|
PR ESCHAROTOMY INITIAL INCISION
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 16035
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$664.50 |
| Rate for Payer: Aetna Commercial |
$239.11
|
| Rate for Payer: Aetna Medicare |
$185.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.95
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$178.44
|
| Rate for Payer: BCN Commercial |
$291.32
|
| Rate for Payer: BCN Medicare Advantage |
$178.44
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$239.11
|
| Rate for Payer: Cofinity Commercial |
$256.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.36
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.28
|
| Rate for Payer: Nomi Health Commercial |
$214.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$664.50
|
| Rate for Payer: PACE SWMI |
$178.44
|
| Rate for Payer: PHP Commercial |
$249.82
|
| Rate for Payer: PHP Medicare Advantage |
$178.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$266.64
|
| Rate for Payer: Priority Health Medicare |
$178.44
|
| Rate for Payer: Priority Health SBD |
$266.64
|
| Rate for Payer: Priority Health Tiered Network |
$266.64
|
| Rate for Payer: Railroad Medicare Medicare |
$178.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.01
|
| Rate for Payer: UHC Core |
$351.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.44
|
| Rate for Payer: UHC Exchange |
$351.01
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
| Rate for Payer: UMR Bronson Commercial |
$407.56
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH
|
Professional
|
Both
|
$3,570.00
|
|
|
Service Code
|
HCPCS 43325
|
| Min. Negotiated Rate |
$811.74 |
| Max. Negotiated Rate |
$2,677.50 |
| Rate for Payer: Aetna Commercial |
$1,700.06
|
| Rate for Payer: Aetna Medicare |
$1,319.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.93
|
| Rate for Payer: BCBS Complete |
$852.33
|
| Rate for Payer: BCBS MAPPO |
$1,268.70
|
| Rate for Payer: BCN Commercial |
$2,041.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,268.70
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cofinity Commercial |
$1,700.06
|
| Rate for Payer: Cofinity Commercial |
$1,826.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,268.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,332.13
|
| Rate for Payer: Meridian Medicaid |
$852.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,395.57
|
| Rate for Payer: Nomi Health Commercial |
$1,522.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,677.50
|
| Rate for Payer: PACE SWMI |
$1,268.70
|
| Rate for Payer: PHP Commercial |
$1,776.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,268.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,487.71
|
| Rate for Payer: Priority Health Medicare |
$1,268.70
|
| Rate for Payer: Priority Health SBD |
$2,487.71
|
| Rate for Payer: Priority Health Tiered Network |
$2,487.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,268.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,426.08
|
| Rate for Payer: UHC Core |
$2,426.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,268.70
|
| Rate for Payer: UHC Exchange |
$2,426.08
|
| Rate for Payer: UHC Medicaid |
$811.74
|
| Rate for Payer: UHCCP Medicaid |
$811.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,642.20
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 43327
|
| Min. Negotiated Rate |
$504.60 |
| Max. Negotiated Rate |
$1,619.25 |
| Rate for Payer: Aetna Commercial |
$1,052.30
|
| Rate for Payer: Aetna Medicare |
$816.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,052.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,130.83
|
| Rate for Payer: BCBS Complete |
$529.83
|
| Rate for Payer: BCBS MAPPO |
$785.30
|
| Rate for Payer: BCN Commercial |
$1,255.91
|
| Rate for Payer: BCN Medicare Advantage |
$785.30
|
| Rate for Payer: Cash Price |
$1,727.20
|
| Rate for Payer: Cash Price |
$1,727.20
|
| Rate for Payer: Cofinity Commercial |
$1,052.30
|
| Rate for Payer: Cofinity Commercial |
$1,130.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.57
|
| Rate for Payer: Meridian Medicaid |
$529.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$863.83
|
| Rate for Payer: Nomi Health Commercial |
$942.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,619.25
|
| Rate for Payer: PACE SWMI |
$785.30
|
| Rate for Payer: PHP Commercial |
$1,099.42
|
| Rate for Payer: PHP Medicare Advantage |
$785.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,530.24
|
| Rate for Payer: Priority Health Medicare |
$785.30
|
| Rate for Payer: Priority Health SBD |
$1,530.24
|
| Rate for Payer: Priority Health Tiered Network |
$1,530.24
|
| Rate for Payer: Railroad Medicare Medicare |
$785.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,461.29
|
| Rate for Payer: UHC Core |
$1,461.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$785.30
|
| Rate for Payer: UHC Exchange |
$1,461.29
|
| Rate for Payer: UHC Medicaid |
$504.60
|
| Rate for Payer: UHCCP Medicaid |
$504.60
|
| Rate for Payer: UMR Bronson Commercial |
$993.14
|
|
|
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 |
$248.11
|
| Rate for Payer: Aetna Medicare |
$192.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.63
|
| Rate for Payer: BCBS Complete |
$125.70
|
| Rate for Payer: BCBS MAPPO |
$185.16
|
| Rate for Payer: BCN Commercial |
$313.73
|
| Rate for Payer: BCN Medicare Advantage |
$185.16
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$248.11
|
| Rate for Payer: Cofinity Commercial |
$266.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.42
|
| Rate for Payer: Meridian Medicaid |
$125.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.68
|
| Rate for Payer: Nomi Health Commercial |
$222.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PACE SWMI |
$185.16
|
| Rate for Payer: PHP Commercial |
$259.22
|
| Rate for Payer: PHP Medicare Advantage |
$185.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$382.25
|
| Rate for Payer: Priority Health Medicare |
$185.16
|
| Rate for Payer: Priority Health SBD |
$382.25
|
| Rate for Payer: Priority Health Tiered Network |
$382.25
|
| Rate for Payer: Railroad Medicare Medicare |
$185.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.60
|
| Rate for Payer: UHC Core |
$374.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.16
|
| Rate for Payer: UHC Exchange |
$374.60
|
| Rate for Payer: UHC Medicaid |
$119.71
|
| Rate for Payer: UHCCP Medicaid |
$119.71
|
| Rate for Payer: UMR Bronson Commercial |
$419.98
|
|
|
PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 91013
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Commercial |
$35.54
|
| Rate for Payer: Aetna Medicare |
$27.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: BCBS MAPPO |
$26.52
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$26.52
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$38.19
|
| Rate for Payer: Cofinity Commercial |
$35.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.17
|
| Rate for Payer: Nomi Health Commercial |
$31.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$26.52
|
| Rate for Payer: PHP Commercial |
$37.13
|
| Rate for Payer: PHP Medicare Advantage |
$26.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.44
|
| Rate for Payer: Priority Health Medicare |
$26.52
|
| Rate for Payer: Priority Health SBD |
$34.44
|
| Rate for Payer: Priority Health Tiered Network |
$34.44
|
| Rate for Payer: Railroad Medicare Medicare |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.75
|
| Rate for Payer: UHC Core |
$39.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.52
|
| Rate for Payer: UHC Exchange |
$39.75
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 91010
|
| Min. Negotiated Rate |
$182.16 |
| Max. Negotiated Rate |
$329.37 |
| Rate for Payer: Aetna Commercial |
$306.50
|
| Rate for Payer: Aetna Commercial |
$306.50
|
| Rate for Payer: Aetna Medicare |
$237.88
|
| Rate for Payer: Aetna Medicare |
$237.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.50
|
| Rate for Payer: BCBS MAPPO |
$228.73
|
| Rate for Payer: BCBS MAPPO |
$228.73
|
| Rate for Payer: BCN Commercial |
$322.19
|
| Rate for Payer: BCN Commercial |
$322.19
|
| Rate for Payer: BCN Medicare Advantage |
$228.73
|
| Rate for Payer: BCN Medicare Advantage |
$228.73
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$306.50
|
| Rate for Payer: Cofinity Commercial |
$329.37
|
| Rate for Payer: Cofinity Commercial |
$329.37
|
| Rate for Payer: Cofinity Commercial |
$306.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$251.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$251.60
|
| Rate for Payer: Nomi Health Commercial |
$274.48
|
| Rate for Payer: Nomi Health Commercial |
$274.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.00
|
| Rate for Payer: PACE SWMI |
$228.73
|
| Rate for Payer: PACE SWMI |
$228.73
|
| Rate for Payer: PHP Commercial |
$320.22
|
| Rate for Payer: PHP Commercial |
$320.22
|
| Rate for Payer: PHP Medicare Advantage |
$228.73
|
| Rate for Payer: PHP Medicare Advantage |
