|
PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 43266
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$1,452.30 |
| Rate for Payer: Aetna Commercial |
$289.61
|
| Rate for Payer: Aetna Medicare |
$345.50
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.30
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.02
|
| Rate for Payer: Priority Health Narrow Network |
$383.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.40
|
| Rate for Payer: UHC Exchange |
$308.40
|
| Rate for Payer: UHCCP Medicaid |
$137.17
|
|
|
PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 43233
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$306.04
|
| Rate for Payer: Aetna Medicare |
$519.50
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$327.90
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.90
|
| Rate for Payer: Priority Health Narrow Network |
$403.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.13
|
| Rate for Payer: UHC Exchange |
$309.13
|
| Rate for Payer: UHCCP Medicaid |
$144.63
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: ASR ASR |
$956.42
|
| Rate for Payer: ASR Commercial |
$956.42
|
| Rate for Payer: BCBS Trust/PPO |
$803.49
|
| Rate for Payer: BCN Commercial |
$764.45
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$926.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Healthscope Commercial |
$986.00
|
| Rate for Payer: Healthscope Whirlpool |
$956.42
|
| Rate for Payer: Mclaren Commercial |
$887.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: Nomi Health Commercial |
$808.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$867.68
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 43247
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$235.23
|
| Rate for Payer: Aetna Medicare |
$493.00
|
| Rate for Payer: BCBS Complete |
$116.97
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$563.45
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Meridian Medicaid |
$116.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.42
|
| Rate for Payer: Priority Health Narrow Network |
$311.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.35
|
| Rate for Payer: UHC Exchange |
$252.35
|
| Rate for Payer: UHCCP Medicaid |
$111.40
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$492.37 |
| Max. Negotiated Rate |
$1,423.83 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: Aetna Medicare |
$918.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: ASR ASR |
$956.42
|
| Rate for Payer: ASR Commercial |
$956.42
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$807.44
|
| Rate for Payer: BCN Commercial |
$764.45
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cofinity Commercial |
$926.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$788.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$986.00
|
| Rate for Payer: Healthscope Whirlpool |
$956.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$918.60
|
| Rate for Payer: Mclaren Commercial |
$887.40
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.10
|
| Rate for Payer: Nomi Health Commercial |
$808.52
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,010.46
|
| Rate for Payer: PHP Medicaid |
$492.37
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$863.93
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$691.19
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$867.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$1,423.83
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP DNSP |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Aetna Commercial |
$235.23
|
| Rate for Payer: Aetna Medicare |
$493.00
|
| Rate for Payer: BCBS Complete |
$116.97
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$563.45
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Meridian Medicaid |
$116.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.42
|
| Rate for Payer: Priority Health Narrow Network |
$311.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.35
|
| Rate for Payer: UHC Exchange |
$252.35
|
| Rate for Payer: UHCCP Medicaid |
$111.40
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
43250
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$940.37 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: Aetna Medicare |
$552.00
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: BCN Commercial |
$664.11
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.09
|
| Rate for Payer: Priority Health Narrow Network |
$300.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.40
|
| Rate for Payer: UHC Exchange |
$237.40
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$717.60 |
| Max. Negotiated Rate |
$2,880.88 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| 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 |
$1,070.88
|
| Rate for Payer: ASR Commercial |
$1,070.88
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$904.07
|
| Rate for Payer: BCN Commercial |
$855.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$1,037.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Healthscope Commercial |
$1,104.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,858.63
|
| Rate for Payer: Mclaren Commercial |
$993.60
|
| 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 |
$938.40
|
| Rate for Payer: Nomi Health Commercial |
$905.28
|
| 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 |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$967.32
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$773.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.52
|
| 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 FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43250
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$940.37 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: Aetna Medicare |
$552.00
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS Trust/PPO |
$940.37
|
| Rate for Payer: BCN Commercial |
$664.11
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.09
|
| Rate for Payer: Priority Health Narrow Network |
$300.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.40
|
| Rate for Payer: UHC Exchange |
$237.40
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
