Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EGD DILATION GASTRIC/DUODENAL STRICTURE

Professional

Both

$993.00

Service Code	HCPCS 43245
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$695.10
Rate for Payer: Aetna Commercial	$234.83
Rate for Payer: BCBS Complete	$116.08
Rate for Payer: BCBS Trust/PPO	$68.68
Rate for Payer: Cash Price	$794.40
Rate for Payer: Cash Price	$794.40
Rate for Payer: Mclaren Medicaid	$110.55
Rate for Payer: Meridian Medicaid	$116.08
Rate for Payer: Priority Health Choice Medicaid	$110.55
Rate for Payer: Priority Health Cigna Priority Health	$695.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$303.40
Rate for Payer: Priority Health Narrow Network	$303.40
Rate for Payer: Priority Health SBD	$303.40

PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION

Professional

Both

$677.00

Service Code	HCPCS 43266
Min. Negotiated Rate	$136.75
Max. Negotiated Rate	$1,452.30
Rate for Payer: Aetna Commercial	$289.61
Rate for Payer: BCBS Complete	$143.59
Rate for Payer: BCBS Trust/PPO	$1,452.30
Rate for Payer: Cash Price	$541.60
Rate for Payer: Cash Price	$541.60
Rate for Payer: Mclaren Medicaid	$136.75
Rate for Payer: Meridian Medicaid	$143.59
Rate for Payer: Priority Health Choice Medicaid	$136.75
Rate for Payer: Priority Health Cigna Priority Health	$473.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$375.13
Rate for Payer: Priority Health Narrow Network	$375.13
Rate for Payer: Priority Health SBD	$375.13

PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER

Professional

Both

$1,019.00

Service Code	HCPCS 43233
Min. Negotiated Rate	$77.66
Max. Negotiated Rate	$713.30
Rate for Payer: Aetna Commercial	$306.04
Rate for Payer: BCBS Complete	$151.41
Rate for Payer: BCBS Trust/PPO	$77.66
Rate for Payer: Cash Price	$815.20
Rate for Payer: Cash Price	$815.20
Rate for Payer: Mclaren Medicaid	$144.20
Rate for Payer: Meridian Medicaid	$151.41
Rate for Payer: Priority Health Choice Medicaid	$144.20
Rate for Payer: Priority Health Cigna Priority Health	$713.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$394.52
Rate for Payer: Priority Health Narrow Network	$394.52
Rate for Payer: Priority Health SBD	$394.52

PR EGD FLEXIBLE FOREIGN BODY REMOVAL

Professional

Both

$967.00

Service Code	HCPCS 43247
Min. Negotiated Rate	$108.30
Max. Negotiated Rate	$676.90
Rate for Payer: Aetna Commercial	$235.23
Rate for Payer: BCBS Complete	$116.75
Rate for Payer: BCBS Trust/PPO	$108.30
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Mclaren Medicaid	$111.19
Rate for Payer: Meridian Medicaid	$116.75
Rate for Payer: Priority Health Choice Medicaid	$111.19
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$305.15
Rate for Payer: Priority Health Narrow Network	$305.15
Rate for Payer: Priority Health SBD	$305.15

PR EGD FLEXIBLE FOREIGN BODY REMOVAL

Facility

$967.00

Service Code	CPT 43247
Hospital Charge Code	43247
Hospital Revenue Code	960
Min. Negotiated Rate	$170.92
Max. Negotiated Rate	$2,519.41
Rate for Payer: Aetna Commercial	$821.95
Rate for Payer: Aetna Medicare	$838.84
Rate for Payer: Aetna New Business (MI Preferred)	$628.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,008.22
Rate for Payer: Amish Plain Church Group Commercial	$1,008.22
Rate for Payer: BCBS Complete	$463.30
Rate for Payer: BCBS MAPPO	$806.58
Rate for Payer: BCBS Trust/PPO	$897.99
Rate for Payer: BCN Medicare Advantage	$806.58
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cofinity Commercial	$676.90
Rate for Payer: Cofinity Commercial	$831.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$806.58
Rate for Payer: Healthscope Commercial	$870.30
Rate for Payer: Mclaren Medicaid	$441.20
Rate for Payer: Mclaren Medicare	$806.58
Rate for Payer: Meridian Medicaid	$463.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$846.91
Rate for Payer: MI Amish Medical Board Commercial	$927.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$821.95
Rate for Payer: PACE Medicare	$766.25
Rate for Payer: PACE SWMI	$806.58
Rate for Payer: PHP Commercial	$821.95
Rate for Payer: PHP Medicare Advantage	$806.58
Rate for Payer: Priority Health Choice Medicaid	$441.20
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,519.41
Rate for Payer: Priority Health Medicare	$806.58
Rate for Payer: Priority Health Narrow Network	$2,015.53
Rate for Payer: Priority Health SBD	$609.21
Rate for Payer: Railroad Medicare Medicare	$806.58
Rate for Payer: UHC All Payor (Choice/PPO)	$188.01
Rate for Payer: UHC Dual Complete DSNP	$806.58
Rate for Payer: UHC Exchange	$170.92
Rate for Payer: UHC Medicare Advantage	$830.78
Rate for Payer: VA VA	$806.58

PR EGD FLEXIBLE FOREIGN BODY REMOVAL

Professional

Both

$967.00

Service Code	HCPCS 43247
Hospital Charge Code	43247
Min. Negotiated Rate	$108.30
Max. Negotiated Rate	$676.90
Rate for Payer: Aetna Commercial	$235.23
Rate for Payer: BCBS Complete	$116.75
Rate for Payer: BCBS Trust/PPO	$108.30
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Mclaren Medicaid	$111.19
Rate for Payer: Meridian Medicaid	$116.75
Rate for Payer: Priority Health Choice Medicaid	$111.19
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$305.15
Rate for Payer: Priority Health Narrow Network	$305.15
Rate for Payer: Priority Health SBD	$305.15

PR EGD FLEXIBLE FOREIGN BODY REMOVAL

Facility

$967.00

Service Code	CPT 43247
Hospital Charge Code	43247
Hospital Revenue Code	960
Min. Negotiated Rate	$609.21
Max. Negotiated Rate	$870.30
Rate for Payer: Aetna Commercial	$821.95
Rate for Payer: Aetna New Business (MI Preferred)	$628.55
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cofinity Commercial	$676.90
Rate for Payer: Cofinity Commercial	$831.62
Rate for Payer: Healthscope Commercial	$870.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$821.95
Rate for Payer: PHP Commercial	$821.95
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health SBD	$609.21

PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

Facility

$1,082.00

Service Code	CPT 43250
Hospital Charge Code	43250
Hospital Revenue Code	960
Min. Negotiated Rate	$681.66
Max. Negotiated Rate	$973.80
Rate for Payer: Aetna Commercial	$919.70
Rate for Payer: Aetna New Business (MI Preferred)	$703.30
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cofinity Commercial	$757.40
Rate for Payer: Cofinity Commercial	$930.52
Rate for Payer: Healthscope Commercial	$973.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$919.70
Rate for Payer: PHP Commercial	$919.70
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health SBD	$681.66

PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

Professional

Both

$1,082.00

Service Code	HCPCS 43250
Min. Negotiated Rate	$107.14
Max. Negotiated Rate	$940.37
Rate for Payer: Aetna Commercial	$227.54
Rate for Payer: BCBS Complete	$112.50
Rate for Payer: BCBS Trust/PPO	$940.37
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Mclaren Medicaid	$107.14
Rate for Payer: Meridian Medicaid	$112.50
Rate for Payer: Priority Health Choice Medicaid	$107.14
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$293.99
Rate for Payer: Priority Health Narrow Network	$293.99
Rate for Payer: Priority Health SBD	$293.99

PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

Facility

$1,082.00

Service Code	CPT 43250
Hospital Charge Code	43250
Hospital Revenue Code	960
Min. Negotiated Rate	$164.70
Max. Negotiated Rate	$5,222.22
Rate for Payer: Aetna Commercial	$919.70
Rate for Payer: Aetna Medicare	$1,760.84
Rate for Payer: Aetna New Business (MI Preferred)	$703.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,116.40
Rate for Payer: Amish Plain Church Group Commercial	$2,116.40
Rate for Payer: BCBS Complete	$972.53
Rate for Payer: BCBS MAPPO	$1,693.12
Rate for Payer: BCBS Trust/PPO	$527.94
Rate for Payer: BCN Medicare Advantage	$1,693.12
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cofinity Commercial	$757.40
Rate for Payer: Cofinity Commercial	$930.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,693.12
Rate for Payer: Healthscope Commercial	$973.80
Rate for Payer: Mclaren Medicaid	$926.14
Rate for Payer: Mclaren Medicare	$1,693.12
Rate for Payer: Meridian Medicaid	$972.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,777.78
Rate for Payer: MI Amish Medical Board Commercial	$1,947.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$919.70
Rate for Payer: PACE Medicare	$1,608.46
Rate for Payer: PACE SWMI	$1,693.12
Rate for Payer: PHP Commercial	$919.70
Rate for Payer: PHP Medicare Advantage	$1,693.12
Rate for Payer: Priority Health Choice Medicaid	$926.14
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,222.22
Rate for Payer: Priority Health Medicare	$1,693.12
Rate for Payer: Priority Health Narrow Network	$4,177.77
Rate for Payer: Priority Health SBD	$681.66
Rate for Payer: Railroad Medicare Medicare	$1,693.12
Rate for Payer: UHC All Payor (Choice/PPO)	$181.17
Rate for Payer: UHC Dual Complete DSNP	$1,693.12
Rate for Payer: UHC Exchange	$164.70
Rate for Payer: UHC Medicare Advantage	$1,743.91
Rate for Payer: VA VA	$1,693.12

PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

Professional

Both

$1,082.00

Service Code	HCPCS 43250
Hospital Charge Code	43250
Min. Negotiated Rate	$107.14
Max. Negotiated Rate	$940.37
Rate for Payer: Aetna Commercial	$227.54
Rate for Payer: BCBS Complete	$112.50
Rate for Payer: BCBS Trust/PPO	$940.37
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Mclaren Medicaid	$107.14
Rate for Payer: Meridian Medicaid	$112.50
Rate for Payer: Priority Health Choice Medicaid	$107.14
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$293.99
Rate for Payer: Priority Health Narrow Network	$293.99
Rate for Payer: Priority Health SBD	$293.99

PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES

Professional

Both

$1,180.00

Service Code	HCPCS 43243
Min. Negotiated Rate	$70.26
Max. Negotiated Rate	$826.00
Rate for Payer: Aetna Commercial	$315.11
Rate for Payer: BCBS Complete	$156.78
Rate for Payer: BCBS Trust/PPO	$70.26
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cash Price	$944.00
Rate for Payer: Mclaren Medicaid	$149.31
Rate for Payer: Meridian Medicaid	$156.78
Rate for Payer: Priority Health Choice Medicaid	$149.31
Rate for Payer: Priority Health Cigna Priority Health	$826.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$409.22
Rate for Payer: Priority Health Narrow Network	$409.22
Rate for Payer: Priority Health SBD	$409.22

PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS

Facility

$867.00

Service Code	CPT 43248
Hospital Charge Code	43248
Hospital Revenue Code	960
Min. Negotiated Rate	$160.77
Max. Negotiated Rate	$2,519.41
Rate for Payer: Aetna Commercial	$736.95
Rate for Payer: Aetna Medicare	$838.84
Rate for Payer: Aetna New Business (MI Preferred)	$563.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,008.22
Rate for Payer: Amish Plain Church Group Commercial	$1,008.22
Rate for Payer: BCBS Complete	$463.30
Rate for Payer: BCBS MAPPO	$806.58
Rate for Payer: BCBS Trust/PPO	$382.97
Rate for Payer: BCN Medicare Advantage	$806.58
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cofinity Commercial	$606.90
Rate for Payer: Cofinity Commercial	$745.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$806.58
Rate for Payer: Healthscope Commercial	$780.30
Rate for Payer: Mclaren Medicaid	$441.20
Rate for Payer: Mclaren Medicare	$806.58
Rate for Payer: Meridian Medicaid	$463.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$846.91
Rate for Payer: MI Amish Medical Board Commercial	$927.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$736.95
Rate for Payer: PACE Medicare	$766.25
Rate for Payer: PACE SWMI	$806.58
Rate for Payer: PHP Commercial	$736.95
Rate for Payer: PHP Medicare Advantage	$806.58
Rate for Payer: Priority Health Choice Medicaid	$441.20
Rate for Payer: Priority Health Cigna Priority Health	$606.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,519.41
Rate for Payer: Priority Health Medicare	$806.58
Rate for Payer: Priority Health Narrow Network	$2,015.53
Rate for Payer: Priority Health SBD	$546.21
Rate for Payer: Railroad Medicare Medicare	$806.58
Rate for Payer: UHC All Payor (Choice/PPO)	$176.85
Rate for Payer: UHC Dual Complete DSNP	$806.58
Rate for Payer: UHC Exchange	$160.77
Rate for Payer: UHC Medicare Advantage	$830.78
Rate for Payer: VA VA	$806.58

PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS

Professional

Both

$867.00

Service Code	HCPCS 43248
Min. Negotiated Rate	$104.58
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$220.50
Rate for Payer: BCBS Complete	$109.81
Rate for Payer: BCBS Trust/PPO	$120.98
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Mclaren Medicaid	$104.58
Rate for Payer: Meridian Medicaid	$109.81
Rate for Payer: Priority Health Choice Medicaid	$104.58
Rate for Payer: Priority Health Cigna Priority Health	$606.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$286.34
Rate for Payer: Priority Health Narrow Network	$286.34
Rate for Payer: Priority Health SBD	$286.34

PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS

Professional

Both

$867.00

Service Code	HCPCS 43248
Hospital Charge Code	43248
Min. Negotiated Rate	$104.58
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$220.50
Rate for Payer: BCBS Complete	$109.81
Rate for Payer: BCBS Trust/PPO	$120.98
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Mclaren Medicaid	$104.58
Rate for Payer: Meridian Medicaid	$109.81
Rate for Payer: Priority Health Choice Medicaid	$104.58
Rate for Payer: Priority Health Cigna Priority Health	$606.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$286.34
Rate for Payer: Priority Health Narrow Network	$286.34
Rate for Payer: Priority Health SBD	$286.34

PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS

Facility

$867.00

Service Code	CPT 43248
Hospital Charge Code	43248
Hospital Revenue Code	960
Min. Negotiated Rate	$546.21
Max. Negotiated Rate	$780.30
Rate for Payer: Aetna Commercial	$736.95
Rate for Payer: Aetna New Business (MI Preferred)	$563.55
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cofinity Commercial	$606.90
Rate for Payer: Cofinity Commercial	$745.62
Rate for Payer: Healthscope Commercial	$780.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$736.95
Rate for Payer: PHP Commercial	$736.95
Rate for Payer: Priority Health Cigna Priority Health	$606.90
Rate for Payer: Priority Health SBD	$546.21

PR EGD INTRALUMINAL TUBE/CATHETER INSERTION

Professional

Both

$856.00

Service Code	HCPCS 43241
Min. Negotiated Rate	$24.83
Max. Negotiated Rate	$599.20
Rate for Payer: Aetna Commercial	$188.57
Rate for Payer: BCBS Complete	$94.15
Rate for Payer: BCBS Trust/PPO	$24.83
Rate for Payer: Cash Price	$684.80
Rate for Payer: Cash Price	$684.80
Rate for Payer: Mclaren Medicaid	$89.67
Rate for Payer: Meridian Medicaid	$94.15
Rate for Payer: Priority Health Choice Medicaid	$89.67
Rate for Payer: Priority Health Cigna Priority Health	$599.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$244.60
Rate for Payer: Priority Health Narrow Network	$244.60
Rate for Payer: Priority Health SBD	$244.60

PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY

Professional

Both

$1,013.00

Service Code	HCPCS 43242
Min. Negotiated Rate	$51.77
Max. Negotiated Rate	$709.10
Rate for Payer: Aetna Commercial	$348.83
Rate for Payer: BCBS Complete	$173.10
Rate for Payer: BCBS Trust/PPO	$51.77
Rate for Payer: Cash Price	$810.40
Rate for Payer: Cash Price	$810.40
Rate for Payer: Mclaren Medicaid	$164.86
Rate for Payer: Meridian Medicaid	$173.10
Rate for Payer: Priority Health Choice Medicaid	$164.86
Rate for Payer: Priority Health Cigna Priority Health	$709.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$453.33
Rate for Payer: Priority Health Narrow Network	$453.33
Rate for Payer: Priority Health SBD	$453.33

PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS

Professional

Both

$1,016.00

Service Code	HCPCS 43238
Min. Negotiated Rate	$14.01
Max. Negotiated Rate	$711.20
Rate for Payer: Aetna Commercial	$308.98
Rate for Payer: BCBS Complete	$152.97
Rate for Payer: BCBS Trust/PPO	$14.01
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Mclaren Medicaid	$145.69
Rate for Payer: Meridian Medicaid	$152.97
Rate for Payer: Priority Health Choice Medicaid	$145.69
Rate for Payer: Priority Health Cigna Priority Health	$711.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$399.82
Rate for Payer: Priority Health Narrow Network	$399.82
Rate for Payer: Priority Health SBD	$399.82

PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE

Professional

Both

$1,418.00

Service Code	HCPCS 43246
Hospital Charge Code	43246
Min. Negotiated Rate	$69.74
Max. Negotiated Rate	$992.60
Rate for Payer: Aetna Commercial	$266.68
Rate for Payer: BCBS Complete	$132.40
Rate for Payer: BCBS Trust/PPO	$69.74
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Mclaren Medicaid	$126.10
Rate for Payer: Meridian Medicaid	$132.40
Rate for Payer: Priority Health Choice Medicaid	$126.10
Rate for Payer: Priority Health Cigna Priority Health	$992.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$346.32
Rate for Payer: Priority Health Narrow Network	$346.32
Rate for Payer: Priority Health SBD	$346.32

PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE

Facility

$1,418.00

Service Code	CPT 43246
Hospital Charge Code	43246
Hospital Revenue Code	960
Min. Negotiated Rate	$893.34
Max. Negotiated Rate	$1,276.20
Rate for Payer: Aetna Commercial	$1,205.30
Rate for Payer: Aetna New Business (MI Preferred)	$921.70
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Cofinity Commercial	$1,219.48
Rate for Payer: Cofinity Commercial	$992.60
Rate for Payer: Healthscope Commercial	$1,276.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,205.30
Rate for Payer: PHP Commercial	$1,205.30
Rate for Payer: Priority Health Cigna Priority Health	$992.60
Rate for Payer: Priority Health SBD	$893.34

PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE

Facility

$1,418.00

Service Code	CPT 43246
Hospital Charge Code	43246
Hospital Revenue Code	960
Min. Negotiated Rate	$193.85
Max. Negotiated Rate	$5,222.22
Rate for Payer: Aetna Commercial	$1,205.30
Rate for Payer: Aetna Medicare	$1,760.84
Rate for Payer: Aetna New Business (MI Preferred)	$921.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,116.40
Rate for Payer: Amish Plain Church Group Commercial	$2,116.40
Rate for Payer: BCBS Complete	$972.53
Rate for Payer: BCBS MAPPO	$1,693.12
Rate for Payer: BCBS Trust/PPO	$875.18
Rate for Payer: BCN Medicare Advantage	$1,693.12
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Cofinity Commercial	$992.60
Rate for Payer: Cofinity Commercial	$1,219.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,693.12
Rate for Payer: Healthscope Commercial	$1,276.20
Rate for Payer: Mclaren Medicaid	$926.14
Rate for Payer: Mclaren Medicare	$1,693.12
Rate for Payer: Meridian Medicaid	$972.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,777.78
Rate for Payer: MI Amish Medical Board Commercial	$1,947.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,205.30
Rate for Payer: PACE Medicare	$1,608.46
Rate for Payer: PACE SWMI	$1,693.12
Rate for Payer: PHP Commercial	$1,205.30
Rate for Payer: PHP Medicare Advantage	$1,693.12
Rate for Payer: Priority Health Choice Medicaid	$926.14
Rate for Payer: Priority Health Cigna Priority Health	$992.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,222.22
Rate for Payer: Priority Health Medicare	$1,693.12
Rate for Payer: Priority Health Narrow Network	$4,177.77
Rate for Payer: Priority Health SBD	$893.34
Rate for Payer: Railroad Medicare Medicare	$1,693.12
Rate for Payer: UHC All Payor (Choice/PPO)	$213.24
Rate for Payer: UHC Dual Complete DSNP	$1,693.12
Rate for Payer: UHC Exchange	$193.85
Rate for Payer: UHC Medicare Advantage	$1,743.91
Rate for Payer: VA VA	$1,693.12

PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE

Professional

Both

$1,418.00

Service Code	HCPCS 43246
Min. Negotiated Rate	$69.74
Max. Negotiated Rate	$992.60
Rate for Payer: Aetna Commercial	$266.68
Rate for Payer: BCBS Complete	$132.40
Rate for Payer: BCBS Trust/PPO	$69.74
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Mclaren Medicaid	$126.10
Rate for Payer: Meridian Medicaid	$132.40
Rate for Payer: Priority Health Choice Medicaid	$126.10
Rate for Payer: Priority Health Cigna Priority Health	$992.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$346.32
Rate for Payer: Priority Health Narrow Network	$346.32
Rate for Payer: Priority Health SBD	$346.32

PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH

Facility

$1,170.00

Service Code	CPT 43251
Hospital Charge Code	43251
Hospital Revenue Code	960
Min. Negotiated Rate	$189.26
Max. Negotiated Rate	$5,222.22
Rate for Payer: Aetna Commercial	$994.50
Rate for Payer: Aetna Medicare	$1,760.84
Rate for Payer: Aetna New Business (MI Preferred)	$760.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,116.40
Rate for Payer: Amish Plain Church Group Commercial	$2,116.40
Rate for Payer: BCBS Complete	$972.53
Rate for Payer: BCBS MAPPO	$1,693.12
Rate for Payer: BCBS Trust/PPO	$812.07
Rate for Payer: BCN Medicare Advantage	$1,693.12
Rate for Payer: Cash Price	$936.00
Rate for Payer: Cash Price	$936.00
Rate for Payer: Cofinity Commercial	$1,006.20
Rate for Payer: Cofinity Commercial	$819.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,693.12
Rate for Payer: Healthscope Commercial	$1,053.00
Rate for Payer: Mclaren Medicaid	$926.14
Rate for Payer: Mclaren Medicare	$1,693.12
Rate for Payer: Meridian Medicaid	$972.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,777.78
Rate for Payer: MI Amish Medical Board Commercial	$1,947.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$994.50
Rate for Payer: PACE Medicare	$1,608.46
Rate for Payer: PACE SWMI	$1,693.12
Rate for Payer: PHP Commercial	$994.50
Rate for Payer: PHP Medicare Advantage	$1,693.12
Rate for Payer: Priority Health Choice Medicaid	$926.14
Rate for Payer: Priority Health Cigna Priority Health	$819.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,222.22
Rate for Payer: Priority Health Medicare	$1,693.12
Rate for Payer: Priority Health Narrow Network	$4,177.77
Rate for Payer: Priority Health SBD	$737.10
Rate for Payer: Railroad Medicare Medicare	$1,693.12
Rate for Payer: UHC All Payor (Choice/PPO)	$208.19
Rate for Payer: UHC Dual Complete DSNP	$1,693.12
Rate for Payer: UHC Exchange	$189.26
Rate for Payer: UHC Medicare Advantage	$1,743.91
Rate for Payer: VA VA	$1,693.12

PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH

Professional

Both

$1,170.00

Service Code	HCPCS 43251
Min. Negotiated Rate	$123.11
Max. Negotiated Rate	$819.00
Rate for Payer: Aetna Commercial	$260.40
Rate for Payer: BCBS Complete	$129.27
Rate for Payer: BCBS Trust/PPO	$748.60
Rate for Payer: Cash Price	$936.00
Rate for Payer: Cash Price	$936.00
Rate for Payer: Mclaren Medicaid	$123.11
Rate for Payer: Meridian Medicaid	$129.27
Rate for Payer: Priority Health Choice Medicaid	$123.11
Rate for Payer: Priority Health Cigna Priority Health	$819.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$338.08
Rate for Payer: Priority Health Narrow Network	$338.08
Rate for Payer: Priority Health SBD	$338.08

Know your out-of-pocket cost for care.

All Charges