|
PR ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH
|
Professional
|
Both
|
$3,191.00
|
|
|
Service Code
|
HCPCS 43331
|
| Min. Negotiated Rate |
$1,276.40 |
| Max. Negotiated Rate |
$2,074.15 |
| Rate for Payer: Aetna Commercial |
$1,730.22
|
| Rate for Payer: Aetna Medicare |
$1,342.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,859.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.22
|
| Rate for Payer: BCBS Complete |
$1,276.40
|
| Rate for Payer: BCBS MAPPO |
$1,291.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,291.21
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Cofinity Commercial |
$1,859.34
|
| Rate for Payer: Cofinity Commercial |
$1,730.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,291.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,355.77
|
| Rate for Payer: Nomi Health Commercial |
$1,549.45
|
| Rate for Payer: PACE SWMI |
$1,291.21
|
| Rate for Payer: PHP Commercial |
$1,807.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,291.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.15
|
| Rate for Payer: Priority Health Medicare |
$1,291.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,291.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,291.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,467.86
|
|
|
PR ESOPHAGOSCOPY,ABLATION TUMOR
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 43228
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Medicare |
$720.00
|
| Rate for Payer: BCBS Complete |
$576.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$936.00
|
| Rate for Payer: UMR Bronson Commercial |
$662.40
|
|
|
PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM
|
Professional
|
Both
|
$403.00
|
|
|
Service Code
|
HCPCS 43214
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$267.65 |
| Rate for Payer: Aetna Commercial |
$249.07
|
| Rate for Payer: Aetna Medicare |
$193.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.65
|
| Rate for Payer: BCBS Complete |
$161.20
|
| Rate for Payer: BCBS MAPPO |
$185.87
|
| Rate for Payer: BCN Medicare Advantage |
$185.87
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Cofinity Commercial |
$249.07
|
| Rate for Payer: Cofinity Commercial |
$267.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.16
|
| Rate for Payer: Nomi Health Commercial |
$223.04
|
| Rate for Payer: PACE SWMI |
$185.87
|
| Rate for Payer: PHP Commercial |
$260.22
|
| Rate for Payer: PHP Medicare Advantage |
$185.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.95
|
| Rate for Payer: Priority Health Medicare |
$185.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.87
|
| Rate for Payer: UHC Medicare Advantage |
$185.87
|
| Rate for Payer: UMR Bronson Commercial |
$185.38
|
|
|
PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 43220
|
| Min. Negotiated Rate |
$112.15 |
| Max. Negotiated Rate |
$986.70 |
| Rate for Payer: Aetna Commercial |
$150.28
|
| Rate for Payer: Aetna Medicare |
$116.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.28
|
| Rate for Payer: BCBS Complete |
$607.20
|
| Rate for Payer: BCBS MAPPO |
$112.15
|
| Rate for Payer: BCN Medicare Advantage |
$112.15
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cofinity Commercial |
$161.50
|
| Rate for Payer: Cofinity Commercial |
$150.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.76
|
| Rate for Payer: Nomi Health Commercial |
$134.58
|
| Rate for Payer: PACE SWMI |
$112.15
|
| Rate for Payer: PHP Commercial |
$157.01
|
| Rate for Payer: PHP Medicare Advantage |
$112.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.70
|
| Rate for Payer: Priority Health Medicare |
$112.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.15
|
| Rate for Payer: UHC Medicare Advantage |
$112.15
|
| Rate for Payer: UMR Bronson Commercial |
$698.28
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 43226
|
| Min. Negotiated Rate |
$124.89 |
| Max. Negotiated Rate |
$512.85 |
| Rate for Payer: Aetna Commercial |
$167.35
|
| Rate for Payer: Aetna Medicare |
$129.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.35
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$124.89
|
| Rate for Payer: BCN Medicare Advantage |
$124.89
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$179.84
|
| Rate for Payer: Cofinity Commercial |
$167.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.13
|
| Rate for Payer: Nomi Health Commercial |
$149.87
|
| Rate for Payer: PACE SWMI |
$124.89
|
| Rate for Payer: PHP Commercial |
$174.85
|
| Rate for Payer: PHP Medicare Advantage |
$124.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$124.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.89
|