$228.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.13
|
| Rate for Payer: Priority Health Medicare |
$228.73
|
| Rate for Payer: Priority Health Medicare |
$228.73
|
| Rate for Payer: Priority Health SBD |
$297.13
|
| Rate for Payer: Priority Health SBD |
$297.13
|
| Rate for Payer: Priority Health Tiered Network |
$297.13
|
| Rate for Payer: Priority Health Tiered Network |
$297.13
|
| Rate for Payer: Railroad Medicare Medicare |
$228.73
|
| Rate for Payer: Railroad Medicare Medicare |
$228.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.75
|
| Rate for Payer: UHC Core |
$309.75
|
| Rate for Payer: UHC Core |
$309.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$228.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$228.73
|
| Rate for Payer: UHC Exchange |
$309.75
|
| Rate for Payer: UHC Exchange |
$309.75
|
| Rate for Payer: UMR Bronson Commercial |
$182.16
|
| Rate for Payer: UMR Bronson Commercial |
$58.42
|
|
|
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 |
$6,417.38 |
| Rate for Payer: Aetna Commercial |
$4,419.37
|
| Rate for Payer: Aetna Medicare |
$3,429.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,419.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,749.18
|
| Rate for Payer: BCBS Complete |
$2,205.64
|
| Rate for Payer: BCBS MAPPO |
$3,298.04
|
| Rate for Payer: BCN Commercial |
$5,243.25
|
| Rate for Payer: BCN Medicare Advantage |
$3,298.04
|
| Rate for Payer: Cash Price |
$5,375.20
|
| Rate for Payer: Cash Price |
$5,375.20
|
| Rate for Payer: Cofinity Commercial |
$4,419.37
|
| Rate for Payer: Cofinity Commercial |
$4,749.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,462.94
|
| Rate for Payer: Meridian Medicaid |
$2,205.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,627.84
|
| Rate for Payer: Nomi Health Commercial |
$3,957.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,039.25
|
| Rate for Payer: PACE SWMI |
$3,298.04
|
| Rate for Payer: PHP Commercial |
$4,617.26
|
| Rate for Payer: PHP Medicare Advantage |
$3,298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,100.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,388.54
|
| Rate for Payer: Priority Health Medicare |
$3,298.04
|
| Rate for Payer: Priority Health SBD |
$6,388.54
|
| Rate for Payer: Priority Health Tiered Network |
$6,388.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,417.38
|
| Rate for Payer: UHC Core |
$6,417.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,298.04
|
| Rate for Payer: UHC Exchange |
$6,417.38
|
| Rate for Payer: UHC Medicaid |
$2,100.61
|
| Rate for Payer: UHCCP Medicaid |
$2,100.61
|
| Rate for Payer: UMR Bronson Commercial |
$3,090.74
|
|
|
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 |
$3,944.71
|
| Rate for Payer: Aetna Medicare |
$3,061.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,944.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,239.09
|
| Rate for Payer: BCBS Complete |
$1,972.14
|
| Rate for Payer: BCBS MAPPO |
$2,943.81
|
| Rate for Payer: BCN Commercial |
$4,718.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,943.81
|
| Rate for Payer: Cash Price |
$5,442.40
|
| Rate for Payer: Cash Price |
$5,442.40
|
| Rate for Payer: Cofinity Commercial |
$3,944.71
|
| Rate for Payer: Cofinity Commercial |
$4,239.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,943.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,091.00
|
| Rate for Payer: Meridian Medicaid |
$1,972.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,238.19
|
| Rate for Payer: Nomi Health Commercial |
$3,532.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,102.25
|
| Rate for Payer: PACE SWMI |
$2,943.81
|
| Rate for Payer: PHP Commercial |
$4,121.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,943.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,878.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,749.63
|
| Rate for Payer: Priority Health Medicare |
$2,943.81
|
| Rate for Payer: Priority Health SBD |
$5,749.63
|
| Rate for Payer: Priority Health Tiered Network |
$5,749.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,943.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,660.59
|
| Rate for Payer: UHC Core |
$5,660.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,943.81
|
| Rate for Payer: UHC Exchange |
$5,660.59
|
| Rate for Payer: UHC Medicaid |
$1,878.23
|
| Rate for Payer: UHCCP Medicaid |
$1,878.23
|
| Rate for Payer: UMR Bronson Commercial |
$3,129.38
|
|
|
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 |
$4,648.73
|
| Rate for Payer: Aetna Medicare |
$3,607.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,648.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,995.65
|
| Rate for Payer: BCBS Complete |
$2,319.25
|
| Rate for Payer: BCBS MAPPO |
$3,469.20
|
| Rate for Payer: BCN Commercial |
$5,535.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,469.20
|
| Rate for Payer: Cash Price |
$5,345.60
|
| Rate for Payer: Cash Price |
$5,345.60
|
| Rate for Payer: Cofinity Commercial |
$4,648.73
|
| Rate for Payer: Cofinity Commercial |
$4,995.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,469.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,642.66
|
| Rate for Payer: Meridian Medicaid |
$2,319.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,816.12
|
| Rate for Payer: Nomi Health Commercial |
$4,163.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,011.50
|
| Rate for Payer: PACE SWMI |
$3,469.20
|
| Rate for Payer: PHP Commercial |
$4,856.88
|
| Rate for Payer: PHP Medicare Advantage |
$3,469.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,208.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,744.72
|
| Rate for Payer: Priority Health Medicare |
$3,469.20
|
| Rate for Payer: Priority Health SBD |
$6,744.72
|
| Rate for Payer: Priority Health Tiered Network |
$6,744.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3,469.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,743.04
|
| Rate for Payer: UHC Core |
$6,743.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,469.20
|
| Rate for Payer: UHC Exchange |
$6,743.04
|
| Rate for Payer: UHC Medicaid |
$2,208.81
|
| Rate for Payer: UHCCP Medicaid |
$2,208.81
|
| Rate for Payer: UMR Bronson Commercial |
$3,073.72
|
|
|
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 |
$162.88
|
| Rate for Payer: Aetna Medicare |
$126.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.03
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS MAPPO |
$121.55
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: BCN Medicare Advantage |
$121.55
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cofinity Commercial |
$162.88
|
| Rate for Payer: Cofinity Commercial |
$175.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.63
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.71
|
| Rate for Payer: Nomi Health Commercial |
$145.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$521.25
|
| Rate for Payer: PACE SWMI |
$121.55
|
| Rate for Payer: PHP Commercial |
$170.17
|
| Rate for Payer: PHP Medicare Advantage |
$121.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$248.77
|
| Rate for Payer: Priority Health Medicare |
$121.55
|
| Rate for Payer: Priority Health SBD |
$248.77
|
| Rate for Payer: Priority Health Tiered Network |
$248.77
|
| Rate for Payer: Railroad Medicare Medicare |
$121.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.44
|
| Rate for Payer: UHC Core |
$243.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$121.55
|
| Rate for Payer: UHC Exchange |
$243.44
|
| Rate for Payer: UHC Medicaid |
$78.81
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
| Rate for Payer: UMR Bronson Commercial |
$319.70
|
|
|
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 |
$145.52
|
| Rate for Payer: Aetna Medicare |
$112.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.38
|
| Rate for Payer: BCBS Complete |
$74.03
|
| Rate for Payer: BCBS MAPPO |
$108.60
|
| Rate for Payer: BCN Commercial |
$181.76
|
| Rate for Payer: BCN Medicare Advantage |
$108.60
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$145.52
|
| Rate for Payer: Cofinity Commercial |
$156.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.03
|
| Rate for Payer: Meridian Medicaid |
$74.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.46
|
| Rate for Payer: Nomi Health Commercial |
$130.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.75
|
| Rate for Payer: PACE SWMI |
$108.60
|
| Rate for Payer: PHP Commercial |
$152.04
|
| Rate for Payer: PHP Medicare Advantage |
$108.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$221.46
|
| Rate for Payer: Priority Health Medicare |
$108.60
|
| Rate for Payer: Priority Health SBD |
$221.46
|
| Rate for Payer: Priority Health Tiered Network |
$221.46
|
| Rate for Payer: Railroad Medicare Medicare |
$108.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.93
|
| Rate for Payer: UHC Core |
$215.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$108.60
|
| Rate for Payer: UHC Exchange |
$215.93
|
| Rate for Payer: UHC Medicaid |
$70.50
|
| Rate for Payer: UHCCP Medicaid |
$70.50
|
| Rate for Payer: UMR Bronson Commercial |
$342.70
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
43235
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$327.80 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Aetna American Axle |
$484.25
|
| Rate for Payer: Aetna Commercial |
$633.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.25
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Advantage |
$521.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$521.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.75
|
| Rate for Payer: PHP Commercial |
$633.25
|
| Rate for Payer: Priority Health SBD |
$469.35
|
| Rate for Payer: UMR Bronson Commercial |
$327.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.75
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
43235
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$275.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna American Axle |
$484.25
|
| Rate for Payer: Aetna Commercial |
$633.25
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$837.39
|
| Rate for Payer: BCN Commercial |
$837.39
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Advantage |
$521.50
|
| 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 |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$670.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$521.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.75
|
| Rate for Payer: Mclaren Medicaid |
$903.72
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.25
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.75
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$633.25
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$469.35
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: UMR Bronson Commercial |
$275.65
|
| Rate for Payer: VA VA |
$903.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.75
|
|
|
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 |
$145.52
|
| Rate for Payer: Aetna Medicare |
$112.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.38
|
| Rate for Payer: BCBS Complete |
$74.03
|
| Rate for Payer: BCBS MAPPO |
$108.60
|
| Rate for Payer: BCN Commercial |
$181.76
|
| Rate for Payer: BCN Medicare Advantage |
$108.60
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$145.52
|
| Rate for Payer: Cofinity Commercial |
$156.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.03
|
| Rate for Payer: Meridian Medicaid |
$74.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.46
|
| Rate for Payer: Nomi Health Commercial |
$130.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.75
|
| Rate for Payer: PACE SWMI |
$108.60
|
| Rate for Payer: PHP Commercial |
$152.04
|
| Rate for Payer: PHP Medicare Advantage |
$108.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$221.46
|
| Rate for Payer: Priority Health Medicare |
$108.60
|
| Rate for Payer: Priority Health SBD |
$221.46
|
| Rate for Payer: Priority Health Tiered Network |
$221.46
|
| Rate for Payer: Railroad Medicare Medicare |
$108.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.93
|
| Rate for Payer: UHC Core |
$215.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$108.60
|
| Rate for Payer: UHC Exchange |
$215.93
|
| Rate for Payer: UHC Medicaid |
$70.50
|
| Rate for Payer: UHCCP Medicaid |
$70.50
|
| Rate for Payer: UMR Bronson Commercial |
$342.70
|
|
|
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 |
$228.51
|
| Rate for Payer: Aetna Medicare |
$177.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.56
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCBS MAPPO |
$170.53
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$170.53
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cofinity Commercial |
$228.51
|
| Rate for Payer: Cofinity Commercial |
$245.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.06
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.58
|
| Rate for Payer: Nomi Health Commercial |
$204.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.00
|
| Rate for Payer: PACE SWMI |
$170.53
|
| Rate for Payer: PHP Commercial |
$238.74
|
| Rate for Payer: PHP Medicare Advantage |
$170.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$350.70
|
| Rate for Payer: Priority Health Medicare |
$170.53
|
| Rate for Payer: Priority Health SBD |
$350.70
|
| Rate for Payer: Priority Health Tiered Network |
$350.70
|
| Rate for Payer: Railroad Medicare Medicare |
$170.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.54
|
| Rate for Payer: UHC Core |
$344.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$170.53
|
| Rate for Payer: UHC Exchange |
$344.54
|
| Rate for Payer: UHC Medicaid |
$110.33
|
| Rate for Payer: UHCCP Medicaid |
$110.33
|
| Rate for Payer: UMR Bronson Commercial |
$436.08
|
|
|
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 |
$1,672.01
|
| Rate for Payer: Aetna Medicare |
$1,297.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,672.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,796.79
|
| Rate for Payer: BCBS Complete |
$838.47
|
| Rate for Payer: BCBS MAPPO |
$1,247.77
|
| Rate for Payer: BCN Commercial |
$2,008.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,247.77
|
| Rate for Payer: Cash Price |
$1,950.40
|
| Rate for Payer: Cash Price |
$1,950.40
|
| Rate for Payer: Cofinity Commercial |
$1,672.01
|
| Rate for Payer: Cofinity Commercial |
$1,796.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,247.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,310.16
|
| Rate for Payer: Meridian Medicaid |
$838.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,372.55
|
| Rate for Payer: Nomi Health Commercial |
$1,497.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,828.50
|
| Rate for Payer: PACE SWMI |
$1,247.77
|
| Rate for Payer: PHP Commercial |
$1,746.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,247.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,447.04
|
| Rate for Payer: Priority Health Medicare |
$1,247.77
|
| Rate for Payer: Priority Health SBD |
$2,447.04
|
| Rate for Payer: Priority Health Tiered Network |
$2,447.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,247.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,385.45
|
| Rate for Payer: UHC Core |
$2,385.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,247.77
|
| Rate for Payer: UHC Exchange |
$2,385.45
|
| Rate for Payer: UHC Medicaid |
$798.54
|
| Rate for Payer: UHCCP Medicaid |
$798.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,121.48
|
|
|
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 |
$1,710.99
|
| Rate for Payer: Aetna Medicare |
$1,327.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,838.68
|
| Rate for Payer: BCBS Complete |
$858.60
|
| Rate for Payer: BCBS MAPPO |
$1,276.86
|
| Rate for Payer: BCN Commercial |
$1,988.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,276.86
|
| Rate for Payer: Cash Price |
$2,629.60
|
| Rate for Payer: Cash Price |
$2,629.60
|
| Rate for Payer: Cofinity Commercial |
$1,710.99
|
| Rate for Payer: Cofinity Commercial |
$1,838.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,276.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,340.70
|
| Rate for Payer: Meridian Medicaid |
$858.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,404.55
|
| Rate for Payer: Nomi Health Commercial |
$1,532.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,465.25
|
| Rate for Payer: PACE SWMI |
$1,276.86
|
| Rate for Payer: PHP Commercial |
$1,787.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,276.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$817.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,423.39
|
| Rate for Payer: Priority Health Medicare |
$1,276.86
|
| Rate for Payer: Priority Health SBD |
$2,423.39
|
| Rate for Payer: Priority Health Tiered Network |
$2,423.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,276.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,377.92
|
| Rate for Payer: UHC Core |
$2,377.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,276.86
|
| Rate for Payer: UHC Exchange |
$2,377.92
|
| Rate for Payer: UHC Medicaid |
$817.71
|
| Rate for Payer: UHCCP Medicaid |
$817.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,512.02
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$682.18
|
|
|
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 |
$223.71
|
| Rate for Payer: Aetna Medicare |
$173.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.41
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS MAPPO |
$166.95
|
| Rate for Payer: BCN Commercial |
$289.82
|
| Rate for Payer: BCN Medicare Advantage |
$166.95
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$240.41
|
| Rate for Payer: Cofinity Commercial |
$223.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.30
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$183.65
|
| Rate for Payer: Nomi Health Commercial |
$200.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.25
|
| Rate for Payer: PACE SWMI |
$166.95
|
| Rate for Payer: PHP Commercial |
$233.73
|
| Rate for Payer: PHP Medicare Advantage |
$166.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$353.14
|
| Rate for Payer: Priority Health Medicare |
$166.95
|
| Rate for Payer: Priority Health SBD |
$353.14
|
| Rate for Payer: Priority Health Tiered Network |
$353.14
|
| Rate for Payer: Railroad Medicare Medicare |
$166.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.79
|
| Rate for Payer: UHC Core |
$339.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$166.95
|
| Rate for Payer: UHC Exchange |
$339.79
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
| Rate for Payer: UMR Bronson Commercial |
$190.90
|
|
|
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 |
$139.64
|
| Rate for Payer: Aetna Medicare |
$108.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.06
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS MAPPO |
$104.21
|
| Rate for Payer: BCN Commercial |
$175.79
|
| Rate for Payer: BCN Medicare Advantage |
$104.21
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$139.64
|
| Rate for Payer: Cofinity Commercial |
$150.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.42
|
| Rate for Payer: Meridian Medicaid |
$70.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.63
|
| Rate for Payer: Nomi Health Commercial |
$125.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,173.00
|
| Rate for Payer: PACE SWMI |
$104.21
|
| Rate for Payer: PHP Commercial |
$145.89
|
| Rate for Payer: PHP Medicare Advantage |
$104.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$214.18
|
| Rate for Payer: Priority Health Medicare |
$104.21
|
| Rate for Payer: Priority Health SBD |
$214.18
|
| Rate for Payer: Priority Health Tiered Network |
$214.18
|
| Rate for Payer: Railroad Medicare Medicare |
$104.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.41
|
| Rate for Payer: UHC Core |
$207.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.21
|
| Rate for Payer: UHC Exchange |
$207.41
|
| Rate for Payer: UHC Medicaid |
$67.52
|
| Rate for Payer: UHCCP Medicaid |
$67.52
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
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 |
$155.40
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.00
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$115.97
|
| Rate for Payer: BCN Commercial |
$194.71
|
| Rate for Payer: BCN Medicare Advantage |
$115.97
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$167.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.77
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.57
|
| Rate for Payer: Nomi Health Commercial |
$139.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.75
|
| Rate for Payer: PACE SWMI |
$115.97
|
| Rate for Payer: PHP Commercial |
$162.36
|
| Rate for Payer: PHP Medicare Advantage |
$115.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$237.23
|
| Rate for Payer: Priority Health Medicare |
$115.97
|
| Rate for Payer: Priority Health SBD |
$237.23
|
| Rate for Payer: Priority Health Tiered Network |
$237.23
|
| Rate for Payer: Railroad Medicare Medicare |
$115.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.11
|
| Rate for Payer: UHC Core |
$229.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.97
|
| Rate for Payer: UHC Exchange |
$229.11
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
| Rate for Payer: UMR Bronson Commercial |
$373.98
|
|
|
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 |
$168.84
|
| Rate for Payer: Aetna Medicare |
$131.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.44
|
| Rate for Payer: BCBS Complete |
$85.44
|
| Rate for Payer: BCBS MAPPO |
$126.00
|
| Rate for Payer: BCN Commercial |
$210.15
|
| Rate for Payer: BCN Medicare Advantage |
$126.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$168.84
|
| Rate for Payer: Cofinity Commercial |
$181.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.30
|
| Rate for Payer: Meridian Medicaid |
$85.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.60
|
| Rate for Payer: Nomi Health Commercial |
$151.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$813.75
|
| Rate for Payer: PACE SWMI |
$126.00
|
| Rate for Payer: PHP Commercial |
$176.40
|
| Rate for Payer: PHP Medicare Advantage |
$126.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$256.05
|
| Rate for Payer: Priority Health Medicare |
$126.00
|
| Rate for Payer: Priority Health SBD |
$256.05
|
| Rate for Payer: Priority Health Tiered Network |
$256.05
|
| Rate for Payer: Railroad Medicare Medicare |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.31
