|
PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 43238
|
| Min. Negotiated Rate |
$218.95 |
| Max. Negotiated Rate |
$673.40 |
| Rate for Payer: Aetna Commercial |
$293.39
|
| Rate for Payer: Aetna Medicare |
$218.95
|
| Rate for Payer: BCBS Complete |
$414.40
|
| Rate for Payer: BCBS MAPPO |
$218.95
|
| Rate for Payer: BCN Medicare Advantage |
$218.95
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cofinity Commercial |
$315.29
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.95
|
| Rate for Payer: Healthscope Commercial |
$262.74
|
| Rate for Payer: Healthscope Whirlpool |
$262.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.90
|
| Rate for Payer: Nomi Health Commercial |
$262.74
|
| Rate for Payer: PACE SWMI |
$218.95
|
| Rate for Payer: PHP Medicare Advantage |
$218.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health Medicare |
$218.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.95
|
| Rate for Payer: UHC Medicare Advantage |
$218.95
|
| Rate for Payer: UHCCP DNSP |
$218.95
|
|
|
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 |
$2,867.66 |
| Rate for Payer: Aetna Commercial |
$1,301.40
|
| Rate for Payer: Aetna Medicare |
$1,850.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: ASR ASR |
$1,402.62
|
| Rate for Payer: ASR Commercial |
$1,402.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.13
|
| Rate for Payer: BCN Commercial |
$1,121.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| 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 |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$1,446.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,402.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,850.10
|
| Rate for Payer: Mclaren Commercial |
$1,301.40
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| 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 |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$2,035.11
|
| Rate for Payer: PHP Medicaid |
$991.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| 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 |
$1,850.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,272.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$2,867.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP DNSP |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
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 |
$189.95 |
| Max. Negotiated Rate |
$939.90 |
| Rate for Payer: Aetna Commercial |
$254.53
|
| Rate for Payer: Aetna Medicare |
$189.95
|
| Rate for Payer: BCBS Complete |
$578.40
|
| Rate for Payer: BCBS MAPPO |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$189.95
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cofinity Commercial |
$273.53
|
| Rate for Payer: Cofinity Commercial |
$254.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.95
|
| Rate for Payer: Healthscope Commercial |
$227.94
|
| Rate for Payer: Healthscope Whirlpool |
$227.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$227.94
|
| Rate for Payer: PACE SWMI |
$189.95
|
| Rate for Payer: PHP Medicare Advantage |
$189.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.90
|
| Rate for Payer: Priority Health Medicare |
$189.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.95
|
| Rate for Payer: UHC Medicare Advantage |
$189.95
|
| Rate for Payer: UHCCP DNSP |
$189.95
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$189.95 |
| Max. Negotiated Rate |
$939.90 |
| Rate for Payer: Aetna Commercial |
$254.53
|
| Rate for Payer: Aetna Medicare |
$189.95
|
| Rate for Payer: BCBS Complete |
$578.40
|
| Rate for Payer: BCBS MAPPO |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$189.95
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cofinity Commercial |
$273.53
|
| Rate for Payer: Cofinity Commercial |
$254.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.95
|
| Rate for Payer: Healthscope Commercial |
$227.94
|
| Rate for Payer: Healthscope Whirlpool |
$227.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$227.94
|
| Rate for Payer: PACE SWMI |
$189.95
|
| Rate for Payer: PHP Medicare Advantage |
$189.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.90
|
| Rate for Payer: Priority Health Medicare |
$189.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.95
|
| Rate for Payer: UHC Medicare Advantage |
$189.95
|
| Rate for Payer: UHCCP DNSP |
$189.95
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 43251
|
| Min. Negotiated Rate |
$184.55 |
| Max. Negotiated Rate |
$775.45 |
| Rate for Payer: Aetna Commercial |
$247.30
|
| Rate for Payer: Aetna Medicare |
$184.55
|
| Rate for Payer: BCBS Complete |
$477.20
|
| Rate for Payer: BCBS MAPPO |
$184.55
|
| Rate for Payer: BCN Medicare Advantage |
$184.55
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cofinity Commercial |
$265.75
|
| Rate for Payer: Cofinity Commercial |
$247.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.55
|
| Rate for Payer: Healthscope Commercial |
$221.46
|
| Rate for Payer: Healthscope Whirlpool |
$221.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.78
|
| Rate for Payer: Nomi Health Commercial |
$221.46
|
| Rate for Payer: PACE SWMI |
$184.55
|
| Rate for Payer: PHP Medicare Advantage |
$184.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.45
|
| Rate for Payer: Priority Health Medicare |
$184.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.55
|