| Rate for Payer: UHC Medicare Advantage |
$124.89
|
| Rate for Payer: UMR Bronson Commercial |
$362.94
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 43215
|
| Min. Negotiated Rate |
$134.68 |
| Max. Negotiated Rate |
$684.45 |
| Rate for Payer: Aetna Commercial |
$180.47
|
| Rate for Payer: Aetna Medicare |
$140.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.47
|
| Rate for Payer: BCBS Complete |
$421.20
|
| Rate for Payer: BCBS MAPPO |
$134.68
|
| Rate for Payer: BCN Medicare Advantage |
$134.68
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$193.94
|
| Rate for Payer: Cofinity Commercial |
$180.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.41
|
| Rate for Payer: Nomi Health Commercial |
$161.62
|
| Rate for Payer: PACE SWMI |
$134.68
|
| Rate for Payer: PHP Commercial |
$188.55
|
| Rate for Payer: PHP Medicare Advantage |
$134.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.45
|
| Rate for Payer: Priority Health Medicare |
$134.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.68
|
| Rate for Payer: UHC Medicare Advantage |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$484.38
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$463.32 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Aetna American Axle |
$684.45
|
| Rate for Payer: Aetna Commercial |
$895.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.45
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$737.10
|
| Rate for Payer: Cofinity Commercial |
$905.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$737.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.40
|
| Rate for Payer: Healthscope Commercial |
$947.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$789.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.05
|
| Rate for Payer: PHP Commercial |
$895.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.45
|
| Rate for Payer: Priority Health SBD |
$663.39
|
| Rate for Payer: UMR Bronson Commercial |
$463.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.75
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$134.68 |
| Max. Negotiated Rate |
$684.45 |
| Rate for Payer: Aetna Commercial |
$180.47
|
| Rate for Payer: Aetna Medicare |
$140.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.47
|
| Rate for Payer: BCBS Complete |
$421.20
|
| Rate for Payer: BCBS MAPPO |
$134.68
|
| Rate for Payer: BCN Medicare Advantage |
$134.68
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$193.94
|
| Rate for Payer: Cofinity Commercial |
$180.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.41
|
| Rate for Payer: Nomi Health Commercial |
$161.62
|
| Rate for Payer: PACE SWMI |
$134.68
|
| Rate for Payer: PHP Commercial |
$188.55
|
| Rate for Payer: PHP Medicare Advantage |
$134.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.45
|
| Rate for Payer: Priority Health Medicare |
$134.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.68
|
| Rate for Payer: UHC Medicare Advantage |
$134.68
|
| Rate for Payer: UMR Bronson Commercial |
$484.38
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$389.61 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna American Axle |
$684.45
|
| Rate for Payer: Aetna Commercial |
$895.05
|
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$737.10
|
| Rate for Payer: Cofinity Commercial |
$905.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$737.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$947.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$737.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$789.75
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.05
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$895.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.45
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health SBD |
$663.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: UMR Bronson Commercial |
$389.61
|
| Rate for Payer: VA VA |
$1,850.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$789.75
|
|
|
PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43217
|
| Min. Negotiated Rate |
$150.91 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$202.22
|
| Rate for Payer: Aetna Medicare |
$156.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.22
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$150.91
|
| Rate for Payer: BCN Medicare Advantage |
$150.91
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$217.31
|
| Rate for Payer: Cofinity Commercial |
$202.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.46
|
| Rate for Payer: Nomi Health Commercial |
$181.09
|
| Rate for Payer: PACE SWMI |
$150.91
|
| Rate for Payer: PHP Commercial |
$211.27
|
| Rate for Payer: PHP Medicare Advantage |
