Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Professional

Both

$709.00

Service Code	HCPCS 43235
Hospital Charge Code	43235
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$496.30
Rate for Payer: Aetna Commercial	$162.76
Rate for Payer: BCBS Complete	$81.19
Rate for Payer: BCBS Trust/PPO	$28.53
Rate for Payer: Cash Price	$567.20
Rate for Payer: Cash Price	$567.20
Rate for Payer: Mclaren Medicaid	$77.32
Rate for Payer: Meridian Medicaid	$81.19
Rate for Payer: Priority Health Choice Medicaid	$77.32
Rate for Payer: Priority Health Cigna Priority Health	$496.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$211.66
Rate for Payer: Priority Health Narrow Network	$211.66
Rate for Payer: Priority Health SBD	$211.66

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Facility

$709.00

Service Code	CPT 43235
Hospital Charge Code	43235
Hospital Revenue Code	960
Min. Negotiated Rate	$446.67
Max. Negotiated Rate	$638.10
Rate for Payer: Aetna Commercial	$602.65
Rate for Payer: Aetna New Business (MI Preferred)	$460.85
Rate for Payer: Cash Price	$567.20
Rate for Payer: Cofinity Commercial	$496.30
Rate for Payer: Cofinity Commercial	$609.74
Rate for Payer: Healthscope Commercial	$638.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$602.65
Rate for Payer: PHP Commercial	$602.65
Rate for Payer: Priority Health Cigna Priority Health	$496.30
Rate for Payer: Priority Health SBD	$446.67

PR ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS

Professional

Both

$902.00

Service Code	HCPCS 43237
Min. Negotiated Rate	$22.07
Max. Negotiated Rate	$631.40
Rate for Payer: Aetna Commercial	$259.91
Rate for Payer: BCBS Complete	$129.04
Rate for Payer: BCBS Trust/PPO	$22.07
Rate for Payer: Cash Price	$721.60
Rate for Payer: Cash Price	$721.60
Rate for Payer: Mclaren Medicaid	$122.90
Rate for Payer: Meridian Medicaid	$129.04
Rate for Payer: Priority Health Choice Medicaid	$122.90
Rate for Payer: Priority Health Cigna Priority Health	$631.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$337.49
Rate for Payer: Priority Health Narrow Network	$337.49
Rate for Payer: Priority Health SBD	$337.49

PR ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH

Professional

Both

$2,321.00

Service Code	HCPCS 43330
Min. Negotiated Rate	$854.34
Max. Negotiated Rate	$2,635.16
Rate for Payer: Aetna Commercial	$1,808.99
Rate for Payer: BCBS Complete	$897.06
Rate for Payer: BCBS Trust/PPO	$2,635.16
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Mclaren Medicaid	$854.34
Rate for Payer: Meridian Medicaid	$897.06
Rate for Payer: Priority Health Choice Medicaid	$854.34
Rate for Payer: Priority Health Cigna Priority Health	$1,624.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,346.60
Rate for Payer: Priority Health Narrow Network	$2,346.60
Rate for Payer: Priority Health SBD	$2,346.60

PR ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH

Professional

Both

$3,128.00

Service Code	HCPCS 43331
Min. Negotiated Rate	$648.75
Max. Negotiated Rate	$2,326.61
Rate for Payer: Aetna Commercial	$1,798.83
Rate for Payer: BCBS Complete	$889.46
Rate for Payer: BCBS Trust/PPO	$648.75
Rate for Payer: Cash Price	$2,502.40
Rate for Payer: Cash Price	$2,502.40
Rate for Payer: Mclaren Medicaid	$847.10
Rate for Payer: Meridian Medicaid	$889.46
Rate for Payer: Priority Health Choice Medicaid	$847.10
Rate for Payer: Priority Health Cigna Priority Health	$2,189.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,326.61
Rate for Payer: Priority Health Narrow Network	$2,326.61
Rate for Payer: Priority Health SBD	$2,326.61

PR ESOPHAGOSCOPY,ABLATION TUMOR

Professional

Both

$1,412.00

Service Code	HCPCS 43228
Min. Negotiated Rate	$564.80
Max. Negotiated Rate	$988.40
Rate for Payer: BCBS Complete	$564.80
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Priority Health Cigna Priority Health	$988.40

PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM

Professional

Both

$395.00

Service Code	HCPCS 43214
Min. Negotiated Rate	$122.48
Max. Negotiated Rate	$336.90
Rate for Payer: Aetna Commercial	$256.38
Rate for Payer: BCBS Complete	$128.60
Rate for Payer: BCBS Trust/PPO	$167.47
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cash Price	$316.00
Rate for Payer: Mclaren Medicaid	$122.48
Rate for Payer: Meridian Medicaid	$128.60
Rate for Payer: Priority Health Choice Medicaid	$122.48
Rate for Payer: Priority Health Cigna Priority Health	$276.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$336.90
Rate for Payer: Priority Health Narrow Network	$336.90
Rate for Payer: Priority Health SBD	$336.90

PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM

Professional

Both

$1,488.00

Service Code	HCPCS 43220
Min. Negotiated Rate	$68.34
Max. Negotiated Rate	$1,041.60
Rate for Payer: Aetna Commercial	$156.84
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: BCBS Trust/PPO	$68.34
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Mclaren Medicaid	$74.55
Rate for Payer: Meridian Medicaid	$78.28
Rate for Payer: Priority Health Choice Medicaid	$74.55
Rate for Payer: Priority Health Cigna Priority Health	$1,041.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$204.03
Rate for Payer: Priority Health Narrow Network	$204.03
Rate for Payer: Priority Health SBD	$204.03

PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION

Professional

Both

$774.00

Service Code	HCPCS 43226
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$541.80
Rate for Payer: Aetna Commercial	$173.52
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$127.32
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Mclaren Medicaid	$82.43
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$541.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$225.79
Rate for Payer: Priority Health Narrow Network	$225.79
Rate for Payer: Priority Health SBD	$225.79

PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

Facility

$1,032.00

Service Code	CPT 43215
Hospital Charge Code	43215
Min. Negotiated Rate	$650.16
Max. Negotiated Rate	$928.80
Rate for Payer: Aetna Commercial	$877.20
Rate for Payer: Aetna New Business (MI Preferred)	$670.80
Rate for Payer: Cash Price	$825.60
Rate for Payer: Cofinity Commercial	$722.40
Rate for Payer: Cofinity Commercial	$887.52
Rate for Payer: Healthscope Commercial	$928.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$877.20
Rate for Payer: PHP Commercial	$877.20
Rate for Payer: Priority Health Cigna Priority Health	$722.40
Rate for Payer: Priority Health SBD	$650.16

PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

Professional

Both

$1,032.00

Service Code	HCPCS 43215
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$722.40
Rate for Payer: Aetna Commercial	$187.69
Rate for Payer: BCBS Complete	$93.71
Rate for Payer: BCBS Trust/PPO	$162.19
Rate for Payer: Cash Price	$825.60
Rate for Payer: Cash Price	$825.60
Rate for Payer: Mclaren Medicaid	$89.25
Rate for Payer: Meridian Medicaid	$93.71
Rate for Payer: Priority Health Choice Medicaid	$89.25
Rate for Payer: Priority Health Cigna Priority Health	$722.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$244.01
Rate for Payer: Priority Health Narrow Network	$244.01
Rate for Payer: Priority Health SBD	$244.01

PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

Professional

Both

$1,032.00

Service Code	HCPCS 43215
Hospital Charge Code	43215
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$722.40
Rate for Payer: Aetna Commercial	$187.69
Rate for Payer: BCBS Complete	$93.71
Rate for Payer: BCBS Trust/PPO	$162.19
Rate for Payer: Cash Price	$825.60
Rate for Payer: Cash Price	$825.60
Rate for Payer: Mclaren Medicaid	$89.25
Rate for Payer: Meridian Medicaid	$93.71
Rate for Payer: Priority Health Choice Medicaid	$89.25
Rate for Payer: Priority Health Cigna Priority Health	$722.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$244.01
Rate for Payer: Priority Health Narrow Network	$244.01
Rate for Payer: Priority Health SBD	$244.01

PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

Facility

$1,032.00

Service Code	CPT 43215
Hospital Charge Code	43215
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$5,222.22
Rate for Payer: Aetna Commercial	$877.20
Rate for Payer: Aetna Medicare	$1,760.84
Rate for Payer: Aetna New Business (MI Preferred)	$670.80
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	$483.82
Rate for Payer: BCN Medicare Advantage	$1,693.12
Rate for Payer: Cash Price	$825.60
Rate for Payer: Cash Price	$825.60
Rate for Payer: Cofinity Commercial	$722.40
Rate for Payer: Cofinity Commercial	$887.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,693.12
Rate for Payer: Healthscope Commercial	$928.80
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	$877.20
Rate for Payer: PACE Medicare	$1,608.46
Rate for Payer: PACE SWMI	$1,693.12
Rate for Payer: PHP Commercial	$877.20
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	$722.40
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	$650.16
Rate for Payer: Railroad Medicare Medicare	$1,693.12
Rate for Payer: UHC All Payor (Choice/PPO)	$150.92
Rate for Payer: UHC Dual Complete DSNP	$1,693.12
Rate for Payer: UHC Exchange	$137.20
Rate for Payer: UHC Medicare Advantage	$1,743.91
Rate for Payer: VA VA	$1,693.12

PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE

Professional

Both

$1,147.00

Service Code	HCPCS 43217
Min. Negotiated Rate	$73.86
Max. Negotiated Rate	$802.90
Rate for Payer: Aetna Commercial	$212.68
Rate for Payer: BCBS Complete	$105.79
Rate for Payer: BCBS Trust/PPO	$73.86
Rate for Payer: Cash Price	$917.60
Rate for Payer: Cash Price	$917.60
Rate for Payer: Mclaren Medicaid	$100.75
Rate for Payer: Meridian Medicaid	$105.79
Rate for Payer: Priority Health Choice Medicaid	$100.75
Rate for Payer: Priority Health Cigna Priority Health	$802.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$275.17
Rate for Payer: Priority Health Narrow Network	$275.17
Rate for Payer: Priority Health SBD	$275.17

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC

Professional

Both

$395.00

Service Code	HCPCS 43200
Min. Negotiated Rate	$28.53
Max. Negotiated Rate	$276.50
Rate for Payer: Aetna Commercial	$116.05
Rate for Payer: BCBS Complete	$58.60
Rate for Payer: BCBS Trust/PPO	$28.53
Rate for Payer: Cash Price	$316.00
Rate for Payer: Cash Price	$316.00
Rate for Payer: Mclaren Medicaid	$55.81
Rate for Payer: Meridian Medicaid	$58.60
Rate for Payer: Priority Health Choice Medicaid	$55.81
Rate for Payer: Priority Health Cigna Priority Health	$276.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$152.29
Rate for Payer: Priority Health Narrow Network	$152.29
Rate for Payer: Priority Health SBD	$152.29

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM

Professional

Both

$867.00

Service Code	HCPCS 43231
Min. Negotiated Rate	$98.83
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$211.32
Rate for Payer: BCBS Complete	$103.77
Rate for Payer: BCBS Trust/PPO	$176.98
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Mclaren Medicaid	$98.83
Rate for Payer: Meridian Medicaid	$103.77
Rate for Payer: Priority Health Choice Medicaid	$98.83
Rate for Payer: Priority Health Cigna Priority Health	$606.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$272.24
Rate for Payer: Priority Health Narrow Network	$272.24
Rate for Payer: Priority Health SBD	$272.24

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

Professional

Both

$774.00

Service Code	HCPCS 43202
Hospital Charge Code	43202
Min. Negotiated Rate	$31.17
Max. Negotiated Rate	$541.80
Rate for Payer: Aetna Commercial	$136.23
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCBS Trust/PPO	$31.17
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health	$541.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.16
Rate for Payer: Priority Health Narrow Network	$178.16
Rate for Payer: Priority Health SBD	$178.16

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

Facility

$774.00

Service Code	CPT 43202
Hospital Charge Code	43202
Min. Negotiated Rate	$487.62
Max. Negotiated Rate	$696.60
Rate for Payer: Aetna Commercial	$657.90
Rate for Payer: Aetna New Business (MI Preferred)	$503.10
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cofinity Commercial	$665.64
Rate for Payer: Cofinity Commercial	$541.80
Rate for Payer: Healthscope Commercial	$696.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$657.90
Rate for Payer: PHP Commercial	$657.90
Rate for Payer: Priority Health Cigna Priority Health	$541.80
Rate for Payer: Priority Health SBD	$487.62

