|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$661.04
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.68
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$134.25
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.19 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.51
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$193.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETER OR LARGER) (INCLUDES FLUOROSCOPIC GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43233
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.85
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$221.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF GASTRIC/DUODENAL STRICTURE(S) (EG, BALLOON, BOUGIE)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$169.94 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.93
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$169.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,497.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,844.66
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.68
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$134.25
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.32 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,428.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.35
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$260.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC ULTRASOUND EXAMINATION, INCLUDING THE ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM OR A SURGICALLY ALTERED STOMACH WHERE THE JEJUNUM IS EXAMINED DISTAL TO THE ANASTOMOSIS
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,394.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.52
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$217.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE ESOPHAGUS, STOMACH OR DUODENUM, AND ADJACENT STRUCTURES
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$188.93 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.82
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$188.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY PASSAGE OF DILATOR(S) THROUGH ESOPHAGUS OVER GUIDE WIRE
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$160.77 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$655.17
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.85
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$160.77
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$15,947.78
|
|
|
Service Code
|
CPT 43266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$210.22 |
| Max. Negotiated Rate |
$15,947.78 |
| Rate for Payer: Aetna Medicare |
$5,268.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,332.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,332.41
|
| Rate for Payer: BCBS Complete |
$2,909.87
|
| Rate for Payer: BCBS MAPPO |
$5,065.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,151.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,065.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,065.93
|
| Rate for Payer: Mclaren Medicaid |
$2,771.06
|
| Rate for Payer: Mclaren Medicare |
$5,065.93
|
| Rate for Payer: Meridian Medicaid |
$2,909.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,319.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,825.82
|
| Rate for Payer: PACE Medicare |
$4,812.63
|
| Rate for Payer: PACE SWMI |
$5,065.93
|
| Rate for Payer: PHP Medicare Advantage |
$5,065.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,771.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,947.78
|
| Rate for Payer: Priority Health Medicare |
$5,065.93
|
| Rate for Payer: Priority Health Narrow Network |
$12,758.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,065.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.24
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,065.93
|
| Rate for Payer: UHC Exchange |
$210.22
|
| Rate for Payer: UHC Medicare Advantage |
$5,217.91
|
| Rate for Payer: VA VA |
$5,065.93
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$170.92 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,536.26
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.01
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$170.92
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.26 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,389.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.19
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$189.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.66 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.53
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$148.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE ESOPHAGUS, STOMACH OR DUODENUM, AND ADJACENT STRUCTURES)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$223.97 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.37
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$223.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S) (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION OF THE ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM OR A SURGICALLY ALTERED STOMACH WHERE THE JEJUNUM IS EXAMINED DISTAL TO THE ANASTOMOSIS)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.78
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$253.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED TRANSMURAL INJECTION OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, NEUROLYTIC AGENT) OR FIDUCIAL MARKER(S) (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION OF THE ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM OR A SURGICALLY ALTERED STOMACH WHERE THE JEJUNUM IS EXAMINED DISTAL TO THE ANASTOMOSIS)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.11 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.42
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$253.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$701.99
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.37
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$85.79
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.22
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$100.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.85 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.94
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$100.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.93 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$752.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.12
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$151.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$15,947.78
|
|
|
Service Code
|
CPT 43212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$182.71 |
| Max. Negotiated Rate |
$15,947.78 |
| Rate for Payer: Aetna Medicare |
$5,268.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,332.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,332.41
|
| Rate for Payer: BCBS Complete |
$2,909.87
|
| Rate for Payer: BCBS MAPPO |
$5,065.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,820.52
|
| Rate for Payer: BCN Medicare Advantage |
$5,065.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,065.93
|
| Rate for Payer: Mclaren Medicaid |
$2,771.06
|
| Rate for Payer: Mclaren Medicare |
$5,065.93
|
| Rate for Payer: Meridian Medicaid |
$2,909.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,319.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,825.82
|
| Rate for Payer: PACE Medicare |
$4,812.63
|
| Rate for Payer: PACE SWMI |
$5,065.93
|
| Rate for Payer: PHP Medicare Advantage |
$5,065.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,771.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,947.78
|
| Rate for Payer: Priority Health Medicare |
$5,065.93
|
| Rate for Payer: Priority Health Narrow Network |
$12,758.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,065.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.98
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,065.93
|
| Rate for Payer: UHC Exchange |
$182.71
|
| Rate for Payer: UHC Medicare Advantage |
$5,217.91
|
| Rate for Payer: VA VA |
$5,065.93
|
|
|
ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.60 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.06
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$114.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.85
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$10,716.54
|
|
|
Service Code
|
CPT 43195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$10,716.54 |
| Rate for Payer: Aetna Medicare |
$3,540.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,255.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,255.24
|
| Rate for Payer: BCBS Complete |
$1,955.37
|
| Rate for Payer: BCBS MAPPO |
$3,404.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,685.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,404.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,404.19
|
| Rate for Payer: Mclaren Medicaid |
$1,862.09
|
| Rate for Payer: Mclaren Medicare |
$3,404.19
|
| Rate for Payer: Meridian Medicaid |
$1,955.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,574.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,914.82
|
| Rate for Payer: PACE Medicare |
$3,233.98
|
| Rate for Payer: PACE SWMI |
$3,404.19
|
| Rate for Payer: PHP Medicare Advantage |
$3,404.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,862.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,716.54
|
| Rate for Payer: Priority Health Medicare |
$3,404.19
|
| Rate for Payer: Priority Health Narrow Network |
$8,573.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,404.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.54
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,404.19
|
| Rate for Payer: UHC Exchange |
$181.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,506.32
|
| Rate for Payer: VA VA |
$3,404.19
|
|
