|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 43236
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$463.40 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: Cash Price |
$529.60
|
| Rate for Payer: Cash Price |
$529.60
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.53
|
| Rate for Payer: Priority Health Narrow Network |
$237.53
|
| Rate for Payer: Priority Health SBD |
$237.53
|
| Rate for Payer: UMR Bronson Commercial |
$304.52
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
43235
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$311.96 |
| Max. Negotiated Rate |
$638.10 |
| Rate for Payer: Aetna American Axle |
$460.85
|
| Rate for Payer: Aetna Commercial |
$602.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.85
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Cofinity Commercial |
$496.30
|
| Rate for Payer: Cofinity Commercial |
$609.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.20
|
| Rate for Payer: Healthscope Commercial |
$638.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$496.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.65
|
| Rate for Payer: PHP Commercial |
$602.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.30
|
| Rate for Payer: Priority Health SBD |
$446.67
|
| Rate for Payer: UMR Bronson Commercial |
$311.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.75
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$709.00
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
43235
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$496.30 |
| Rate for Payer: Aetna Commercial |
$162.76
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Meridian Medicaid |
$81.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.66
|
| Rate for Payer: Priority Health Narrow Network |
$211.66
|
| Rate for Payer: Priority Health SBD |
$211.66
|
| Rate for Payer: UMR Bronson Commercial |
$326.14
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
43235
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$118.86 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna American Axle |
$460.85
|
| Rate for Payer: Aetna Commercial |
$602.65
|
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.85
|
| 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 |
$1,088.08
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Cofinity Commercial |
$609.74
|
| Rate for Payer: Cofinity Commercial |
$496.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Healthscope Commercial |
$638.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$496.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.75
|
| 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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.65
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Commercial |
$602.65
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.30
|
| 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: Priority Health SBD |
$446.67
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$118.86
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: UMR Bronson Commercial |
$262.33
|
| Rate for Payer: VA VA |
$805.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.75
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$709.00
|
|
|
Service Code
|
HCPCS 43235
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$496.30 |
| Rate for Payer: Aetna Commercial |
$162.76
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Meridian Medicaid |
$81.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.66
|
| Rate for Payer: Priority Health Narrow Network |
$211.66
|
| Rate for Payer: Priority Health SBD |
$211.66
|
| Rate for Payer: UMR Bronson Commercial |
$326.14
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 43237
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$631.40 |
| Rate for Payer: Aetna Commercial |
$259.91
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.49
|
| Rate for Payer: Priority Health Narrow Network |
$337.49
|
| Rate for Payer: Priority Health SBD |
$337.49
|
| Rate for Payer: UMR Bronson Commercial |
$414.92
|
|
|
PR ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH
|
Professional
|
Both
|
$2,321.00
|
|
|
Service Code
|
HCPCS 43330
|
| Min. Negotiated Rate |
$854.34 |
| Max. Negotiated Rate |
$2,635.16 |
| Rate for Payer: Aetna Commercial |
$1,808.99
|
| Rate for Payer: BCBS Complete |
$897.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,635.16
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Meridian Medicaid |
$897.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$854.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,346.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,346.60
|
| Rate for Payer: Priority Health SBD |
$2,346.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,067.66
|
|
|
PR ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH
|
Professional
|
Both
|
$3,128.00
|
|
|
Service Code
|
HCPCS 43331
|
| Min. Negotiated Rate |
$648.75 |
| Max. Negotiated Rate |
$2,326.61 |
| Rate for Payer: Aetna Commercial |
$1,798.83
|
| Rate for Payer: BCBS Complete |
$889.46
|
| Rate for Payer: BCBS Trust/PPO |
$648.75
|
| Rate for Payer: Cash Price |
$2,502.40
|
| Rate for Payer: Cash Price |
$2,502.40
|
| Rate for Payer: Meridian Medicaid |
$889.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$847.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,326.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,326.61
|
| Rate for Payer: Priority Health SBD |
$2,326.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,438.88
|
|
|
PR ESOPHAGOSCOPY,ABLATION TUMOR
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
HCPCS 43228
|
| Min. Negotiated Rate |
$564.80 |
| Max. Negotiated Rate |
$988.40 |
| Rate for Payer: BCBS Complete |
$564.80
|
| Rate for Payer: Cash Price |
$1,129.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.40
|
| Rate for Payer: UMR Bronson Commercial |
$649.52
|
|
|
PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 43214
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$336.90 |
| Rate for Payer: Aetna Commercial |
$256.38
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS Trust/PPO |
$167.47
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.90
|
| Rate for Payer: Priority Health Narrow Network |
$336.90
|
| Rate for Payer: Priority Health SBD |
$336.90
|
| Rate for Payer: UMR Bronson Commercial |
$181.70
|
|
|
PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
HCPCS 43220
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: Aetna Commercial |
$156.84
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS Trust/PPO |
$68.34
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.03
|
| Rate for Payer: Priority Health Narrow Network |
$204.03
|
| Rate for Payer: Priority Health SBD |
$204.03
|
| Rate for Payer: UMR Bronson Commercial |
$684.48
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 43226
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna Commercial |
$173.52
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS Trust/PPO |
$127.32
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.79
|
| Rate for Payer: Priority Health Narrow Network |
$225.79
|
| Rate for Payer: Priority Health SBD |
$225.79
|
| Rate for Payer: UMR Bronson Commercial |
$356.04
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$454.08 |
| Max. Negotiated Rate |
$928.80 |
| Rate for Payer: Aetna American Axle |
$670.80
|
| Rate for Payer: Aetna Commercial |
$877.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.80
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cofinity Commercial |