| Rate for Payer: UHC Medicare Advantage |
$184.55
|
| Rate for Payer: UHCCP DNSP |
$184.55
|
|
|
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
|
|
|
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 |
$184.55 |
| Max. Negotiated Rate |
$775.45 |
| Rate for Payer: Aetna Commercial |
$247.30
|
| Rate for Payer: Aetna Medicare |
$184.55
|
| Rate for Payer: BCBS Complete |
$477.20
|
| Rate for Payer: BCBS MAPPO |
$184.55
|
| Rate for Payer: BCN Medicare Advantage |
$184.55
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cash Price |
$954.40
|
| Rate for Payer: Cofinity Commercial |
$265.75
|
| Rate for Payer: Cofinity Commercial |
$247.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.55
|
| Rate for Payer: Healthscope Commercial |
$221.46
|
| Rate for Payer: Healthscope Whirlpool |
$221.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.78
|
| Rate for Payer: Nomi Health Commercial |
$221.46
|
| Rate for Payer: PACE SWMI |
$184.55
|
| Rate for Payer: PHP Medicare Advantage |
$184.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.45
|
| Rate for Payer: Priority Health Medicare |
$184.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.55
|
| Rate for Payer: UHC Medicare Advantage |
$184.55
|
| Rate for Payer: UHCCP DNSP |
$184.55
|
|
|
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 |
$2,867.66 |
| Rate for Payer: Aetna Commercial |
$1,073.70
|
| Rate for Payer: Aetna Medicare |
$1,850.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: ASR ASR |
$1,157.21
|
| Rate for Payer: ASR Commercial |
$1,157.21
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCBS Trust/PPO |
$976.95
|
| Rate for Payer: BCN Commercial |
$924.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| 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 |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$1,193.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,850.10
|
| Rate for Payer: Mclaren Commercial |
$1,073.70
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.05
|
| Rate for Payer: Nomi Health Commercial |
$978.26
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$2,035.11
|
| Rate for Payer: PHP Medicaid |
$991.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| 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 |
$1,850.10
|
| Rate for Payer: Priority Health Narrow Network |
$836.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,049.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$2,867.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP DNSP |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
43239
|
| Min. Negotiated Rate |
$130.16 |
| Max. Negotiated Rate |
$544.70 |
| Rate for Payer: Aetna Commercial |
$174.41
|
| Rate for Payer: Aetna Medicare |
$130.16
|
| Rate for Payer: BCBS Complete |
$335.20
|
| Rate for Payer: BCBS MAPPO |
$130.16
|
| Rate for Payer: BCN Medicare Advantage |
$130.16
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$187.43
|
| Rate for Payer: Cofinity Commercial |
$174.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.16
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Healthscope Whirlpool |
$156.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.67
|
| Rate for Payer: Nomi Health Commercial |
$156.19
|
| Rate for Payer: PACE SWMI |
$130.16
|
| Rate for Payer: PHP Medicare Advantage |
$130.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Medicare |
$130.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.16
|
| Rate for Payer: UHC Medicare Advantage |
$130.16
|
| Rate for Payer: UHCCP DNSP |
$130.16
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$812.86
|
| Rate for Payer: ASR Commercial |
$812.86
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$686.24
|
| Rate for Payer: BCN Commercial |
$649.70
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$787.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$838.00
|
| Rate for Payer: Healthscope Whirlpool |
$812.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$754.20
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.30
|
| Rate for Payer: Nomi Health Commercial |
$687.16
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$734.26
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$587.44
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$737.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$130.16 |
| Max. Negotiated Rate |
$544.70 |
| Rate for Payer: Aetna Commercial |
$174.41
|
| Rate for Payer: Aetna Medicare |
$130.16
|
| Rate for Payer: BCBS Complete |
$335.20
|
| Rate for Payer: BCBS MAPPO |
$130.16
|
| Rate for Payer: BCN Medicare Advantage |
$130.16
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$187.43
|
| Rate for Payer: Cofinity Commercial |
$174.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.16
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Healthscope Whirlpool |
$156.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.67
|
| Rate for Payer: Nomi Health Commercial |
$156.19
|
| Rate for Payer: PACE SWMI |
$130.16
|
| Rate for Payer: PHP Medicare Advantage |
$130.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Medicare |
$130.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.16
|
| Rate for Payer: UHC Medicare Advantage |
$130.16
|
| Rate for Payer: UHCCP DNSP |
$130.16
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$544.70 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: ASR ASR |
$812.86
|
| Rate for Payer: ASR Commercial |
$812.86
|
| Rate for Payer: BCBS Trust/PPO |
$682.89
|
| Rate for Payer: BCN Commercial |
$649.70
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$787.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.40
|
| Rate for Payer: Healthscope Commercial |
$838.00
|
| Rate for Payer: Healthscope Whirlpool |
$812.86
|
| Rate for Payer: Mclaren Commercial |
$754.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.30
|
| Rate for Payer: Nomi Health Commercial |
$687.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$737.44
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$749.45 |
| Rate for Payer: Aetna Commercial |
$252.66
|
| Rate for Payer: Aetna Medicare |
$188.55
|
| Rate for Payer: BCBS Complete |
$461.20
|
| Rate for Payer: BCBS MAPPO |
$188.55
|
| Rate for Payer: BCN Medicare Advantage |
$188.55
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cofinity Commercial |
$271.51
|
| Rate for Payer: Cofinity Commercial |
$252.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.55
|
| Rate for Payer: Healthscope Commercial |
$226.26
|
| Rate for Payer: Healthscope Whirlpool |
$226.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.98
|
| Rate for Payer: Nomi Health Commercial |
$226.26
|
| Rate for Payer: PACE SWMI |
$188.55
|
| Rate for Payer: PHP Medicare Advantage |
$188.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.45
|
| Rate for Payer: Priority Health Medicare |
$188.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.55
|
| Rate for Payer: UHC Medicare Advantage |
$188.55
|
| Rate for Payer: UHCCP DNSP |
$188.55
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$542.10 |
| Rate for Payer: Aetna Commercial |
$340.48
|
| Rate for Payer: Aetna Medicare |
$254.09
|
| Rate for Payer: BCBS Complete |
$333.60
|
| Rate for Payer: BCBS MAPPO |
$254.09
|
| Rate for Payer: BCN Medicare Advantage |
$254.09
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cofinity Commercial |
$365.89
|
| Rate for Payer: Cofinity Commercial |
$340.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.09
|
| Rate for Payer: Healthscope Commercial |
$304.91
|
| Rate for Payer: Healthscope Whirlpool |
$304.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.79
|
| Rate for Payer: Nomi Health Commercial |
$304.91
|
| Rate for Payer: PACE SWMI |
$254.09
|
| Rate for Payer: PHP Medicare Advantage |
$254.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.10
|
| Rate for Payer: Priority Health Medicare |
$254.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.09
|
| Rate for Payer: UHC Medicare Advantage |
$254.09
|
| Rate for Payer: UHCCP DNSP |
$254.09
|
|
|
PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 43240
|
| Min. Negotiated Rate |
$367.67 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Aetna Commercial |
$492.68
|
| Rate for Payer: Aetna Medicare |
$367.67
|
| Rate for Payer: BCBS Complete |
$475.20
|
| Rate for Payer: BCBS MAPPO |
$367.67
|
| Rate for Payer: BCN Medicare Advantage |
$367.67
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$529.44
|
| Rate for Payer: Cofinity Commercial |
$492.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$367.67
|
| Rate for Payer: Healthscope Commercial |
$441.20
|
| Rate for Payer: Healthscope Whirlpool |
$441.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$386.05
|
| Rate for Payer: Nomi Health Commercial |
$441.20
|
| Rate for Payer: PACE SWMI |
$367.67
|
| Rate for Payer: PHP Medicare Advantage |
$367.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.20
|
| Rate for Payer: Priority Health Medicare |
$367.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$367.67
|
| Rate for Payer: UHC Medicare Advantage |
$367.67
|
| Rate for Payer: UHCCP DNSP |
$367.67
|
|
|
PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 43253
|
| Min. Negotiated Rate |
$247.03 |
| Max. Negotiated Rate |
$522.60 |
| Rate for Payer: Aetna Commercial |
$331.02
|
| Rate for Payer: Aetna Medicare |
$247.03
|
| Rate for Payer: BCBS Complete |
$321.60
|
| Rate for Payer: BCBS MAPPO |
$247.03
|
| Rate for Payer: BCN Medicare Advantage |
$247.03
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cofinity Commercial |
$355.72
|
| Rate for Payer: Cofinity Commercial |
$331.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.03
|
| Rate for Payer: Healthscope Commercial |
$296.44
|
| Rate for Payer: Healthscope Whirlpool |
$296.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.38
|
| Rate for Payer: Nomi Health Commercial |
$296.44
|
| Rate for Payer: PACE SWMI |
$247.03
|
| Rate for Payer: PHP Medicare Advantage |
$247.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.60
|
| Rate for Payer: Priority Health Medicare |
$247.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.03
|
| Rate for Payer: UHC Medicare Advantage |
$247.03
|
| Rate for Payer: UHCCP DNSP |
$247.03
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Aetna Medicare |
$13.33
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$13.33
|
| Rate for Payer: BCN Medicare Advantage |
$13.33
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.33
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Healthscope Whirlpool |
$16.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PACE SWMI |
$13.33
|
| Rate for Payer: PHP Medicare Advantage |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$13.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.33
|
| Rate for Payer: UHC Medicare Advantage |
$13.33
|
| Rate for Payer: UHCCP DNSP |
$13.33
|
|
|
PR EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Aetna Commercial |
$10.25
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Healthscope Whirlpool |
$9.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| Rate for Payer: UHCCP DNSP |
$7.65
|
|
|
PR EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0404
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Aetna Commercial |
$7.61
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$5.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$6.82
|
| Rate for Payer: Healthscope Whirlpool |
$6.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.96
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: PACE SWMI |
$5.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$5.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.68
|
| Rate for Payer: UHC Medicare Advantage |
$5.68
|
| Rate for Payer: UHCCP DNSP |
$5.68
|
|
|
PR ELASTIC GARMENT/COVERING
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS A4466
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 95983
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$61.68
|
| Rate for Payer: Aetna Medicare |
$46.03
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$46.03
|
| Rate for Payer: BCN Medicare Advantage |
$46.03
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Cofinity Commercial |
$61.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.03
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Healthscope Whirlpool |
$55.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.33
|
| Rate for Payer: Nomi Health Commercial |
$55.24
|
| Rate for Payer: PACE SWMI |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$46.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.03
|
| Rate for Payer: UHC Medicare Advantage |
$46.03
|
| Rate for Payer: UHCCP DNSP |
$46.03
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95984
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Commercial |
$54.42
|
| Rate for Payer: Aetna Medicare |
$40.61
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$40.61
|
| Rate for Payer: BCN Medicare Advantage |
$40.61
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$54.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.61
|
| Rate for Payer: Healthscope Commercial |
$48.73
|
| Rate for Payer: Healthscope Whirlpool |
$48.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.64
|
| Rate for Payer: Nomi Health Commercial |
$48.73
|
| Rate for Payer: PACE SWMI |
$40.61
|
| Rate for Payer: PHP Medicare Advantage |
$40.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$40.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.61
|
| Rate for Payer: UHC Medicare Advantage |
$40.61
|
| Rate for Payer: UHCCP DNSP |
$40.61
|
|
|
PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 95977
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$71.50 |
| Rate for Payer: Aetna Commercial |
$63.49
|
| Rate for Payer: Aetna Medicare |
$47.38
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$47.38
|
| Rate for Payer: BCN Medicare Advantage |
$47.38
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$68.23
|
| Rate for Payer: Cofinity Commercial |
$63.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.38
|
| Rate for Payer: Healthscope Commercial |
$56.86
|
| Rate for Payer: Healthscope Whirlpool |
$56.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.75
|
| Rate for Payer: Nomi Health Commercial |
$56.86
|
| Rate for Payer: PACE SWMI |
$47.38
|
| Rate for Payer: PHP Medicare Advantage |
$47.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$47.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.38
|
| Rate for Payer: UHC Medicare Advantage |
$47.38
|
| Rate for Payer: UHCCP DNSP |
$47.38
|
|
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95972
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: Aetna Medicare |
$37.67
|
| Rate for Payer: Aetna Medicare |
$37.67
|
| Rate for Payer: BCBS Complete |
$191.60
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$37.67
|
| Rate for Payer: BCBS MAPPO |
$37.67
|
| Rate for Payer: BCN Medicare Advantage |
$37.67
|
| Rate for Payer: BCN Medicare Advantage |
$37.67
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$50.48
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$50.48
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.67
|
| Rate for Payer: Healthscope Commercial |
$45.20
|
| Rate for Payer: Healthscope Commercial |
$45.20
|
| Rate for Payer: Healthscope Whirlpool |
$45.20
|
| Rate for Payer: Healthscope Whirlpool |
$45.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.55
|
| Rate for Payer: Nomi Health Commercial |
$45.20
|
| Rate for Payer: Nomi Health Commercial |
$45.20
|
| Rate for Payer: PACE SWMI |
$37.67
|
| Rate for Payer: PACE SWMI |
$37.67
|
| Rate for Payer: PHP Medicare Advantage |
$37.67
|
| Rate for Payer: PHP Medicare Advantage |
$37.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$37.67
|
| Rate for Payer: Priority Health Medicare |
$37.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.67
|
| Rate for Payer: UHC Medicare Advantage |
$37.67
|
| Rate for Payer: UHC Medicare Advantage |
$37.67
|
| Rate for Payer: UHCCP DNSP |
$37.67
|
| Rate for Payer: UHCCP DNSP |
$37.67
|
|
