|
PR ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43204
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$179.22
|
| Rate for Payer: Aetna Medicare |
$568.50
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCN Commercial |
$200.19
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Mclaren Medicaid |
$76.89
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$243.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.91
|
| Rate for Payer: UHC Medicaid |
$76.89
|
| Rate for Payer: UHCCP Medicaid |
$76.89
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
HCPCS 43229
|
| Min. Negotiated Rate |
$111.40 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Aetna Commercial |
$262.30
|
| Rate for Payer: Aetna Medicare |
$329.00
|
| Rate for Payer: BCBS Complete |
$116.97
|
| Rate for Payer: BCN Commercial |
$289.82
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Mclaren Medicaid |
$111.40
|
| Rate for Payer: Meridian Medicaid |
$116.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.40
|
| 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 |
$111.40
|
| Rate for Payer: UHCCP Medicaid |
$111.40
|
|
|
PR ESOPHAGOSCOPY,INSERT TUBE/STENT
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 43219
|
| Min. Negotiated Rate |
$616.40 |
| Max. Negotiated Rate |
$1,155.75 |
| Rate for Payer: Aetna Medicare |
$770.50
|
| Rate for Payer: BCBS Complete |
$616.40
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,155.75
|
|
|
PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 43232
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$798.75 |
| Rate for Payer: Aetna Commercial |
$264.70
|
| Rate for Payer: Aetna Medicare |
$532.50
|
| Rate for Payer: BCBS Complete |
$118.75
|
| Rate for Payer: BCN Commercial |
$291.81
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Mclaren Medicaid |
$113.10
|
| Rate for Payer: Meridian Medicaid |
$118.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$355.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.56
|
| Rate for Payer: UHC Medicaid |
$113.10
|
| Rate for Payer: UHCCP Medicaid |
$113.10
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 43195
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$339.18 |
| Rate for Payer: Aetna Commercial |
$242.98
|
| Rate for Payer: Aetna Medicare |
$196.00
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCN Commercial |
$278.37
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Mclaren Medicaid |
$101.60
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.18
|
| Rate for Payer: UHC Medicaid |
$101.60
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 43191
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$204.70
|
| Rate for Payer: Aetna Medicare |
$207.00
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCN Commercial |
$234.05
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$285.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.18
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 43192
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$310.05 |
| Rate for Payer: Aetna Commercial |
$224.57
|
| Rate for Payer: Aetna Medicare |
$177.00
|
| Rate for Payer: BCBS Complete |
$98.41
|
| Rate for Payer: BCN Commercial |
$254.47
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Mclaren Medicaid |
$93.72
|
| Rate for Payer: Meridian Medicaid |
$98.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$310.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.05
|
| Rate for Payer: UHC Medicaid |
$93.72
|
| Rate for Payer: UHCCP Medicaid |
$93.72
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$410.25 |
| Rate for Payer: Aetna Commercial |
$223.22
|
| Rate for Payer: Aetna Medicare |
$273.50
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCN Commercial |
$254.97
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Mclaren Medicaid |
$94.36
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$310.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.65
|
| Rate for Payer: UHC Medicaid |
$94.36
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Aetna Commercial |
$256.30
|
| Rate for Payer: Aetna Medicare |
$247.50
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Mclaren Medicaid |
$103.09
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| 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 |
$103.09
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$443.25 |
| Rate for Payer: Aetna Commercial |
$253.36
|
| Rate for Payer: Aetna Medicare |
$295.50
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCN Commercial |
$280.36
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Mclaren Medicaid |
$108.20
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$341.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.60
|
| Rate for Payer: UHC Medicaid |
$108.20
|
| Rate for Payer: UHCCP Medicaid |
$108.20
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$1,021.50 |
| Rate for Payer: Aetna Commercial |
$724.74
|
| Rate for Payer: Aetna Medicare |
$681.00
|
| Rate for Payer: BCBS Complete |
$320.71
|
| Rate for Payer: BCN Commercial |
$824.16
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Meridian Medicaid |
$320.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,004.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,004.17
|
| Rate for Payer: UHC Medicaid |
$305.44
|
| Rate for Payer: UHCCP Medicaid |
$305.44
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$659.45 |
| Max. Negotiated Rate |
$1,937.99 |
| Rate for Payer: Aetna Commercial |
$1,431.41
|
| Rate for Payer: Aetna Medicare |
$1,230.50
|
| Rate for Payer: BCBS Complete |
$692.42
|
| Rate for Payer: BCN Commercial |
$1,590.55
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Mclaren Medicaid |
$659.45
|
| Rate for Payer: Meridian Medicaid |
$692.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,845.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,937.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,937.99
|
| Rate for Payer: UHC Medicaid |
$659.45
|
| Rate for Payer: UHCCP Medicaid |
$659.45
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,643.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$813.45 |
| Max. Negotiated Rate |
$2,732.25 |
| Rate for Payer: Aetna Commercial |
$1,767.68
|
| Rate for Payer: Aetna Medicare |
$1,821.50
|
| Rate for Payer: BCBS Complete |
$854.12
|
| Rate for Payer: BCN Commercial |
$1,964.03
|
| Rate for Payer: Cash Price |
$2,914.40
|
| Rate for Payer: Cash Price |
$2,914.40
|
| Rate for Payer: Mclaren Medicaid |
$813.45
|
| Rate for Payer: Meridian Medicaid |
$854.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,732.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$813.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,393.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,393.06
|
| Rate for Payer: UHC Medicaid |
$813.45
|
| Rate for Payer: UHCCP Medicaid |
$813.45
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,374.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$802.58 |
| Max. Negotiated Rate |
$2,530.50 |
| Rate for Payer: Aetna Commercial |
$1,746.60
|
| Rate for Payer: Aetna Medicare |
$1,687.00
|
| Rate for Payer: BCBS Complete |
$842.71
|
| Rate for Payer: BCN Commercial |
$1,940.13
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Mclaren Medicaid |
$802.58
|
| Rate for Payer: Meridian Medicaid |
$842.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,530.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$802.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,363.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,363.93
|
| Rate for Payer: UHC Medicaid |
$802.58
|
| Rate for Payer: UHCCP Medicaid |
$802.58
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$204.48 |
| Rate for Payer: Aetna Commercial |
$155.95
|
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCN Commercial |
$167.82
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Mclaren Medicaid |
$66.03
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.48
|
| Rate for Payer: UHC Medicaid |
$66.03
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$577.16 |
| Rate for Payer: Aetna Commercial |
$474.97
|
| Rate for Payer: Aetna Commercial |
$474.97
|
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: Aetna Medicare |
$422.00
|
| Rate for Payer: BCN Commercial |
$577.16
|
| Rate for Payer: BCN Commercial |
$577.16
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$633.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$532.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$532.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.27
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$76.04 |
| Max. Negotiated Rate |
$903.75 |
| Rate for Payer: Aetna Commercial |
$177.41
|
| Rate for Payer: Aetna Medicare |
$602.50
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCN Commercial |
$198.19
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Mclaren Medicaid |
$76.04
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.49
|
| Rate for Payer: UHC Medicaid |
$76.04
|
| Rate for Payer: UHCCP Medicaid |
$76.04
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$187.01
|
| Rate for Payer: Aetna Medicare |
$568.50
|
| Rate for Payer: BCBS Complete |
$84.31
|
| Rate for Payer: BCN Commercial |
$207.65
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Mclaren Medicaid |
$80.30
|
| Rate for Payer: Meridian Medicaid |
$84.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.01
|
| Rate for Payer: UHC Medicaid |
$80.30
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,858.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$1,727.64 |
| Max. Negotiated Rate |
$5,304.87 |
| Rate for Payer: Aetna Commercial |
$3,673.09
|
| Rate for Payer: Aetna Medicare |
$3,429.00
|
| Rate for Payer: BCBS Complete |