43250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$717.60 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: ASR ASR |
$1,070.88
|
| Rate for Payer: ASR Commercial |
$1,070.88
|
| Rate for Payer: BCBS Trust/PPO |
$899.65
|
| Rate for Payer: BCN Commercial |
$855.93
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$1,037.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$883.20
|
| Rate for Payer: Healthscope Commercial |
$1,104.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.88
|
| Rate for Payer: Mclaren Commercial |
$993.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$938.40
|
| Rate for Payer: Nomi Health Commercial |
$905.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.52
|
|
|
PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 43243
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$315.11
|
| Rate for Payer: Aetna Medicare |
$602.00
|
| Rate for Payer: BCBS Complete |
$157.45
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$340.12
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Meridian Medicaid |
$157.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.22
|
| Rate for Payer: Priority Health Narrow Network |
$418.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.56
|
| Rate for Payer: UHC Exchange |
$337.56
|
| Rate for Payer: UHCCP Medicaid |
$149.95
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 43248
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$607.43 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$442.00
|
| Rate for Payer: BCBS Complete |
$110.04
|
| Rate for Payer: BCBS Trust/PPO |
$120.98
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Meridian Medicaid |
$110.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.92
|
| Rate for Payer: Priority Health Narrow Network |
$292.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.04
|
| Rate for Payer: UHC Exchange |
$237.04
|
| Rate for Payer: UHCCP Medicaid |
$104.80
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$492.37 |
| Max. Negotiated Rate |
$1,423.83 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: Aetna Medicare |
$918.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: ASR ASR |
$857.48
|
| Rate for Payer: ASR Commercial |
$857.48
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$723.91
|
| Rate for Payer: BCN Commercial |
$685.37
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$830.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$884.00
|
| Rate for Payer: Healthscope Whirlpool |
$857.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$918.60
|
| Rate for Payer: Mclaren Commercial |
$795.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.40
|
| Rate for Payer: Nomi Health Commercial |
$724.88
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,010.46
|
| Rate for Payer: PHP Medicaid |
$492.37
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$774.56
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$619.68
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$777.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$1,423.83
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP DNSP |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
43248
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: ASR ASR |
$857.48
|
| Rate for Payer: ASR Commercial |
$857.48
|
| Rate for Payer: BCBS Trust/PPO |
$720.37
|
| Rate for Payer: BCN Commercial |
$685.37
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$830.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.20
|
| Rate for Payer: Healthscope Commercial |
$884.00
|
| Rate for Payer: Healthscope Whirlpool |
$857.48
|
| Rate for Payer: Mclaren Commercial |
$795.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.40
|
| Rate for Payer: Nomi Health Commercial |
$724.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$777.92
|
|
|
PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
43248
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$607.43 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$442.00
|
| Rate for Payer: BCBS Complete |
$110.04
|
| Rate for Payer: BCBS Trust/PPO |
$120.98
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Meridian Medicaid |
$110.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.92
|
| Rate for Payer: Priority Health Narrow Network |
$292.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.04
|
| Rate for Payer: UHC Exchange |
$237.04
|
| Rate for Payer: UHCCP Medicaid |
$104.80
|
|
|
PR EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 43241
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$567.45 |
| Rate for Payer: Aetna Commercial |
$188.57
|
| Rate for Payer: Aetna Medicare |
$436.50
|
| Rate for Payer: BCBS Complete |
$94.60
|
| Rate for Payer: BCBS Trust/PPO |
$24.83
|
| Rate for Payer: BCN Commercial |
$203.29
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Meridian Medicaid |
$94.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.17
|
| Rate for Payer: Priority Health Narrow Network |
$251.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.49
|
| Rate for Payer: UHC Exchange |
$195.49
|
| Rate for Payer: UHCCP Medicaid |
$90.10
|
|
|
PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY
|
Professional
|
Both
|
$1,033.00
|
|
|
Service Code
|
HCPCS 43242
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$671.45 |
| Rate for Payer: Aetna Commercial |
$348.83
|
| Rate for Payer: Aetna Medicare |
$516.50
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$51.77
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: Cash Price |
$826.40
|
| Rate for Payer: Cash Price |
$826.40
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$461.77
|
| Rate for Payer: Priority Health Narrow Network |
$461.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$534.64
|
| Rate for Payer: UHC Exchange |
$534.64
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
|
|
PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 43238
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$673.40 |
| Rate for Payer: Aetna Commercial |
$308.98
|
| Rate for Payer: Aetna Medicare |
$518.00
|
| Rate for Payer: BCBS Complete |
$153.87
|
| Rate for Payer: BCBS Trust/PPO |
$14.01
|
| Rate for Payer: BCN Commercial |
$332.30
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Meridian Medicaid |
$153.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.08
|
| Rate for Payer: Priority Health Narrow Network |
$408.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.01
|
| Rate for Payer: UHC Exchange |
$371.01
|
| Rate for Payer: UHCCP Medicaid |
$146.54
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Facility
|
OP
|
$1,446.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
43246
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$939.90 |
| Max. Negotiated Rate |
$2,880.88 |
| Rate for Payer: Aetna Commercial |
$1,301.40
|
| 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 |
$1,402.62
|
| Rate for Payer: ASR Commercial |
$1,402.62
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.13
|
| Rate for Payer: BCN Commercial |
$1,121.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cofinity Commercial |
$1,359.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Healthscope Commercial |
$1,446.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,402.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,858.63
|
| Rate for Payer: Mclaren Commercial |
$1,301.40
|
| 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 |
$1,229.10
|
| Rate for Payer: Nomi Health Commercial |
$1,185.72
|
| 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 |
$939.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,266.99
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,272.48
|
| 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 PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$69.74 |
| Max. Negotiated Rate |
$939.90 |
| Rate for Payer: Aetna Commercial |
$266.68
|
| Rate for Payer: Aetna Medicare |
$723.00
|
| Rate for Payer: BCBS Complete |
$132.85
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Meridian Medicaid |
$132.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.18
|
| Rate for Payer: Priority Health Narrow Network |
$353.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.69
|
| Rate for Payer: UHC Exchange |
$317.69
|
| Rate for Payer: UHCCP Medicaid |
$126.52
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,446.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
43246
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$939.90 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: Aetna Commercial |
$1,301.40
|
| Rate for Payer: ASR ASR |
$1,402.62
|
| Rate for Payer: ASR Commercial |
$1,402.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,178.35
|
| Rate for Payer: BCN Commercial |
$1,121.08
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cofinity Commercial |
$1,359.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.80
|
| Rate for Payer: Healthscope Commercial |
$1,446.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,402.62
|
| Rate for Payer: Mclaren Commercial |
$1,301.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,229.10
|
| Rate for Payer: Nomi Health Commercial |
$1,185.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,272.48
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
43246
|
| Min. Negotiated Rate |
$69.74 |
| Max. Negotiated Rate |
$939.90 |
| Rate for Payer: Aetna Commercial |
$266.68
|
| Rate for Payer: Aetna Medicare |
$723.00
|
| Rate for Payer: BCBS Complete |
$132.85
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Meridian Medicaid |
$132.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.18
|
| Rate for Payer: Priority Health Narrow Network |
$353.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.69
|
| Rate for Payer: UHC Exchange |
$317.69
|
| Rate for Payer: UHCCP Medicaid |
$126.52
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
43251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$775.45 |
| Max. Negotiated Rate |
$2,880.88 |
| Rate for Payer: Aetna Commercial |
$1,073.70
|
| 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 |
$1,157.21
|
| Rate for Payer: ASR Commercial |
$1,157.21
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$976.95
|
| Rate for Payer: BCN Commercial |
$924.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cofinity Commercial |
$1,121.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Healthscope Commercial |
$1,193.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,858.63
|
| Rate for Payer: Mclaren Commercial |
$1,073.70
|
| 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 |
$1,014.05
|
| Rate for Payer: Nomi Health Commercial |
$978.26
|
| 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 |
$775.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,045.31
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$836.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,049.84
|
| 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 REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
43251
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$775.45 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: Aetna Medicare |
$596.50
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS Trust/PPO |
$748.60
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Meridian Medicaid |
$129.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.83
|
| Rate for Payer: Priority Health Narrow Network |
$344.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.35
|
| Rate for Payer: UHC Exchange |
$274.35
|
| Rate for Payer: UHCCP Medicaid |
$123.54
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
43251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$775.45 |
| Max. Negotiated Rate |
$1,193.00 |
| Rate for Payer: Aetna Commercial |
$1,073.70
|
| Rate for Payer: ASR ASR |
$1,157.21
|
| Rate for Payer: ASR Commercial |
$1,157.21
|
| Rate for Payer: BCBS Trust/PPO |
$972.18
|
| Rate for Payer: BCN Commercial |
$924.93
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cofinity Commercial |
$1,121.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.40
|
| Rate for Payer: Healthscope Commercial |
$1,193.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.21
|
| Rate for Payer: Mclaren Commercial |
$1,073.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.05
|
| Rate for Payer: Nomi Health Commercial |
$978.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,049.84
|
|