|
| Rate for Payer: UHC Core |
$249.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$126.00
|
| Rate for Payer: UHC Exchange |
$249.31
|
| Rate for Payer: UHC Medicaid |
$81.37
|
| Rate for Payer: UHCCP Medicaid |
$81.37
|
| Rate for Payer: UMR Bronson Commercial |
$499.10
|
|
|
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 |
$187.61
|
| Rate for Payer: Aetna Medicare |
$145.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.61
|
| Rate for Payer: BCBS Complete |
$95.28
|
| Rate for Payer: BCBS MAPPO |
$140.01
|
| Rate for Payer: BCN Commercial |
$236.55
|
| Rate for Payer: BCN Medicare Advantage |
$140.01
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$187.61
|
| Rate for Payer: Cofinity Commercial |
$201.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.01
|
| Rate for Payer: Meridian Medicaid |
$95.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$154.01
|
| Rate for Payer: Nomi Health Commercial |
$168.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.75
|
| Rate for Payer: PACE SWMI |
$140.01
|
| Rate for Payer: PHP Commercial |
$196.01
|
| Rate for Payer: PHP Medicare Advantage |
$140.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$288.22
|
| Rate for Payer: Priority Health Medicare |
$140.01
|
| Rate for Payer: Priority Health SBD |
$288.22
|
| Rate for Payer: Priority Health Tiered Network |
$288.22
|
| Rate for Payer: Railroad Medicare Medicare |
$140.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.98
|
| Rate for Payer: UHC Core |
$281.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$140.01
|
| Rate for Payer: UHC Exchange |
$281.98
|
| Rate for Payer: UHC Medicaid |
$90.74
|
| Rate for Payer: UHCCP Medicaid |
$90.74
|
| Rate for Payer: UMR Bronson Commercial |
$554.30
|
|
|
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 |
$104.65
|
| Rate for Payer: Aetna Medicare |
$81.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.46
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$78.10
|
| Rate for Payer: BCN Commercial |
$130.47
|
| Rate for Payer: BCN Medicare Advantage |
$78.10
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$104.65
|
| Rate for Payer: Cofinity Commercial |
$112.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.00
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.91
|
| Rate for Payer: Nomi Health Commercial |
$93.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.25
|
| Rate for Payer: PACE SWMI |
$78.10
|
| Rate for Payer: PHP Commercial |
$109.34
|
| Rate for Payer: PHP Medicare Advantage |
$78.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$158.97
|
| Rate for Payer: Priority Health Medicare |
$78.10
|
| Rate for Payer: Priority Health SBD |
$158.97
|
| Rate for Payer: Priority Health Tiered Network |
$158.97
|
| Rate for Payer: Railroad Medicare Medicare |
$78.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.49
|
| Rate for Payer: UHC Core |
$153.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.10
|
| Rate for Payer: UHC Exchange |
$153.49
|
| Rate for Payer: UHC Medicaid |
$50.69
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: UMR Bronson Commercial |
$190.90
|
|
|
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 |
$182.01
|
| Rate for Payer: Aetna Medicare |
$141.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.60
|
| Rate for Payer: BCBS Complete |
$92.37
|
| Rate for Payer: BCBS MAPPO |
$135.83
|
| Rate for Payer: BCN Commercial |
$229.57
|
| Rate for Payer: BCN Medicare Advantage |
$135.83
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$182.01
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.62
|
| Rate for Payer: Meridian Medicaid |
$92.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.41
|
| Rate for Payer: Nomi Health Commercial |
$163.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: PACE SWMI |
$135.83
|
| Rate for Payer: PHP Commercial |
$190.16
|
| Rate for Payer: PHP Medicare Advantage |
$135.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$279.72
|
| Rate for Payer: Priority Health Medicare |
$135.83
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: Priority Health Tiered Network |
$279.72
|
| Rate for Payer: Railroad Medicare Medicare |
$135.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.16
|
| Rate for Payer: UHC Core |
$280.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.83
|
| Rate for Payer: UHC Exchange |
$280.16
|
| Rate for Payer: UHC Medicaid |
$87.97
|
| Rate for Payer: UHCCP Medicaid |
$87.97
|
| Rate for Payer: UMR Bronson Commercial |
$419.06
|
|