$722.40
|
| Rate for Payer: Cofinity Commercial |
$887.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.60
|
| Rate for Payer: Healthscope Commercial |
$928.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$877.20
|
| Rate for Payer: PHP Commercial |
$877.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.40
|
| Rate for Payer: Priority Health SBD |
$650.16
|
| Rate for Payer: UMR Bronson Commercial |
$454.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.00
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$722.40 |
| Rate for Payer: Aetna Commercial |
$187.69
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS Trust/PPO |
$162.19
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Meridian Medicaid |
$93.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.01
|
| Rate for Payer: Priority Health Narrow Network |
$244.01
|
| Rate for Payer: Priority Health SBD |
$244.01
|
| Rate for Payer: UMR Bronson Commercial |
$474.72
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna American Axle |
$670.80
|
| Rate for Payer: Aetna Commercial |
$877.20
|
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.80
|
| 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 |
$827.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cofinity Commercial |
$887.52
|
| Rate for Payer: Cofinity Commercial |
$722.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$928.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.00
|
| 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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$877.20
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$877.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.40
|
| 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: Priority Health SBD |
$650.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$137.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: UMR Bronson Commercial |
$381.84
|
| Rate for Payer: VA VA |
$1,691.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.00
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
HCPCS 43215
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$722.40 |
| Rate for Payer: Aetna Commercial |
$187.69
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS Trust/PPO |
$162.19
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Meridian Medicaid |
$93.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.01
|
| Rate for Payer: Priority Health Narrow Network |
$244.01
|
| Rate for Payer: Priority Health SBD |
$244.01
|
| Rate for Payer: UMR Bronson Commercial |
$474.72
|
|
|
PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE
|
Professional
|
Both
|
$1,147.00
|
|
|
Service Code
|
HCPCS 43217
|
| Min. Negotiated Rate |
$73.86 |
| Max. Negotiated Rate |
$802.90 |
| Rate for Payer: Aetna Commercial |
$212.68
|
| Rate for Payer: BCBS Complete |
$105.79
|
| Rate for Payer: BCBS Trust/PPO |
$73.86
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Meridian Medicaid |
$105.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.17
|
| Rate for Payer: Priority Health Narrow Network |
$275.17
|
| Rate for Payer: Priority Health SBD |
$275.17
|
| Rate for Payer: UMR Bronson Commercial |
$527.62
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 43200
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: Aetna Commercial |
$116.05
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.29
|
| Rate for Payer: Priority Health Narrow Network |
$152.29
|
| Rate for Payer: Priority Health SBD |
$152.29
|
| Rate for Payer: UMR Bronson Commercial |
$181.70
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 43231
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$606.90 |
| Rate for Payer: Aetna Commercial |
$211.32
|
| Rate for Payer: BCBS Complete |
$103.77
|
| Rate for Payer: BCBS Trust/PPO |
$176.98
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$103.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.24
|
| Rate for Payer: Priority Health Narrow Network |
$272.24
|
| Rate for Payer: Priority Health SBD |
$272.24
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna Commercial |
$136.23
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS Trust/PPO |
$31.17
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.16
|
| Rate for Payer: Priority Health Narrow Network |
$178.16
|
| Rate for Payer: Priority Health SBD |
$178.16
|
| Rate for Payer: UMR Bronson Commercial |
$356.04
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$340.56 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Aetna American Axle |
$503.10
|
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.10
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Commercial |
$665.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.20
|
| Rate for Payer: Healthscope Commercial |
$696.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.90
|
| Rate for Payer: PHP Commercial |
$657.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: Priority Health SBD |
$487.62
|
| Rate for Payer: UMR Bronson Commercial |
$340.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.50
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna American Axle |
$503.10
|
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.10
|
| 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: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Commercial |
$665.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Healthscope Commercial |
$696.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.50
|
| 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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.90
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Commercial |
$657.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| 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: Priority Health SBD |
$487.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.22
|
| 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: UMR Bronson Commercial |
$286.38
|
| Rate for Payer: VA VA |
$1,691.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.50
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 43202
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna Commercial |
$136.23
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS Trust/PPO |
$31.17
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.16
|
| Rate for Payer: Priority Health Narrow Network |
$178.16
|
| Rate for Payer: Priority Health SBD |
$178.16
|
| Rate for Payer: UMR Bronson Commercial |
$356.04
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 43201
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$339.50 |
| Rate for Payer: Aetna Commercial |
$136.26
|
| Rate for Payer: BCBS Complete |
$68.88
|
| Rate for Payer: BCBS Trust/PPO |
$30.11
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Meridian Medicaid |
$68.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.34
|
| Rate for Payer: Priority Health Narrow Network |
$179.34
|
| Rate for Payer: Priority Health SBD |
$179.34
|
| Rate for Payer: UMR Bronson Commercial |
$223.10
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 43227
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$757.40 |
| Rate for Payer: Aetna Commercial |
$219.16
|
| Rate for Payer: BCBS Complete |
$109.14
|
| Rate for Payer: BCBS Trust/PPO |
$43.32
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Meridian Medicaid |
$109.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.57
|
| Rate for Payer: Priority Health Narrow Network |
$284.57
|
| Rate for Payer: Priority Health SBD |
$284.57
|
| Rate for Payer: UMR Bronson Commercial |
$497.72
|
|