$1,814.02
|
| Rate for Payer: BCN Commercial |
$4,353.85
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Mclaren Medicaid |
$1,727.64
|
| Rate for Payer: Meridian Medicaid |
$1,814.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,143.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,304.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,304.87
|
| Rate for Payer: UHC Medicaid |
$1,727.64
|
| Rate for Payer: UHCCP Medicaid |
$1,727.64
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,794.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$1,831.16 |
| Max. Negotiated Rate |
$5,845.50 |
| Rate for Payer: Aetna Commercial |
$3,959.46
|
| Rate for Payer: Aetna Medicare |
$3,897.00
|
| Rate for Payer: BCBS Complete |
$1,922.72
|
| Rate for Payer: BCN Commercial |
$4,653.13
|
| Rate for Payer: Cash Price |
$6,235.20
|
| Rate for Payer: Cash Price |
$6,235.20
|
| Rate for Payer: Mclaren Medicaid |
$1,831.16
|
| Rate for Payer: Meridian Medicaid |
$1,922.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,845.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,831.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,669.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,669.55
|
| Rate for Payer: UHC Medicaid |
$1,831.16
|
| Rate for Payer: UHCCP Medicaid |
$1,831.16
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,134.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$351.88 |
| Max. Negotiated Rate |
$1,600.50 |
| Rate for Payer: Aetna Commercial |
$820.41
|
| Rate for Payer: Aetna Medicare |
$1,067.00
|
| Rate for Payer: BCBS Complete |
$369.47
|
| Rate for Payer: BCN Commercial |
$947.16
|
| Rate for Payer: Cash Price |
$1,707.20
|
| Rate for Payer: Cash Price |
$1,707.20
|
| Rate for Payer: Mclaren Medicaid |
$351.88
|
| Rate for Payer: Meridian Medicaid |
$369.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,600.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,154.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,154.05
|
| Rate for Payer: UHC Medicaid |
$351.88
|
| Rate for Payer: UHCCP Medicaid |
$351.88
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,382.00
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$601.73 |
| Max. Negotiated Rate |
$2,004.73 |
| Rate for Payer: Aetna Commercial |
$1,456.07
|
| Rate for Payer: Aetna Medicare |
$1,191.00
|
| Rate for Payer: BCBS Complete |
$631.82
|
| Rate for Payer: BCN Commercial |
$1,645.33
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Mclaren Medicaid |
$601.73
|
| Rate for Payer: Meridian Medicaid |
$631.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$601.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,004.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,004.73
|
| Rate for Payer: UHC Medicaid |
$601.73
|
| Rate for Payer: UHCCP Medicaid |
$601.73
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$5,126.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$893.11 |
| Max. Negotiated Rate |
$3,844.50 |
| Rate for Payer: Aetna Commercial |
$1,993.99
|
| Rate for Payer: Aetna Medicare |
$2,563.00
|
| Rate for Payer: BCBS Complete |
$937.77
|
| Rate for Payer: BCN Commercial |
$2,192.61
|
| Rate for Payer: Cash Price |
$4,100.80
|
| Rate for Payer: Cash Price |
$4,100.80
|
| Rate for Payer: Mclaren Medicaid |
$893.11
|
| Rate for Payer: Meridian Medicaid |
$937.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,844.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$893.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,671.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,671.56
|
| Rate for Payer: UHC Medicaid |
$893.11
|
| Rate for Payer: UHCCP Medicaid |
$893.11
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,455.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$942.95 |
| Max. Negotiated Rate |
$2,848.73 |
| Rate for Payer: Aetna Commercial |
$2,140.84
|
| Rate for Payer: Aetna Medicare |
$1,727.50
|
| Rate for Payer: BCBS Complete |
$990.10
|
| Rate for Payer: BCN Commercial |
$2,338.02
|
| Rate for Payer: Cash Price |
$2,764.00
|
| Rate for Payer: Cash Price |
$2,764.00
|
| Rate for Payer: Mclaren Medicaid |
$942.95
|
| Rate for Payer: Meridian Medicaid |
$990.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,591.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$942.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,848.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,848.73
|
| Rate for Payer: UHC Medicaid |
$942.95
|
| Rate for Payer: UHCCP Medicaid |
$942.95
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$10.62
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCN Commercial |
$14.45
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Mclaren Medicaid |
$6.39
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.32
|
| Rate for Payer: UHC Medicaid |
$6.39
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
|