$150.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$150.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.91
|
| Rate for Payer: UHC Medicare Advantage |
$150.91
|
| Rate for Payer: UMR Bronson Commercial |
$538.20
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$403.00
|
|
|
Service Code
|
HCPCS 43200
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$261.95 |
| Rate for Payer: Aetna Commercial |
$111.31
|
| Rate for Payer: Aetna Medicare |
$86.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.31
|
| Rate for Payer: BCBS Complete |
$161.20
|
| Rate for Payer: BCBS MAPPO |
$83.07
|
| Rate for Payer: BCN Medicare Advantage |
$83.07
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Cofinity Commercial |
$119.62
|
| Rate for Payer: Cofinity Commercial |
$111.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.22
|
| Rate for Payer: Nomi Health Commercial |
$99.68
|
| Rate for Payer: PACE SWMI |
$83.07
|
| Rate for Payer: PHP Commercial |
$116.30
|
| Rate for Payer: PHP Medicare Advantage |
$83.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.95
|
| Rate for Payer: Priority Health Medicare |
$83.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.07
|
| Rate for Payer: UHC Medicare Advantage |
$83.07
|
| Rate for Payer: UMR Bronson Commercial |
$185.38
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 43231
|
| Min. Negotiated Rate |
$146.36 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: Aetna Commercial |
$196.12
|
| Rate for Payer: Aetna Medicare |
$152.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.12
|
| Rate for Payer: BCBS Complete |
$353.60
|
| Rate for Payer: BCBS MAPPO |
$146.36
|
| Rate for Payer: BCN Medicare Advantage |
$146.36
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$210.76
|
| Rate for Payer: Cofinity Commercial |
$196.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.68
|
| Rate for Payer: Nomi Health Commercial |
$175.63
|
| Rate for Payer: PACE SWMI |
$146.36
|
| Rate for Payer: PHP Commercial |
$204.90
|
| Rate for Payer: PHP Medicare Advantage |
$146.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health Medicare |
$146.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.36
|
| Rate for Payer: UHC Medicare Advantage |
$146.36
|
| Rate for Payer: UMR Bronson Commercial |
$406.64
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$710.10 |
| Rate for Payer: Aetna American Axle |
$512.85
|
| Rate for Payer: Aetna Commercial |
$670.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.85
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$552.30
|
| Rate for Payer: Cofinity Commercial |
$678.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.20
|
| Rate for Payer: Healthscope Commercial |
$710.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$552.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$591.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.65
|
| Rate for Payer: PHP Commercial |
$670.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health SBD |
$497.07
|
| Rate for Payer: UMR Bronson Commercial |
$347.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$591.75
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$291.93 |
| Max. Negotiated Rate |
$5,207.85 |
| Rate for Payer: Aetna American Axle |
$512.85
|
| Rate for Payer: Aetna Commercial |
$670.65
|
| Rate for Payer: Aetna Medicare |
$1,924.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$678.54
|
| Rate for Payer: Cofinity Commercial |
$552.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$710.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$552.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$591.75
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.65
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$670.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health SBD |
$497.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$3,535.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: UMR Bronson Commercial |
$291.93
|
| Rate for Payer: VA VA |
$1,850.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$591.75
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 43202
|
| Min. Negotiated Rate |
$96.99 |
| Max. Negotiated Rate |
$512.85 |
| Rate for Payer: Aetna Commercial |
$129.97
|
| Rate for Payer: Aetna Medicare |
$100.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.97
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$96.99
|
| Rate for Payer: BCN Medicare Advantage |
$96.99
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$139.67
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.84
|
| Rate for Payer: Nomi Health Commercial |
$116.39
|
