|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$405.66 |
| Max. Negotiated Rate |
$1,238.25 |
| Rate for Payer: Aetna Commercial |
$543.58
|
| Rate for Payer: Aetna Medicare |
$421.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.58
|
| Rate for Payer: BCBS Complete |
$762.00
|
| Rate for Payer: BCBS MAPPO |
$405.66
|
| Rate for Payer: BCN Medicare Advantage |
$405.66
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cofinity Commercial |
$584.15
|
| Rate for Payer: Cofinity Commercial |
$543.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.66
|
| Rate for Payer: Healthscope Commercial |
$649.06
|
| Rate for Payer: Healthscope Commercial |
$750.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,238.25
|
| Rate for Payer: Nomi Health Commercial |
$486.79
|
| Rate for Payer: PACE SWMI |
$405.66
|
| Rate for Payer: PHP Medicare Advantage |
$405.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health Medicare |
$405.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$405.66
|
| Rate for Payer: UHC Medicare Advantage |
$405.66
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$302.93 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$405.93
|
| Rate for Payer: Aetna Medicare |
$315.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.93
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$302.93
|
| Rate for Payer: BCN Medicare Advantage |
$302.93
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$436.22
|
| Rate for Payer: Cofinity Commercial |
$405.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.93
|
| Rate for Payer: Healthscope Commercial |
$484.69
|
| Rate for Payer: Healthscope Commercial |
$560.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$717.60
|
| Rate for Payer: Nomi Health Commercial |
$363.52
|
| Rate for Payer: PACE SWMI |
$302.93
|
| Rate for Payer: PHP Medicare Advantage |
$302.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$302.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.93
|
| Rate for Payer: UHC Medicare Advantage |
$302.93
|
|
|
PR ERCP,INSERT STENT,BILIARY/PANC
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 43268
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$1,108.25 |
| Rate for Payer: Aetna Medicare |
$852.50
|
| Rate for Payer: BCBS Complete |
$682.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,108.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,108.25
|
|
|
PR ERCP,NASOBILIARY DRAIN TUBE
|
Professional
|
Both
|
$1,649.00
|
|
|
Service Code
|
HCPCS 43267
|
| Min. Negotiated Rate |
$659.60 |
| Max. Negotiated Rate |
$1,071.85 |
| Rate for Payer: Aetna Medicare |
$824.50
|
| Rate for Payer: BCBS Complete |
$659.60
|
| Rate for Payer: Cash Price |
$1,319.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,071.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.85
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$342.26 |
| Max. Negotiated Rate |
$1,195.35 |
| Rate for Payer: Aetna Commercial |
$458.63
|
| Rate for Payer: Aetna Medicare |
$355.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.63
|
| Rate for Payer: BCBS Complete |
$735.60
|
| Rate for Payer: BCBS MAPPO |
$342.26
|
| Rate for Payer: BCN Medicare Advantage |
$342.26
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cofinity Commercial |
$492.85
|
| Rate for Payer: Cofinity Commercial |
$458.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.26
|
| Rate for Payer: Healthscope Commercial |
$633.18
|
| Rate for Payer: Healthscope Commercial |
$547.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.35
|
| Rate for Payer: Nomi Health Commercial |
$410.71
|
| Rate for Payer: PACE SWMI |
$342.26
|
| Rate for Payer: PHP Medicare Advantage |
$342.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.35
|
| Rate for Payer: Priority Health Medicare |
$342.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.26
|
| Rate for Payer: UHC Medicare Advantage |
$342.26
|
|
|
PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 43275
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$653.81 |
| Rate for Payer: Aetna Commercial |
$473.57
|
| Rate for Payer: Aetna Medicare |
$367.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.57
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$353.41
|
| Rate for Payer: BCN Medicare Advantage |
$353.41
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$508.91
|
| Rate for Payer: Cofinity Commercial |
$473.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.41
|
| Rate for Payer: Healthscope Commercial |
$565.46
|
| Rate for Payer: Healthscope Commercial |
$653.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$531.70
|
| Rate for Payer: Nomi Health Commercial |
$424.09
|
| Rate for Payer: PACE SWMI |
$353.41
|
| Rate for Payer: PHP Medicare Advantage |
$353.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$353.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.41
|
| Rate for Payer: UHC Medicare Advantage |
$353.41
|
|
|
PR ERCP,RMV F.B./CHANGE STENT
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 43269
|
| Min. Negotiated Rate |
$677.20 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Medicare |
$846.50
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
|
|
PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
HCPCS 43274
|
| Min. Negotiated Rate |
$434.24 |
| Max. Negotiated Rate |
$928.85 |
| Rate for Payer: Aetna Commercial |
$581.88
|
| Rate for Payer: Aetna Medicare |
$451.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.31
|
| Rate for Payer: BCBS Complete |
$571.60
|
| Rate for Payer: BCBS MAPPO |
$434.24
|
| Rate for Payer: BCN Medicare Advantage |
$434.24
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Cofinity Commercial |
$625.31
|
| Rate for Payer: Cofinity Commercial |
$581.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.24
|
| Rate for Payer: Healthscope Commercial |
$803.34
|
| Rate for Payer: Healthscope Commercial |
$694.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.85
|
| Rate for Payer: Nomi Health Commercial |
$521.09
|
| Rate for Payer: PACE SWMI |
$434.24
|
| Rate for Payer: PHP Medicare Advantage |
$434.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.85
|
| Rate for Payer: Priority Health Medicare |
$434.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.24
|
| Rate for Payer: UHC Medicare Advantage |
$434.24
|
|
|
PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 43278
|
| Min. Negotiated Rate |
$406.48 |
| Max. Negotiated Rate |
$876.20 |
| Rate for Payer: Aetna Commercial |
$544.68
|
| Rate for Payer: Aetna Medicare |
$422.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.33
|
| Rate for Payer: BCBS Complete |
$539.20
|
| Rate for Payer: BCBS MAPPO |
$406.48
|
| Rate for Payer: BCN Medicare Advantage |
$406.48
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$544.68
|
| Rate for Payer: Cofinity Commercial |
$585.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.48
|
| Rate for Payer: Healthscope Commercial |
$650.37
|
| Rate for Payer: Healthscope Commercial |
$751.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$426.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.20
|
| Rate for Payer: Nomi Health Commercial |
$487.78
|
| Rate for Payer: PACE SWMI |
$406.48
|
| Rate for Payer: PHP Medicare Advantage |
$406.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health Medicare |
$406.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.48
|
| Rate for Payer: UHC Medicare Advantage |
$406.48
|
|
|
PR ERCP W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43261
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$425.58
|
| Rate for Payer: Aetna Medicare |
$330.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.58
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$317.60
|
| Rate for Payer: BCN Medicare Advantage |
$317.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$457.34
|
| Rate for Payer: Cofinity Commercial |
$425.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.60
|
| Rate for Payer: Healthscope Commercial |
$587.56
|
| Rate for Payer: Healthscope Commercial |
$508.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.50
|
| Rate for Payer: Nomi Health Commercial |
$381.12
|
| Rate for Payer: PACE SWMI |
$317.60
|
| Rate for Payer: PHP Medicare Advantage |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$317.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.60
|
| Rate for Payer: UHC Medicare Advantage |
$317.60
|
|
|
PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI
|
Professional
|
Both
|
$1,622.00
|
|
|
Service Code
|
HCPCS 43263
|
| Min. Negotiated Rate |
$335.83 |
| Max. Negotiated Rate |
$1,054.30 |
| Rate for Payer: Aetna Commercial |
$450.01
|
| Rate for Payer: Aetna Medicare |
$349.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.01
|
| Rate for Payer: BCBS Complete |
$648.80
|
| Rate for Payer: BCBS MAPPO |
$335.83
|
| Rate for Payer: BCN Medicare Advantage |
$335.83
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cofinity Commercial |
$483.60
|
| Rate for Payer: Cofinity Commercial |
$450.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.83
|
| Rate for Payer: Healthscope Commercial |
$537.33
|
| Rate for Payer: Healthscope Commercial |
$621.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,054.30
|
| Rate for Payer: Nomi Health Commercial |
$403.00
|
| Rate for Payer: PACE SWMI |
$335.83
|
| Rate for Payer: PHP Medicare Advantage |
$335.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.30
|
| Rate for Payer: Priority Health Medicare |
$335.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.83
|
| Rate for Payer: UHC Medicare Advantage |
$335.83
|
|
|
PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 43262
|
| Min. Negotiated Rate |
$335.15 |
| Max. Negotiated Rate |
$1,097.20 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Medicare |
$348.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.10
|
| Rate for Payer: BCBS Complete |
$675.20
|
| Rate for Payer: BCBS MAPPO |
$335.15
|
| Rate for Payer: BCN Medicare Advantage |
$335.15
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$482.62
|
| Rate for Payer: Cofinity Commercial |
$449.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.15
|
| Rate for Payer: Healthscope Commercial |
$620.03
|
| Rate for Payer: Healthscope Commercial |
$536.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$351.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,097.20
|
| Rate for Payer: Nomi Health Commercial |
$402.18
|
| Rate for Payer: PACE SWMI |
$335.15
|
| Rate for Payer: PHP Medicare Advantage |
$335.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health Medicare |
$335.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.15
|
| Rate for Payer: UHC Medicare Advantage |
$335.15
|
|
|
PR ESCHAROTOMY EACH ADDITIONAL INCISION
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 16036
|
| Min. Negotiated Rate |
$79.98 |
| Max. Negotiated Rate |
$282.10 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Aetna Medicare |
$83.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.17
|
| Rate for Payer: BCBS Complete |
$173.60
|
| Rate for Payer: BCBS MAPPO |
$79.98
|
| Rate for Payer: BCN Medicare Advantage |
$79.98
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.98
|
| Rate for Payer: Healthscope Commercial |
$127.97
|
| Rate for Payer: Healthscope Commercial |
$147.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.10
|
| Rate for Payer: Nomi Health Commercial |
$95.98
|
| Rate for Payer: PACE SWMI |
$79.98
|
| Rate for Payer: PHP Medicare Advantage |
$79.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: Priority Health Medicare |
$79.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.98
|
| Rate for Payer: UHC Medicare Advantage |
$79.98
|
|
|
PR ESCHAROTOMY FIRST INCISION
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 16035
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna Commercial |
$252.01
|
| Rate for Payer: Aetna Medicare |
$195.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.01
|
| Rate for Payer: BCBS Complete |
$344.00
|
| Rate for Payer: BCBS MAPPO |
$188.07
|
| Rate for Payer: BCN Medicare Advantage |
$188.07
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cofinity Commercial |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$252.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.07
|
| Rate for Payer: Healthscope Commercial |
$347.93
|
| Rate for Payer: Healthscope Commercial |
$300.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.00
|
| Rate for Payer: Nomi Health Commercial |
$225.68
|
| Rate for Payer: PACE SWMI |
$188.07
|
| Rate for Payer: PHP Medicare Advantage |
$188.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.00
|
| Rate for Payer: Priority Health Medicare |
$188.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.07
|
| Rate for Payer: UHC Medicare Advantage |
$188.07
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH
|
Professional
|
Both
|
$3,466.00
|
|
|
Service Code
|
HCPCS 43325
|
| Min. Negotiated Rate |
$1,321.97 |
| Max. Negotiated Rate |
$2,445.64 |
| Rate for Payer: Aetna Commercial |
$1,771.44
|
| Rate for Payer: Aetna Medicare |
$1,374.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,771.44
|
| Rate for Payer: BCBS Complete |
$1,386.40
|
| Rate for Payer: BCBS MAPPO |
$1,321.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,321.97
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cofinity Commercial |
$1,903.64
|
| Rate for Payer: Cofinity Commercial |
$1,771.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,321.97
|
| Rate for Payer: Healthscope Commercial |
$2,115.15
|
| Rate for Payer: Healthscope Commercial |
$2,445.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,388.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,252.90
|
| Rate for Payer: Nomi Health Commercial |
$1,586.36
|
| Rate for Payer: PACE SWMI |
$1,321.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,321.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.90
|
| Rate for Payer: Priority Health Medicare |
$1,321.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,321.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,321.97
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY
|
Professional
|
Both
|
$2,096.00
|
|
|
Service Code
|
HCPCS 43327
|
| Min. Negotiated Rate |
$810.51 |
| Max. Negotiated Rate |
$1,499.44 |
| Rate for Payer: Aetna Commercial |
$1,086.08
|
| Rate for Payer: Aetna Medicare |
$842.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,167.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.08
|
| Rate for Payer: BCBS Complete |
$838.40
|
| Rate for Payer: BCBS MAPPO |
$810.51
|
| Rate for Payer: BCN Medicare Advantage |
$810.51
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cofinity Commercial |
$1,167.13
|
| Rate for Payer: Cofinity Commercial |
$1,086.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.51
|
| Rate for Payer: Healthscope Commercial |
$1,499.44
|
| Rate for Payer: Healthscope Commercial |
$1,296.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$851.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,362.40
|
| Rate for Payer: Nomi Health Commercial |
$972.61
|
| Rate for Payer: PACE SWMI |
$810.51
|
| Rate for Payer: PHP Medicare Advantage |
$810.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.40
|
| Rate for Payer: Priority Health Medicare |
$810.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.51
|
| Rate for Payer: UHC Medicare Advantage |
$810.51
|
|
|
PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 43460
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$575.90 |
| Rate for Payer: Aetna Commercial |
$268.72
|
| Rate for Payer: Aetna Medicare |
$208.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.72
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$200.54
|
| Rate for Payer: BCN Medicare Advantage |
$200.54
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$288.78
|
| Rate for Payer: Cofinity Commercial |
$268.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.54
|
| Rate for Payer: Healthscope Commercial |
$320.86
|
| Rate for Payer: Healthscope Commercial |
$371.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.90
|
| Rate for Payer: Nomi Health Commercial |
$240.65
|
| Rate for Payer: PACE SWMI |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$200.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.54
|
| Rate for Payer: UHC Medicare Advantage |
$200.54
|
|
|
PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 91013
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna Commercial |
$30.42
|
| Rate for Payer: Aetna Medicare |
$23.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.42
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$22.70
|
| Rate for Payer: BCN Medicare Advantage |
$22.70
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.70
|
| Rate for Payer: Healthscope Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$41.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$27.24
|
| Rate for Payer: PACE SWMI |
$22.70
|
| Rate for Payer: PHP Medicare Advantage |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$22.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.70
|
| Rate for Payer: UHC Medicare Advantage |
$22.70
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 91010
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$360.62 |
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: Aetna Medicare |
$202.73
|
| Rate for Payer: Aetna Medicare |
$202.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.21
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS Complete |
$153.60
|
| Rate for Payer: BCBS MAPPO |
$194.93
|
| Rate for Payer: BCBS MAPPO |
$194.93
|
| Rate for Payer: BCN Medicare Advantage |
$194.93
|
| Rate for Payer: BCN Medicare Advantage |
$194.93
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cofinity Commercial |
$261.21
|
| Rate for Payer: Cofinity Commercial |
$261.21
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.93
|
| Rate for Payer: Healthscope Commercial |
$360.62
|
| Rate for Payer: Healthscope Commercial |
$360.62
|
| Rate for Payer: Healthscope Commercial |
$311.89
|
| Rate for Payer: Healthscope Commercial |
$311.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.95
|
| Rate for Payer: Nomi Health Commercial |
$233.92
|
| Rate for Payer: Nomi Health Commercial |
$233.92
|
| Rate for Payer: PACE SWMI |
$194.93
|
| Rate for Payer: PACE SWMI |
$194.93
|
| Rate for Payer: PHP Medicare Advantage |
$194.93
|
| Rate for Payer: PHP Medicare Advantage |
$194.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$194.93
|
| Rate for Payer: Priority Health Medicare |
$194.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.93
|
| Rate for Payer: UHC Medicare Advantage |
$194.93
|
| Rate for Payer: UHC Medicare Advantage |
$194.93
|
|
|
PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ
|
Professional
|
Both
|
$6,523.00
|
|
|
Service Code
|
HCPCS 43287
|
| Min. Negotiated Rate |
$2,609.20 |
| Max. Negotiated Rate |
$6,317.82 |
| Rate for Payer: Aetna Commercial |
$4,576.15
|
| Rate for Payer: Aetna Medicare |
$3,551.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,917.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,576.15
|
| Rate for Payer: BCBS Complete |
$2,609.20
|
| Rate for Payer: BCBS MAPPO |
$3,415.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,415.04
|
| Rate for Payer: Cash Price |
$5,218.40
|
| Rate for Payer: Cash Price |
$5,218.40
|
| Rate for Payer: Cofinity Commercial |
$4,917.66
|
| Rate for Payer: Cofinity Commercial |
$4,576.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,415.04
|
| Rate for Payer: Healthscope Commercial |
$6,317.82
|
| Rate for Payer: Healthscope Commercial |
$5,464.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,585.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,239.95
|
| Rate for Payer: Nomi Health Commercial |
$4,098.05
|
| Rate for Payer: PACE SWMI |
$3,415.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,415.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,239.95
|
| Rate for Payer: Priority Health Medicare |
$3,415.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,415.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,415.04
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ
|
Professional
|
Both
|
$6,605.00
|
|
|
Service Code
|
HCPCS 43286
|
| Min. Negotiated Rate |
$2,642.00 |
| Max. Negotiated Rate |
$5,673.27 |
| Rate for Payer: Aetna Commercial |
$4,109.28
|
| Rate for Payer: Aetna Medicare |
$3,189.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,415.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,109.28
|
| Rate for Payer: BCBS Complete |
$2,642.00
|
| Rate for Payer: BCBS MAPPO |
$3,066.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,066.63
|
| Rate for Payer: Cash Price |
$5,284.00
|
| Rate for Payer: Cash Price |
$5,284.00
|
| Rate for Payer: Cofinity Commercial |
$4,415.95
|
| Rate for Payer: Cofinity Commercial |
$4,109.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,066.63
|
| Rate for Payer: Healthscope Commercial |
$4,906.61
|
| Rate for Payer: Healthscope Commercial |
$5,673.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,293.25
|
| Rate for Payer: Nomi Health Commercial |
$3,679.96
|
| Rate for Payer: PACE SWMI |
$3,066.63
|
| Rate for Payer: PHP Medicare Advantage |
$3,066.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,293.25
|
| Rate for Payer: Priority Health Medicare |
$3,066.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,066.63
|
| Rate for Payer: UHC Medicare Advantage |
$3,066.63
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ
|
Professional
|
Both
|
$6,487.00
|
|
|
Service Code
|
HCPCS 43288
|
| Min. Negotiated Rate |
$2,594.80 |
| Max. Negotiated Rate |
$6,667.47 |
| Rate for Payer: Aetna Commercial |
$4,829.41
|
| Rate for Payer: Aetna Medicare |
$3,748.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,189.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,829.41
|
| Rate for Payer: BCBS Complete |
$2,594.80
|
| Rate for Payer: BCBS MAPPO |
$3,604.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,604.04
|
| Rate for Payer: Cash Price |
$5,189.60
|
| Rate for Payer: Cash Price |
$5,189.60
|
| Rate for Payer: Cofinity Commercial |
$5,189.82
|
| Rate for Payer: Cofinity Commercial |
$4,829.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,604.04
|
| Rate for Payer: Healthscope Commercial |
$6,667.47
|
| Rate for Payer: Healthscope Commercial |
$5,766.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,784.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,216.55
|
| Rate for Payer: Nomi Health Commercial |
$4,324.85
|
| Rate for Payer: PACE SWMI |
$3,604.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,604.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,216.55
|
| Rate for Payer: Priority Health Medicare |
$3,604.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,604.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,604.04
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 43236
|
| Min. Negotiated Rate |
$130.16 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Aetna Commercial |
$174.41
|
| Rate for Payer: Aetna Medicare |
$135.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.41
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS MAPPO |
$130.16
|
| Rate for Payer: BCN Medicare Advantage |
$130.16
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| 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 |
$208.26
|
| Rate for Payer: Healthscope Commercial |
$240.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.75
|
| 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 |
$438.75
|
| 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
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
43235
|
| Min. Negotiated Rate |
$115.86 |
| Max. Negotiated Rate |
$469.95 |
| Rate for Payer: Aetna Commercial |
$155.25
|
| Rate for Payer: Aetna Medicare |
$120.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.25
|
| Rate for Payer: BCBS Complete |
$289.20
|
| Rate for Payer: BCBS MAPPO |
$115.86
|
| Rate for Payer: BCN Medicare Advantage |
$115.86
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$166.84
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.86
|
| Rate for Payer: Healthscope Commercial |
$185.38
|
| Rate for Payer: Healthscope Commercial |
$214.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.95
|
| Rate for Payer: Nomi Health Commercial |
$139.03
|
| Rate for Payer: PACE SWMI |
$115.86
|
| Rate for Payer: PHP Medicare Advantage |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health Medicare |
$115.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.86
|
| Rate for Payer: UHC Medicare Advantage |
$115.86
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
43235
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$455.49 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Commercial |
$614.55
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.95
|
| 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: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$621.78
|
| Rate for Payer: Cofinity Commercial |
$506.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$506.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$650.70
|
| 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 |
$614.55
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$614.55
|
| 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 |
$469.95
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$455.49
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$514.80
|
| Rate for Payer: VA VA |
$914.38
|
|
