for Payer: BCBS Trust/PPO |
$322.85
|
| Rate for Payer: BCN Commercial |
$305.66
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$370.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$394.25
|
| Rate for Payer: Healthscope Whirlpool |
$382.42
|
| Rate for Payer: Mclaren Commercial |
$354.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: Nomi Health Commercial |
$323.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.44
|
| Rate for Payer: Priority Health Narrow Network |
$276.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.94
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$394.25
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.26 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna Commercial |
$354.82
|
| Rate for Payer: ASR ASR |
$382.42
|
| Rate for Payer: ASR Commercial |
$382.42
|
| Rate for Payer: BCBS Trust/PPO |
$321.27
|
| Rate for Payer: BCN Commercial |
$305.66
|
| Rate for Payer: Cash Price |
$315.40
|
| Rate for Payer: Cofinity Commercial |
$370.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.40
|
| Rate for Payer: Healthscope Commercial |
$394.25
|
| Rate for Payer: Healthscope Whirlpool |
$382.42
|
| Rate for Payer: Mclaren Commercial |
$354.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.11
|
| Rate for Payer: Nomi Health Commercial |
$323.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.94
|
|
|
PREGABALIN 75 MG CAPSULE
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 60687049511
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
|
Professional
|
Both
|
$1,413.00
|
|
|
Service Code
|
HCPCS 43270
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$1,076.07 |
| Rate for Payer: Aetna Commercial |
$298.44
|
| Rate for Payer: Aetna Medicare |
$706.50
|
| Rate for Payer: BCBS Complete |
$148.73
|
| Rate for Payer: BCBS Trust/PPO |
$724.83
|
| Rate for Payer: BCN Commercial |
$1,076.07
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Meridian Medicaid |
$148.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.35
|
| Rate for Payer: Priority Health Narrow Network |
$394.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.76
|
| Rate for Payer: UHC Exchange |
$323.76
|
| Rate for Payer: UHCCP Medicaid |
$141.65
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$204.01
|
| Rate for Payer: Aetna Medicare |
$901.00
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.86
|
| Rate for Payer: Priority Health Narrow Network |
$270.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.75
|
| Rate for Payer: UHC Exchange |
$218.75
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$204.01
|
| Rate for Payer: Aetna Medicare |
$901.00
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS Trust/PPO |
$845.81
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.86
|
| Rate for Payer: Priority Health Narrow Network |
$270.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.75
|
| Rate for Payer: UHC Exchange |
$218.75
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,171.30 |
| Max. Negotiated Rate |
$1,802.00 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: ASR ASR |
$1,747.94
|
| Rate for Payer: ASR Commercial |
$1,747.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.45
|
| Rate for Payer: BCN Commercial |
$1,397.09
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,693.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Healthscope Commercial |
$1,802.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,747.94
|
| Rate for Payer: Mclaren Commercial |
$1,621.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: Nomi Health Commercial |
$1,477.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,585.76
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
43249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$996.23 |
| Max. Negotiated Rate |
$2,880.88 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Medicare |
$1,858.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: ASR ASR |
$1,747.94
|
| Rate for Payer: ASR Commercial |
$1,747.94
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,475.66
|
| Rate for Payer: BCN Commercial |
$1,397.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,693.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Healthscope Commercial |
$1,802.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,747.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,858.63
|
| Rate for Payer: Mclaren Commercial |
$1,621.80
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: Nomi Health Commercial |
$1,477.64
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Commercial |
$2,044.49
|
| Rate for Payer: PHP Medicaid |
$996.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,578.91
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,263.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,585.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$2,880.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP DNSP |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$996.23
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43244
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$325.46
|
| Rate for Payer: Aetna Medicare |
$568.50
|
| Rate for Payer: BCBS Complete |
$161.70
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Meridian Medicaid |
$161.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.75
|
| Rate for Payer: Priority Health Narrow Network |
$430.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.76
|
| Rate for Payer: UHC Exchange |
$372.76
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
|
|
PR EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
|
Professional
|
Both
|
$587.00
|
|
|
Service Code
|
HCPCS 43257
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$850.03 |
| Rate for Payer: Aetna Commercial |
$308.63
|
| Rate for Payer: Aetna Medicare |
$293.50
|
| Rate for Payer: BCBS Complete |
$153.65
|
| Rate for Payer: BCBS Trust/PPO |
$850.03
|
| Rate for Payer: BCN Commercial |
$332.79
|
| Rate for Payer: Cash Price |
$469.60
|
| Rate for Payer: Cash Price |
$469.60
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.25
|
| Rate for Payer: Priority Health Narrow Network |
$412.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$398.24
|
| Rate for Payer: UHC Exchange |
$398.24
|
| Rate for Payer: UHCCP Medicaid |
$146.33
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
HCPCS 43245
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$876.69 |
| Rate for Payer: Aetna Commercial |
$234.83
|
| Rate for Payer: Aetna Medicare |
$506.50
|
| Rate for Payer: BCBS Complete |
$117.19
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$876.69
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Cash Price |
$810.40
|
| Rate for Payer: Meridian Medicaid |
$117.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.63
|
| Rate for Payer: Priority Health Narrow Network |
$309.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.43
|
| Rate for Payer: UHC Exchange |
$236.43
|
| Rate for Payer: UHCCP Medicaid |
$111.61
|
|