| Rate for Payer: PACE SWMI |
$96.99
|
| Rate for Payer: PHP Commercial |
$135.79
|
| Rate for Payer: PHP Medicare Advantage |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$96.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.99
|
| Rate for Payer: UHC Medicare Advantage |
$96.99
|
| Rate for Payer: UMR Bronson Commercial |
$362.94
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$96.99 |
| Max. Negotiated Rate |
$512.85 |
| Rate for Payer: Aetna Commercial |
$129.97
|
| Rate for Payer: Aetna Medicare |
$100.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.97
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$96.99
|
| Rate for Payer: BCN Medicare Advantage |
$96.99
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Cofinity Commercial |
$139.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.84
|
| Rate for Payer: Nomi Health Commercial |
$116.39
|
| Rate for Payer: PACE SWMI |
$96.99
|
| Rate for Payer: PHP Commercial |
$135.79
|
| Rate for Payer: PHP Medicare Advantage |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$96.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.99
|
| Rate for Payer: UHC Medicare Advantage |
$96.99
|
| Rate for Payer: UMR Bronson Commercial |
$362.94
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 43201
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$321.75 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna Medicare |
$101.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.27
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS MAPPO |
$97.96
|
| Rate for Payer: BCN Medicare Advantage |
$97.96
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$141.06
|
| Rate for Payer: Cofinity Commercial |
$131.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.86
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: PACE SWMI |
$97.96
|
| Rate for Payer: PHP Commercial |
$137.14
|
| Rate for Payer: PHP Medicare Advantage |
$97.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health Medicare |
$97.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.96
|
| Rate for Payer: UHC Medicare Advantage |
$97.96
|
| Rate for Payer: UMR Bronson Commercial |
$227.70
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43227
|
| Min. Negotiated Rate |
$155.47 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$208.33
|
| Rate for Payer: Aetna Medicare |
$161.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.33
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$155.47
|
| Rate for Payer: BCN Medicare Advantage |
$155.47
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$223.88
|
| Rate for Payer: Cofinity Commercial |
$208.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.24
|
| Rate for Payer: Nomi Health Commercial |
$186.56
|
| Rate for Payer: PACE SWMI |
$155.47
|
| Rate for Payer: PHP Commercial |
$217.66
|
| Rate for Payer: PHP Medicare Advantage |
$155.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$155.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.47
|
| Rate for Payer: UHC Medicare Advantage |
$155.47
|
| Rate for Payer: UMR Bronson Commercial |
$507.84
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43204
|
| Min. Negotiated Rate |
$127.54 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$170.90
|
| Rate for Payer: Aetna Medicare |
$132.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.90
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$127.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.54
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$183.66
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.92
|
| Rate for Payer: Nomi Health Commercial |
$153.05
|
| Rate for Payer: PACE SWMI |
$127.54
|
| Rate for Payer: PHP Commercial |
$178.56
|
| Rate for Payer: PHP Medicare Advantage |
$127.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$127.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.54
|
| Rate for Payer: UHC Medicare Advantage |
$127.54
|
| Rate for Payer: UMR Bronson Commercial |
$507.84
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 43229
|
| Min. Negotiated Rate |
$185.28 |
| Max. Negotiated Rate |
$415.35 |
| Rate for Payer: Aetna Commercial |
$248.28
|
| Rate for Payer: Aetna Medicare |
$192.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.28
|
| Rate for Payer: BCBS Complete |
$255.60
|
| Rate for Payer: BCBS MAPPO |
$185.28
|
| Rate for Payer: BCN Medicare Advantage |
$185.28
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$266.80
|
| Rate for Payer: Cofinity Commercial |
$248.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.54
|
| Rate for Payer: Nomi Health Commercial |
$222.34
|
| Rate for Payer: PACE SWMI |
$185.28
|
