|
PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 43460
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$575.90 |
| Rate for Payer: Aetna Commercial |
$268.72
|
| Rate for Payer: Aetna Medicare |
$200.54
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$200.54
|
| Rate for Payer: BCN Medicare Advantage |
$200.54
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$288.78
|
| Rate for Payer: Cofinity Commercial |
$268.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.54
|
| Rate for Payer: Healthscope Commercial |
$240.65
|
| Rate for Payer: Healthscope Whirlpool |
$240.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.57
|
| Rate for Payer: Nomi Health Commercial |
$240.65
|
| Rate for Payer: PACE SWMI |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$200.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.54
|
| Rate for Payer: UHC Medicare Advantage |
$200.54
|
| Rate for Payer: UHCCP DNSP |
$200.54
|
|
|
PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 91013
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$32.69 |
| Rate for Payer: Aetna Commercial |
$30.42
|
| Rate for Payer: Aetna Medicare |
$22.70
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$22.70
|
| Rate for Payer: BCN Medicare Advantage |
$22.70
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.70
|
| Rate for Payer: Healthscope Commercial |
$27.24
|
| Rate for Payer: Healthscope Whirlpool |
$27.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.84
|
| Rate for Payer: Nomi Health Commercial |
$27.24
|
| Rate for Payer: PACE SWMI |
$22.70
|
| Rate for Payer: PHP Medicare Advantage |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$22.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.70
|
| Rate for Payer: UHC Medicare Advantage |
$22.70
|
| Rate for Payer: UHCCP DNSP |
$22.70
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 91010
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$280.70 |
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: Aetna Commercial |
$261.21
|
| Rate for Payer: Aetna Medicare |
$194.93
|
| Rate for Payer: Aetna Medicare |
$194.93
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS Complete |
$153.60
|
| Rate for Payer: BCBS MAPPO |
$194.93
|
| Rate for Payer: BCBS MAPPO |
$194.93
|
| Rate for Payer: BCN Medicare Advantage |
$194.93
|
| Rate for Payer: BCN Medicare Advantage |
$194.93
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cofinity Commercial |
$261.21
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$261.21
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.93
|
| Rate for Payer: Healthscope Commercial |
$233.92
|
| Rate for Payer: Healthscope Commercial |
$233.92
|
| Rate for Payer: Healthscope Whirlpool |
$233.92
|
| Rate for Payer: Healthscope Whirlpool |
$233.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.68
|
| Rate for Payer: Nomi Health Commercial |
$233.92
|
| Rate for Payer: Nomi Health Commercial |
$233.92
|
| Rate for Payer: PACE SWMI |
$194.93
|
| Rate for Payer: PACE SWMI |
$194.93
|
| Rate for Payer: PHP Medicare Advantage |
$194.93
|
| Rate for Payer: PHP Medicare Advantage |
$194.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.60
|
| Rate for Payer: Priority Health Medicare |
$194.93
|
| Rate for Payer: Priority Health Medicare |
$194.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.93
|
| Rate for Payer: UHC Medicare Advantage |
$194.93
|
| Rate for Payer: UHC Medicare Advantage |
$194.93
|
| Rate for Payer: UHCCP DNSP |
$194.93
|
| Rate for Payer: UHCCP DNSP |
$194.93
|
|
|
PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ
|
Professional
|
Both
|
$6,523.00
|
|
|
Service Code
|
HCPCS 43287
|
| Min. Negotiated Rate |
$2,609.20 |
| Max. Negotiated Rate |
$4,917.66 |
| Rate for Payer: Aetna Commercial |
$4,576.15
|
| Rate for Payer: Aetna Medicare |
$3,415.04
|
| Rate for Payer: BCBS Complete |
$2,609.20
|
| Rate for Payer: BCBS MAPPO |
$3,415.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,415.04
|
| Rate for Payer: Cash Price |
$5,218.40
|
| Rate for Payer: Cash Price |
$5,218.40
|
| Rate for Payer: Cofinity Commercial |
$4,917.66
|
| Rate for Payer: Cofinity Commercial |
$4,576.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,415.04
|
| Rate for Payer: Healthscope Commercial |
$4,098.05
|
| Rate for Payer: Healthscope Whirlpool |
$4,098.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,585.79
|
| Rate for Payer: Nomi Health Commercial |
$4,098.05
|
| Rate for Payer: PACE SWMI |
$3,415.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,415.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,239.95
|
| Rate for Payer: Priority Health Medicare |
$3,415.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,415.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,415.04
|
| Rate for Payer: UHCCP DNSP |
$3,415.04
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ
|
Professional
|
Both
|
$6,605.00
|
|
|
Service Code
|
HCPCS 43286
|
| Min. Negotiated Rate |
$2,642.00 |
| Max. Negotiated Rate |
$4,415.95 |
| Rate for Payer: Aetna Commercial |
$4,109.28
|
| Rate for Payer: Aetna Medicare |
$3,066.63
|
| Rate for Payer: BCBS Complete |
$2,642.00
|
| Rate for Payer: BCBS MAPPO |
$3,066.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,066.63
|
| Rate for Payer: Cash Price |
$5,284.00
|
| Rate for Payer: Cash Price |
$5,284.00
|
| Rate for Payer: Cofinity Commercial |
$4,415.95
|
| Rate for Payer: Cofinity Commercial |
$4,109.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,066.63
|
| Rate for Payer: Healthscope Commercial |
$3,679.96
|
| Rate for Payer: Healthscope Whirlpool |
$3,679.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,219.96
|
| Rate for Payer: Nomi Health Commercial |
$3,679.96
|
| Rate for Payer: PACE SWMI |
$3,066.63
|
| Rate for Payer: PHP Medicare Advantage |
$3,066.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,293.25
|
| Rate for Payer: Priority Health Medicare |
$3,066.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,066.63
|
| Rate for Payer: UHC Medicare Advantage |
$3,066.63
|
| Rate for Payer: UHCCP DNSP |
$3,066.63
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ
|
Professional
|
Both
|
$6,487.00
|
|
|
Service Code
|
HCPCS 43288
|
| Min. Negotiated Rate |
$2,594.80 |
| Max. Negotiated Rate |
$5,189.82 |
| Rate for Payer: Aetna Commercial |
$4,829.41
|
| Rate for Payer: Aetna Medicare |
$3,604.04
|
| Rate for Payer: BCBS Complete |
$2,594.80
|
| Rate for Payer: BCBS MAPPO |
$3,604.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,604.04
|
| Rate for Payer: Cash Price |
$5,189.60
|
| Rate for Payer: Cash Price |
$5,189.60
|
| Rate for Payer: Cofinity Commercial |
$5,189.82
|
| Rate for Payer: Cofinity Commercial |
$4,829.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,604.04
|
| Rate for Payer: Healthscope Commercial |
$4,324.85
|
| Rate for Payer: Healthscope Whirlpool |
$4,324.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,784.24
|
| Rate for Payer: Nomi Health Commercial |
$4,324.85
|
| Rate for Payer: PACE SWMI |
$3,604.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,604.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,216.55
|
| Rate for Payer: Priority Health Medicare |
$3,604.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,604.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,604.04
|
| Rate for Payer: UHCCP DNSP |
$3,604.04
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 43236
|
| Min. Negotiated Rate |
$130.16 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Aetna Commercial |
$174.41
|
| Rate for Payer: Aetna Medicare |
$130.16
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS MAPPO |
$130.16
|
| Rate for Payer: BCN Medicare Advantage |
$130.16
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$187.43
|
| Rate for Payer: Cofinity Commercial |
$174.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.16
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Healthscope Whirlpool |
$156.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.67
|
| Rate for Payer: Nomi Health Commercial |
$156.19
|
| Rate for Payer: PACE SWMI |
$130.16
|
| Rate for Payer: PHP Medicare Advantage |
$130.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health Medicare |
$130.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.16
|
| Rate for Payer: UHC Medicare Advantage |
$130.16
|
| Rate for Payer: UHCCP DNSP |
$130.16
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
43235
|
| Min. Negotiated Rate |
$115.86 |
| Max. Negotiated Rate |
$469.95 |
| Rate for Payer: Aetna Commercial |
$155.25
|
| Rate for Payer: Aetna Medicare |
$115.86
|
| Rate for Payer: BCBS Complete |
$289.20
|
| Rate for Payer: BCBS MAPPO |
$115.86
|
| Rate for Payer: BCN Medicare Advantage |
$115.86
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$166.84
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.86
|
| Rate for Payer: Healthscope Commercial |
$139.03
|
| Rate for Payer: Healthscope Whirlpool |
$139.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.65
|
| Rate for Payer: Nomi Health Commercial |
$139.03
|
| Rate for Payer: PACE SWMI |
$115.86
|
| Rate for Payer: PHP Medicare Advantage |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health Medicare |
$115.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.86
|
| Rate for Payer: UHC Medicare Advantage |
$115.86
|
| Rate for Payer: UHCCP DNSP |
$115.86
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
43235
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$469.95 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$650.70
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$701.31
|
| Rate for Payer: ASR Commercial |
$701.31
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$592.06
|
| Rate for Payer: BCN Commercial |
$560.54
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$679.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$723.00
|
| Rate for Payer: Healthscope Whirlpool |
$701.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$650.70
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.55
|
| Rate for Payer: Nomi Health Commercial |
$592.86
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.49
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$506.82
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 43235
|
| Min. Negotiated Rate |
$115.86 |
| Max. Negotiated Rate |
$469.95 |
| Rate for Payer: Aetna Commercial |
$155.25
|
| Rate for Payer: Aetna Medicare |
$115.86
|
| Rate for Payer: BCBS Complete |
$289.20
|
| Rate for Payer: BCBS MAPPO |
$115.86
|
| