Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE

Professional

Both

$913.00

Service Code	HCPCS 43460
Min. Negotiated Rate	$119.71
Max. Negotiated Rate	$684.75
Rate for Payer: Aetna Commercial	$282.44
Rate for Payer: Aetna Medicare	$456.50
Rate for Payer: BCBS Complete	$125.70
Rate for Payer: BCN Commercial	$313.73
Rate for Payer: Cash Price	$730.40
Rate for Payer: Cash Price	$730.40
Rate for Payer: Mclaren Medicaid	$119.71
Rate for Payer: Meridian Medicaid	$125.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$684.75
Rate for Payer: Priority Health Choice Medicaid	$119.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$382.25
Rate for Payer: Priority Health Narrow/Tiered Network	$382.25
Rate for Payer: UHC Medicaid	$119.71
Rate for Payer: UHCCP Medicaid	$119.71

PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION

Professional

Both

$44.00

Service Code	HCPCS 91013
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$37.35
Rate for Payer: Aetna Commercial	$28.42
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCN Commercial	$37.35
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.44
Rate for Payer: Priority Health Narrow/Tiered Network	$34.44

PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT

Professional

Both

$396.00

Service Code	HCPCS 91010
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$322.19
Rate for Payer: Aetna Commercial	$236.76
Rate for Payer: Aetna Commercial	$236.76
Rate for Payer: Aetna Medicare	$63.50
Rate for Payer: Aetna Medicare	$198.00
Rate for Payer: BCN Commercial	$322.19
Rate for Payer: BCN Commercial	$322.19
Rate for Payer: Cash Price	$101.60
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$101.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$297.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$297.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$297.13
Rate for Payer: Priority Health Narrow/Tiered Network	$297.13
Rate for Payer: Priority Health Narrow/Tiered Network	$297.13

PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ

Professional

Both

$6,719.00

Service Code	HCPCS 43287
Min. Negotiated Rate	$2,100.61
Max. Negotiated Rate	$6,388.54
Rate for Payer: Aetna Commercial	$4,797.22
Rate for Payer: Aetna Medicare	$3,359.50
Rate for Payer: BCBS Complete	$2,205.64
Rate for Payer: BCN Commercial	$5,243.25
Rate for Payer: Cash Price	$5,375.20
Rate for Payer: Cash Price	$5,375.20
Rate for Payer: Mclaren Medicaid	$2,100.61
Rate for Payer: Meridian Medicaid	$2,205.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,039.25
Rate for Payer: Priority Health Choice Medicaid	$2,100.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$6,388.54
Rate for Payer: Priority Health Narrow/Tiered Network	$6,388.54
Rate for Payer: UHC Medicaid	$2,100.61
Rate for Payer: UHCCP Medicaid	$2,100.61

PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ

Professional

Both

$6,803.00

Service Code	HCPCS 43286
Min. Negotiated Rate	$1,878.23
Max. Negotiated Rate	$5,749.63
Rate for Payer: Aetna Commercial	$4,282.47
Rate for Payer: Aetna Medicare	$3,401.50
Rate for Payer: BCBS Complete	$1,972.14
Rate for Payer: BCN Commercial	$4,718.87
Rate for Payer: Cash Price	$5,442.40
Rate for Payer: Cash Price	$5,442.40
Rate for Payer: Mclaren Medicaid	$1,878.23
Rate for Payer: Meridian Medicaid	$1,972.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,102.25
Rate for Payer: Priority Health Choice Medicaid	$1,878.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,749.63
Rate for Payer: Priority Health Narrow/Tiered Network	$5,749.63
Rate for Payer: UHC Medicaid	$1,878.23
Rate for Payer: UHCCP Medicaid	$1,878.23

PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ

Professional

Both

$6,682.00

Service Code	HCPCS 43288
Min. Negotiated Rate	$2,208.81
Max. Negotiated Rate	$6,744.72
Rate for Payer: Aetna Commercial	$5,050.41
Rate for Payer: Aetna Medicare	$3,341.00
Rate for Payer: BCBS Complete	$2,319.25
Rate for Payer: BCN Commercial	$5,535.56
Rate for Payer: Cash Price	$5,345.60
Rate for Payer: Cash Price	$5,345.60
Rate for Payer: Mclaren Medicaid	$2,208.81
Rate for Payer: Meridian Medicaid	$2,319.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,011.50
Rate for Payer: Priority Health Choice Medicaid	$2,208.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$6,744.72
Rate for Payer: Priority Health Narrow/Tiered Network	$6,744.72
Rate for Payer: UHC Medicaid	$2,208.81
Rate for Payer: UHCCP Medicaid	$2,208.81

PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION

Professional

Both

$695.00

Service Code	HCPCS 43236
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$521.25
Rate for Payer: Aetna Commercial	$183.36
Rate for Payer: Aetna Medicare	$347.50
Rate for Payer: BCBS Complete	$82.75
Rate for Payer: BCN Commercial	$204.18
Rate for Payer: Cash Price	$556.00
Rate for Payer: Cash Price	$556.00
Rate for Payer: Mclaren Medicaid	$78.81
Rate for Payer: Meridian Medicaid	$82.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$521.25
Rate for Payer: Priority Health Choice Medicaid	$78.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$248.77
Rate for Payer: Priority Health Narrow/Tiered Network	$248.77
Rate for Payer: UHC Medicaid	$78.81
Rate for Payer: UHCCP Medicaid	$78.81

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Professional

Both

$745.00

Service Code	HCPCS 43235
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$558.75
Rate for Payer: Aetna Commercial	$162.76
Rate for Payer: Aetna Medicare	$372.50
Rate for Payer: BCBS Complete	$74.03
Rate for Payer: BCN Commercial	$181.76
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Mclaren Medicaid	$70.50
Rate for Payer: Meridian Medicaid	$74.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$558.75
Rate for Payer: Priority Health Choice Medicaid	$70.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$221.46
Rate for Payer: Priority Health Narrow/Tiered Network	$221.46
Rate for Payer: UHC Medicaid	$70.50
Rate for Payer: UHCCP Medicaid	$70.50

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Professional

Both

$745.00

Service Code	HCPCS 43235
Hospital Charge Code	43235
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$558.75
Rate for Payer: Aetna Commercial	$162.76
Rate for Payer: Aetna Medicare	$372.50
Rate for Payer: BCBS Complete	$74.03
Rate for Payer: BCN Commercial	$181.76
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cash Price	$596.00
Rate for Payer: Mclaren Medicaid	$70.50
Rate for Payer: Meridian Medicaid	$74.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$558.75
Rate for Payer: Priority Health Choice Medicaid	$70.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$221.46
Rate for Payer: Priority Health Narrow/Tiered Network	$221.46
Rate for Payer: UHC Medicaid	$70.50
Rate for Payer: UHCCP Medicaid	$70.50

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Facility

$745.00

Service Code	CPT 43235
Hospital Charge Code	43235
Hospital Revenue Code	960
Min. Negotiated Rate	$131.34
Max. Negotiated Rate	$670.50
Rate for Payer: Aetna Commercial	$633.25
Rate for Payer: Aetna Medicare	$193.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$232.81
Rate for Payer: Amish Plain Church Group Commercial	$232.81
Rate for Payer: BCBS Complete	$137.90
Rate for Payer: BCBS MAPPO	$186.25
Rate for Payer: BCBS Trust/PPO	$612.46
Rate for Payer: BCN Commercial	$612.46
Rate for Payer: BCN Medicare Advantage	$186.25
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cofinity Commercial	$640.70
Rate for Payer: Encore Health Key Benefits Commercial	$596.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$186.25
Rate for Payer: Healthscope Commercial	$670.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$558.75
Rate for Payer: Mclaren Medicaid	$131.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$195.56
Rate for Payer: Meridian Medicaid	$137.90
Rate for Payer: MI Amish Medical Board Commercial	$214.19
Rate for Payer: Molina Medicare/Medicaid	$204.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$633.25
Rate for Payer: Nomi Health Commercial	$610.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$558.75
Rate for Payer: PACE Senior Care Partners	$176.94
Rate for Payer: PACE SWMI	$186.25
Rate for Payer: PHP Commercial	$633.25
Rate for Payer: PHP Medicare Advantage	$186.25
Rate for Payer: Priority Health Choice Medicaid	$131.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$648.15
Rate for Payer: Priority Health Medicare	$188.11
Rate for Payer: Priority Health Narrow/Tiered Network	$518.52
Rate for Payer: Railroad Medicare Medicare	$186.25
Rate for Payer: UHC Core	$622.08
Rate for Payer: UHC Exchange	$186.25
Rate for Payer: UHC Medicaid	$131.34
Rate for Payer: UHC Medicare Advantage	$186.25
Rate for Payer: UHCCP Medicaid	$131.34
Rate for Payer: VA VA	$186.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$558.75

PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Facility

$745.00

Service Code	CPT 43235
Hospital Charge Code	43235
Hospital Revenue Code	960
Min. Negotiated Rate	$518.52
Max. Negotiated Rate	$670.50
Rate for Payer: Aetna Commercial	$633.25
Rate for Payer: BCBS Trust/PPO	$615.30
Rate for Payer: BCN Commercial	$615.30
Rate for Payer: Cash Price	$596.00
Rate for Payer: Cofinity Commercial	$640.70
Rate for Payer: Encore Health Key Benefits Commercial	$596.00
Rate for Payer: Healthscope Commercial	$670.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$558.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$633.25
Rate for Payer: Nomi Health Commercial	$610.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$558.75
Rate for Payer: PHP Commercial	$633.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$648.15
Rate for Payer: Priority Health Narrow/Tiered Network	$518.52
Rate for Payer: UHC Core	$622.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$558.75

PR ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS

Professional

Both

$948.00

Service Code	HCPCS 43237
Min. Negotiated Rate	$110.33
Max. Negotiated Rate	$711.00
Rate for Payer: Aetna Commercial	$259.91
Rate for Payer: Aetna Medicare	$474.00
Rate for Payer: BCBS Complete	$115.85
Rate for Payer: BCN Commercial	$287.83
Rate for Payer: Cash Price	$758.40
Rate for Payer: Cash Price	$758.40
Rate for Payer: Mclaren Medicaid	$110.33
Rate for Payer: Meridian Medicaid	$115.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$711.00
Rate for Payer: Priority Health Choice Medicaid	$110.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$350.70
Rate for Payer: Priority Health Narrow/Tiered Network	$350.70
Rate for Payer: UHC Medicaid	$110.33
Rate for Payer: UHCCP Medicaid	$110.33

PR ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH

Professional

Both

$2,438.00

Service Code	HCPCS 43330
Min. Negotiated Rate	$798.54
Max. Negotiated Rate	$2,447.04
Rate for Payer: Aetna Commercial	$1,808.99
Rate for Payer: Aetna Medicare	$1,219.00
Rate for Payer: BCBS Complete	$838.47
Rate for Payer: BCN Commercial	$2,008.36
Rate for Payer: Cash Price	$1,950.40
Rate for Payer: Cash Price	$1,950.40
Rate for Payer: Mclaren Medicaid	$798.54
Rate for Payer: Meridian Medicaid	$838.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,828.50
Rate for Payer: Priority Health Choice Medicaid	$798.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,447.04
Rate for Payer: Priority Health Narrow/Tiered Network	$2,447.04
Rate for Payer: UHC Medicaid	$798.54
Rate for Payer: UHCCP Medicaid	$798.54

PR ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH

Professional

Both

$3,287.00

Service Code	HCPCS 43331
Min. Negotiated Rate	$817.71
Max. Negotiated Rate	$2,465.25
Rate for Payer: Aetna Commercial	$1,798.83
Rate for Payer: Aetna Medicare	$1,643.50
Rate for Payer: BCBS Complete	$858.60
Rate for Payer: BCN Commercial	$1,988.93
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Cash Price	$2,629.60
Rate for Payer: Mclaren Medicaid	$817.71
Rate for Payer: Meridian Medicaid	$858.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,465.25
Rate for Payer: Priority Health Choice Medicaid	$817.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,423.39
Rate for Payer: Priority Health Narrow/Tiered Network	$2,423.39
Rate for Payer: UHC Medicaid	$817.71
Rate for Payer: UHCCP Medicaid	$817.71

PR ESOPHAGOSCOPY,ABLATION TUMOR

Professional

Both

$1,483.00

Service Code	HCPCS 43228
Min. Negotiated Rate	$593.20
Max. Negotiated Rate	$1,112.25
Rate for Payer: Aetna Medicare	$741.50
Rate for Payer: BCBS Complete	$593.20
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,112.25

PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM

Professional

Both

$415.00

Service Code	HCPCS 43214
Min. Negotiated Rate	$107.35
Max. Negotiated Rate	$353.14
Rate for Payer: Aetna Commercial	$256.38
Rate for Payer: Aetna Medicare	$207.50
Rate for Payer: BCBS Complete	$112.72
Rate for Payer: BCN Commercial	$289.82
Rate for Payer: Cash Price	$332.00
Rate for Payer: Cash Price	$332.00
Rate for Payer: Mclaren Medicaid	$107.35
Rate for Payer: Meridian Medicaid	$112.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$311.25
Rate for Payer: Priority Health Choice Medicaid	$107.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$353.14
Rate for Payer: Priority Health Narrow/Tiered Network	$353.14
Rate for Payer: UHC Medicaid	$107.35
Rate for Payer: UHCCP Medicaid	$107.35

PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM

Professional

Both

$1,564.00

Service Code	HCPCS 43220
Min. Negotiated Rate	$67.52
Max. Negotiated Rate	$1,173.00
Rate for Payer: Aetna Commercial	$156.84
Rate for Payer: Aetna Medicare	$782.00
Rate for Payer: BCBS Complete	$70.90
Rate for Payer: BCN Commercial	$175.79
Rate for Payer: Cash Price	$1,251.20
Rate for Payer: Cash Price	$1,251.20
Rate for Payer: Mclaren Medicaid	$67.52
Rate for Payer: Meridian Medicaid	$70.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,173.00
Rate for Payer: Priority Health Choice Medicaid	$67.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$214.18
Rate for Payer: Priority Health Narrow/Tiered Network	$214.18
Rate for Payer: UHC Medicaid	$67.52
Rate for Payer: UHCCP Medicaid	$67.52

PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION

Professional

Both

$813.00

Service Code	HCPCS 43226
Min. Negotiated Rate	$74.76
Max. Negotiated Rate	$609.75
Rate for Payer: Aetna Commercial	$173.52
Rate for Payer: Aetna Medicare	$406.50
Rate for Payer: BCBS Complete	$78.50
Rate for Payer: BCN Commercial	$194.71
Rate for Payer: Cash Price	$650.40
Rate for Payer: Cash Price	$650.40
Rate for Payer: Mclaren Medicaid	$74.76
Rate for Payer: Meridian Medicaid	$78.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$609.75
Rate for Payer: Priority Health Choice Medicaid	$74.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$237.23
Rate for Payer: Priority Health Narrow/Tiered Network	$237.23
Rate for Payer: UHC Medicaid	$74.76
Rate for Payer: UHCCP Medicaid	$74.76

PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

Professional

Both

$1,085.00

Service Code	HCPCS 43215
Min. Negotiated Rate	$81.37
Max. Negotiated Rate	$813.75
Rate for Payer: Aetna Commercial	$187.69
Rate for Payer: Aetna Medicare	$542.50
Rate for Payer: BCBS Complete	$85.44
Rate for Payer: BCN Commercial	$210.15
Rate for Payer: Cash Price	$868.00
Rate for Payer: Cash Price	$868.00
Rate for Payer: Mclaren Medicaid	$81.37
Rate for Payer: Meridian Medicaid	$85.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$813.75
Rate for Payer: Priority Health Choice Medicaid	$81.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$256.05
Rate for Payer: Priority Health Narrow/Tiered Network	$256.05
Rate for Payer: UHC Medicaid	$81.37
Rate for Payer: UHCCP Medicaid	$81.37

PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE

Professional

Both

$1,205.00

Service Code	HCPCS 43217
Min. Negotiated Rate	$90.74
Max. Negotiated Rate	$903.75
Rate for Payer: Aetna Commercial	$212.68
Rate for Payer: Aetna Medicare	$602.50
Rate for Payer: BCBS Complete	$95.28
Rate for Payer: BCN Commercial	$236.55
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cash Price	$964.00
Rate for Payer: Mclaren Medicaid	$90.74
Rate for Payer: Meridian Medicaid	$95.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.75
Rate for Payer: Priority Health Choice Medicaid	$90.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$288.22
Rate for Payer: Priority Health Narrow/Tiered Network	$288.22
Rate for Payer: UHC Medicaid	$90.74
Rate for Payer: UHCCP Medicaid	$90.74

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC

Professional

Both

$415.00

Service Code	HCPCS 43200
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$311.25
Rate for Payer: Aetna Commercial	$116.05
Rate for Payer: Aetna Medicare	$207.50
Rate for Payer: BCBS Complete	$53.22
Rate for Payer: BCN Commercial	$130.47
Rate for Payer: Cash Price	$332.00
Rate for Payer: Cash Price	$332.00
Rate for Payer: Mclaren Medicaid	$50.69
Rate for Payer: Meridian Medicaid	$53.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$311.25
Rate for Payer: Priority Health Choice Medicaid	$50.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$158.97
Rate for Payer: Priority Health Narrow/Tiered Network	$158.97
Rate for Payer: UHC Medicaid	$50.69
Rate for Payer: UHCCP Medicaid	$50.69

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM

Professional

Both

$911.00

Service Code	HCPCS 43231
Min. Negotiated Rate	$87.97
Max. Negotiated Rate	$683.25
Rate for Payer: Aetna Commercial	$211.32
Rate for Payer: Aetna Medicare	$455.50
Rate for Payer: BCBS Complete	$92.37
Rate for Payer: BCN Commercial	$229.57
Rate for Payer: Cash Price	$728.80
Rate for Payer: Cash Price	$728.80
Rate for Payer: Mclaren Medicaid	$87.97
Rate for Payer: Meridian Medicaid	$92.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$683.25
Rate for Payer: Priority Health Choice Medicaid	$87.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$279.72
Rate for Payer: Priority Health Narrow/Tiered Network	$279.72
Rate for Payer: UHC Medicaid	$87.97
Rate for Payer: UHCCP Medicaid	$87.97

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

Professional

Both

$813.00

Service Code	HCPCS 43202
Min. Negotiated Rate	$59.43
Max. Negotiated Rate	$609.75
Rate for Payer: Aetna Commercial	$136.23
Rate for Payer: Aetna Medicare	$406.50
Rate for Payer: BCBS Complete	$62.40
Rate for Payer: BCN Commercial	$152.39
Rate for Payer: Cash Price	$650.40
Rate for Payer: Cash Price	$650.40
Rate for Payer: Mclaren Medicaid	$59.43
Rate for Payer: Meridian Medicaid	$62.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$609.75
Rate for Payer: Priority Health Choice Medicaid	$59.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$185.67
Rate for Payer: Priority Health Narrow/Tiered Network	$185.67
Rate for Payer: UHC Medicaid	$59.43
Rate for Payer: UHCCP Medicaid	$59.43

PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ

Professional

Both

$510.00

Service Code	HCPCS 43201
Min. Negotiated Rate	$58.79
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$136.26
Rate for Payer: Aetna Medicare	$255.00
Rate for Payer: BCBS Complete	$61.73
Rate for Payer: BCN Commercial	$153.87
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Mclaren Medicaid	$58.79
Rate for Payer: Meridian Medicaid	$61.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$382.50
Rate for Payer: Priority Health Choice Medicaid	$58.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$187.49
Rate for Payer: Priority Health Narrow/Tiered Network	$187.49
Rate for Payer: UHC Medicaid	$58.79
Rate for Payer: UHCCP Medicaid	$58.79

PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL

Professional

Both

$1,137.00

Service Code	HCPCS 43227
Min. Negotiated Rate	$93.72
Max. Negotiated Rate	$852.75
Rate for Payer: Aetna Commercial	$219.16
Rate for Payer: Aetna Medicare	$568.50
Rate for Payer: BCBS Complete	$98.41
Rate for Payer: BCN Commercial	$243.51
Rate for Payer: Cash Price	$909.60
Rate for Payer: Cash Price	$909.60
Rate for Payer: Mclaren Medicaid	$93.72
Rate for Payer: Meridian Medicaid	$98.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$852.75
Rate for Payer: Priority Health Choice Medicaid	$93.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$296.70
Rate for Payer: Priority Health Narrow/Tiered Network	$296.70
Rate for Payer: UHC Medicaid	$93.72
Rate for Payer: UHCCP Medicaid	$93.72

Know your out-of-pocket cost for care.

All Charges