| Rate for Payer: PHP Commercial |
$259.39
|
| Rate for Payer: PHP Medicare Advantage |
$185.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.35
|
| Rate for Payer: Priority Health Medicare |
$185.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.28
|
| Rate for Payer: UHC Medicare Advantage |
$185.28
|
| Rate for Payer: UMR Bronson Commercial |
$293.94
|
|
|
PR ESOPHAGOSCOPY,INSERT TUBE/STENT
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
HCPCS 43219
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$972.40 |
| Rate for Payer: Aetna Medicare |
$748.00
|
| Rate for Payer: BCBS Complete |
$598.40
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$972.40
|
| Rate for Payer: UMR Bronson Commercial |
$688.16
|
|
|
PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 43232
|
| Min. Negotiated Rate |
$186.32 |
| Max. Negotiated Rate |
$672.10 |
| Rate for Payer: Aetna Commercial |
$249.67
|
| Rate for Payer: Aetna Medicare |
$193.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.30
|
| Rate for Payer: BCBS Complete |
$413.60
|
| Rate for Payer: BCBS MAPPO |
$186.32
|
| Rate for Payer: BCN Medicare Advantage |
$186.32
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cofinity Commercial |
$249.67
|
| Rate for Payer: Cofinity Commercial |
$268.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.64
|
| Rate for Payer: Nomi Health Commercial |
$223.58
|
| Rate for Payer: PACE SWMI |
$186.32
|
| Rate for Payer: PHP Commercial |
$260.85
|
| Rate for Payer: PHP Medicare Advantage |
$186.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.10
|
| Rate for Payer: Priority Health Medicare |
$186.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.32
|
| Rate for Payer: UHC Medicare Advantage |
$186.32
|
| Rate for Payer: UMR Bronson Commercial |
$475.64
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 43195
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$255.67 |
| Rate for Payer: Aetna Commercial |
$237.92
|
| Rate for Payer: Aetna Medicare |
$184.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.92
|
| Rate for Payer: BCBS Complete |
$152.40
|
| Rate for Payer: BCBS MAPPO |
$177.55
|
| Rate for Payer: BCN Medicare Advantage |
$177.55
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$255.67
|
| Rate for Payer: Cofinity Commercial |
$237.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.43
|
| Rate for Payer: Nomi Health Commercial |
$213.06
|
| Rate for Payer: PACE SWMI |
$177.55
|
| Rate for Payer: PHP Commercial |
$248.57
|
| Rate for Payer: PHP Medicare Advantage |
$177.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health Medicare |
$177.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.55
|
| Rate for Payer: UHC Medicare Advantage |
$177.55
|
| Rate for Payer: UMR Bronson Commercial |
$175.26
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 43191
|
| Min. Negotiated Rate |
$148.97 |
| Max. Negotiated Rate |
$261.30 |
| Rate for Payer: Aetna Commercial |
$199.62
|
| Rate for Payer: Aetna Medicare |
$154.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.62
|
| Rate for Payer: BCBS Complete |
$160.80
|
| Rate for Payer: BCBS MAPPO |
$148.97
|
| Rate for Payer: BCN Medicare Advantage |
$148.97
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$214.52
|
| Rate for Payer: Cofinity Commercial |
$199.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.42
|
| Rate for Payer: Nomi Health Commercial |
$178.76
|
| Rate for Payer: PACE SWMI |
$148.97
|
| Rate for Payer: PHP Commercial |
$208.56
|
| Rate for Payer: PHP Medicare Advantage |
$148.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health Medicare |
$148.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.97
|
| Rate for Payer: UHC Medicare Advantage |
$148.97
|
| Rate for Payer: UMR Bronson Commercial |
$184.92
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 43192
|
| Min. Negotiated Rate |
$137.60 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$217.08
|
| Rate for Payer: Aetna Medicare |
$168.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.08
|
| Rate for Payer: BCBS Complete |
$137.60
|
| Rate for Payer: BCBS MAPPO |
$162.00
|
| Rate for Payer: BCN Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.10
|
| Rate for Payer: Nomi Health Commercial |
$194.40
|
| Rate for Payer: PACE SWMI |
$162.00
|
| Rate for Payer: PHP Commercial |
$226.80
|
| Rate for Payer: PHP Medicare Advantage |
$162.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.60
|
| Rate for Payer: Priority Health Medicare |
$162.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.00
|
| Rate for Payer: UHC Medicare Advantage |
$162.00
|
| Rate for Payer: UMR Bronson Commercial |
$158.24
|
|
