Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR

Professional

Both

$1,175.00

Service Code	HCPCS 27185
Min. Negotiated Rate	$470.00
Max. Negotiated Rate	$1,001.07
Rate for Payer: Aetna Commercial	$931.55
Rate for Payer: Aetna Medicare	$723.00
Rate for Payer: BCBS Complete	$470.00
Rate for Payer: BCBS MAPPO	$695.19
Rate for Payer: BCN Medicare Advantage	$695.19
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cofinity Commercial	$931.55
Rate for Payer: Cofinity Commercial	$1,001.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$695.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$729.95
Rate for Payer: Nomi Health Commercial	$834.23
Rate for Payer: PACE SWMI	$695.19
Rate for Payer: PHP Medicare Advantage	$695.19
Rate for Payer: Priority Health Cigna Priority Health	$763.75
Rate for Payer: Priority Health Medicare	$702.14
Rate for Payer: UHC All Payor (Choice/PPO)	$695.19
Rate for Payer: UHC Dual Complete DSNP	$695.19
Rate for Payer: UHC Exchange	$695.19
Rate for Payer: UHC Medicare Advantage	$695.19

PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING

Professional

Both

$381.00

Service Code	HCPCS 59300
Min. Negotiated Rate	$143.88
Max. Negotiated Rate	$247.65
Rate for Payer: Aetna Commercial	$192.80
Rate for Payer: Aetna Medicare	$149.64
Rate for Payer: BCBS Complete	$152.40
Rate for Payer: BCBS MAPPO	$143.88
Rate for Payer: BCN Medicare Advantage	$143.88
Rate for Payer: Cash Price	$304.80
Rate for Payer: Cash Price	$304.80
Rate for Payer: Cofinity Commercial	$207.19
Rate for Payer: Cofinity Commercial	$192.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$143.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$151.07
Rate for Payer: Nomi Health Commercial	$172.66
Rate for Payer: PACE SWMI	$143.88
Rate for Payer: PHP Medicare Advantage	$143.88
Rate for Payer: Priority Health Cigna Priority Health	$247.65
Rate for Payer: Priority Health Medicare	$145.32
Rate for Payer: UHC All Payor (Choice/PPO)	$143.88
Rate for Payer: UHC Dual Complete DSNP	$143.88
Rate for Payer: UHC Exchange	$143.88
Rate for Payer: UHC Medicare Advantage	$143.88

PR EPOETIN ALFA, NON-ESRD

Professional

Both

$39.00

Service Code	HCPCS J0885
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare	$8.88
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCBS MAPPO	$8.54
Rate for Payer: BCN Medicare Advantage	$8.54
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cofinity Commercial	$12.30
Rate for Payer: Cofinity Commercial	$11.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$8.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8.97
Rate for Payer: Nomi Health Commercial	$10.25
Rate for Payer: PACE SWMI	$8.54
Rate for Payer: PHP Medicare Advantage	$8.54
Rate for Payer: Priority Health Cigna Priority Health	$25.35
Rate for Payer: Priority Health Medicare	$8.63
Rate for Payer: UHC All Payor (Choice/PPO)	$8.54
Rate for Payer: UHC Dual Complete DSNP	$8.54
Rate for Payer: UHC Exchange	$8.54
Rate for Payer: UHC Medicare Advantage	$8.54

PR ERCP,ABLATION TUMOR

Professional

Both

$1,655.00

Service Code	HCPCS 43272
Min. Negotiated Rate	$662.00
Max. Negotiated Rate	$1,075.75
Rate for Payer: Aetna Medicare	$827.50
Rate for Payer: BCBS Complete	$662.00
Rate for Payer: Cash Price	$1,324.00
Rate for Payer: Priority Health Cigna Priority Health	$1,075.75

PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA

Professional

Both

$1,185.00

Service Code	HCPCS 43277
Min. Negotiated Rate	$355.29
Max. Negotiated Rate	$770.25
Rate for Payer: Aetna Commercial	$476.09
Rate for Payer: Aetna Medicare	$369.50
Rate for Payer: BCBS Complete	$474.00
Rate for Payer: BCBS MAPPO	$355.29
Rate for Payer: BCN Medicare Advantage	$355.29
Rate for Payer: Cash Price	$948.00
Rate for Payer: Cash Price	$948.00
Rate for Payer: Cofinity Commercial	$476.09
Rate for Payer: Cofinity Commercial	$511.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$355.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$373.05
Rate for Payer: Nomi Health Commercial	$426.35
Rate for Payer: PACE SWMI	$355.29
Rate for Payer: PHP Medicare Advantage	$355.29
Rate for Payer: Priority Health Cigna Priority Health	$770.25
Rate for Payer: Priority Health Medicare	$358.84
Rate for Payer: UHC All Payor (Choice/PPO)	$355.29
Rate for Payer: UHC Dual Complete DSNP	$355.29
Rate for Payer: UHC Exchange	$355.29
Rate for Payer: UHC Medicare Advantage	$355.29

PR ERCP,BALLOON DIL DUCTS

Professional

Both

$1,672.00

Service Code	HCPCS 43271
Min. Negotiated Rate	$668.80
Max. Negotiated Rate	$1,086.80
Rate for Payer: Aetna Medicare	$836.00
Rate for Payer: BCBS Complete	$668.80
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Priority Health Cigna Priority Health	$1,086.80

PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE

Professional

Both

$1,487.00

Service Code	HCPCS 43276
Min. Negotiated Rate	$451.73
Max. Negotiated Rate	$966.55
Rate for Payer: Aetna Commercial	$605.32
Rate for Payer: Aetna Medicare	$469.80
Rate for Payer: BCBS Complete	$594.80
Rate for Payer: BCBS MAPPO	$451.73
Rate for Payer: BCN Medicare Advantage	$451.73
Rate for Payer: Cash Price	$1,189.60
Rate for Payer: Cash Price	$1,189.60
Rate for Payer: Cofinity Commercial	$605.32
Rate for Payer: Cofinity Commercial	$650.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$451.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$474.32
Rate for Payer: Nomi Health Commercial	$542.08
Rate for Payer: PACE SWMI	$451.73
Rate for Payer: PHP Medicare Advantage	$451.73
Rate for Payer: Priority Health Cigna Priority Health	$966.55
Rate for Payer: Priority Health Medicare	$456.25
Rate for Payer: UHC All Payor (Choice/PPO)	$451.73
Rate for Payer: UHC Dual Complete DSNP	$451.73
Rate for Payer: UHC Exchange	$451.73
Rate for Payer: UHC Medicare Advantage	$451.73

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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$425.94
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	$409.72
Rate for Payer: UHC All Payor (Choice/PPO)	$405.66
Rate for Payer: UHC Dual Complete DSNP	$405.66
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$318.08
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	$305.96
Rate for Payer: UHC All Payor (Choice/PPO)	$302.93
Rate for Payer: UHC Dual Complete DSNP	$302.93
Rate for Payer: UHC Exchange	$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: 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: 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: 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	$458.63
Rate for Payer: Cofinity Commercial	$492.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$342.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$359.37
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	$345.68
Rate for Payer: UHC All Payor (Choice/PPO)	$342.26
Rate for Payer: UHC Dual Complete DSNP	$342.26
Rate for Payer: UHC Exchange	$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	$531.70
Rate for Payer: Aetna Commercial	$473.57
Rate for Payer: Aetna Medicare	$367.55
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$371.08
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	$356.94
Rate for Payer: UHC All Payor (Choice/PPO)	$353.41
Rate for Payer: UHC Dual Complete DSNP	$353.41
Rate for Payer: UHC Exchange	$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: 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$455.95
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	$438.58
Rate for Payer: UHC All Payor (Choice/PPO)	$434.24
Rate for Payer: UHC Dual Complete DSNP	$434.24
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$426.80
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	$410.54
Rate for Payer: UHC All Payor (Choice/PPO)	$406.48
Rate for Payer: UHC Dual Complete DSNP	$406.48
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$333.48
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	$320.78
Rate for Payer: UHC All Payor (Choice/PPO)	$317.60
Rate for Payer: UHC Dual Complete DSNP	$317.60
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$352.62
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	$339.19
Rate for Payer: UHC All Payor (Choice/PPO)	$335.83
Rate for Payer: UHC Dual Complete DSNP	$335.83
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$351.91
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	$338.50
Rate for Payer: UHC All Payor (Choice/PPO)	$335.15
Rate for Payer: UHC Dual Complete DSNP	$335.15
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$83.98
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	$80.78
Rate for Payer: UHC All Payor (Choice/PPO)	$79.98
Rate for Payer: UHC Dual Complete DSNP	$79.98
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$197.47
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	$189.95
Rate for Payer: UHC All Payor (Choice/PPO)	$188.07
Rate for Payer: UHC Dual Complete DSNP	$188.07
Rate for Payer: UHC Exchange	$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	$2,252.90
Rate for Payer: Aetna Commercial	$1,771.44
Rate for Payer: Aetna Medicare	$1,374.85
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,388.07
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	$1,335.19
Rate for Payer: UHC All Payor (Choice/PPO)	$1,321.97
Rate for Payer: UHC Dual Complete DSNP	$1,321.97
Rate for Payer: UHC Exchange	$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	$1,362.40
Rate for Payer: Aetna Commercial	$1,086.08
Rate for Payer: Aetna Medicare	$842.93
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$851.04
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	$818.62
Rate for Payer: UHC All Payor (Choice/PPO)	$810.51
Rate for Payer: UHC Dual Complete DSNP	$810.51
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$210.57
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	$202.55
Rate for Payer: UHC All Payor (Choice/PPO)	$200.54
Rate for Payer: UHC Dual Complete DSNP	$200.54
Rate for Payer: UHC Exchange	$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	$32.69
Rate for Payer: Aetna Commercial	$30.42
Rate for Payer: Aetna Medicare	$23.61
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$23.84
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	$22.93
Rate for Payer: UHC All Payor (Choice/PPO)	$22.70
Rate for Payer: UHC Dual Complete DSNP	$22.70
Rate for Payer: UHC Exchange	$22.70
Rate for Payer: UHC Medicare Advantage	$22.70

Know your out-of-pocket cost for care.

All Charges