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

Facility

$774.00

Service Code	CPT 43202
Hospital Charge Code	43202
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$5,222.22
Rate for Payer: Aetna Commercial	$657.90
Rate for Payer: Aetna Medicare	$1,760.84
Rate for Payer: Aetna New Business (MI Preferred)	$503.10
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	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cofinity Commercial	$541.80
Rate for Payer: Cofinity Commercial	$665.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,693.12
Rate for Payer: Healthscope Commercial	$696.60
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	$657.90
Rate for Payer: PACE Medicare	$1,608.46
Rate for Payer: PACE SWMI	$1,693.12
Rate for Payer: PHP Commercial	$657.90
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	$541.80
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	$487.62
Rate for Payer: Railroad Medicare Medicare	$1,693.12
Rate for Payer: UHC All Payor (Choice/PPO)	$110.22
Rate for Payer: UHC Dual Complete DSNP	$1,693.12
Rate for Payer: UHC Exchange	$100.20
Rate for Payer: UHC Medicare Advantage	$1,743.91
Rate for Payer: VA VA	$1,693.12

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

Professional

Both

$774.00

Service Code	HCPCS 43202
Min. Negotiated Rate	$31.17
Max. Negotiated Rate	$541.80
Rate for Payer: Aetna Commercial	$136.23
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCBS Trust/PPO	$31.17
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health	$541.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.16
Rate for Payer: Priority Health Narrow Network	$178.16
Rate for Payer: Priority Health SBD	$178.16

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ

Professional

Both

$485.00

Service Code	HCPCS 43201
Min. Negotiated Rate	$30.11
Max. Negotiated Rate	$339.50
Rate for Payer: Aetna Commercial	$136.26
Rate for Payer: BCBS Complete	$68.88
Rate for Payer: BCBS Trust/PPO	$30.11
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cash Price	$388.00
Rate for Payer: Mclaren Medicaid	$65.60
Rate for Payer: Meridian Medicaid	$68.88
Rate for Payer: Priority Health Choice Medicaid	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$339.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$179.34
Rate for Payer: Priority Health Narrow Network	$179.34
Rate for Payer: Priority Health SBD	$179.34

PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL

Professional

Both

$1,082.00

Service Code	HCPCS 43227
Min. Negotiated Rate	$43.32
Max. Negotiated Rate	$757.40
Rate for Payer: Aetna Commercial	$219.16
Rate for Payer: BCBS Complete	$109.14
Rate for Payer: BCBS Trust/PPO	$43.32
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Mclaren Medicaid	$103.94
Rate for Payer: Meridian Medicaid	$109.14
Rate for Payer: Priority Health Choice Medicaid	$103.94
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$284.57
Rate for Payer: Priority Health Narrow Network	$284.57
Rate for Payer: Priority Health SBD	$284.57

PR ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES

Professional

Both

$1,082.00

Service Code	HCPCS 43204
Min. Negotiated Rate	$84.99
Max. Negotiated Rate	$757.40
Rate for Payer: Aetna Commercial	$179.22
Rate for Payer: BCBS Complete	$89.24
Rate for Payer: BCBS Trust/PPO	$249.36
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Mclaren Medicaid	$84.99
Rate for Payer: Meridian Medicaid	$89.24
Rate for Payer: Priority Health Choice Medicaid	$84.99
Rate for Payer: Priority Health Cigna Priority Health	$757.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$233.42
Rate for Payer: Priority Health Narrow Network	$233.42
Rate for Payer: Priority Health SBD	$233.42

PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION

Professional

Both

$626.00

Service Code	HCPCS 43229
Min. Negotiated Rate	$123.53
Max. Negotiated Rate	$438.20
Rate for Payer: Aetna Commercial	$262.30
Rate for Payer: BCBS Complete	$129.94
Rate for Payer: BCBS Trust/PPO	$123.53
Rate for Payer: Cash Price	$500.80
Rate for Payer: Cash Price	$500.80
Rate for Payer: Mclaren Medicaid	$123.75
Rate for Payer: Meridian Medicaid	$129.94
Rate for Payer: Priority Health Choice Medicaid	$123.75
Rate for Payer: Priority Health Cigna Priority Health	$438.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$339.26
Rate for Payer: Priority Health Narrow Network	$339.26
Rate for Payer: Priority Health SBD	$339.26

PR ESOPHAGOSCOPY,INSERT TUBE/STENT

Professional

Both

$1,467.00

Service Code	HCPCS 43219
Min. Negotiated Rate	$586.80
Max. Negotiated Rate	$1,026.90
Rate for Payer: BCBS Complete	$586.80
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Priority Health Cigna Priority Health	$1,026.90

Know your out-of-pocket cost for care.

All Charges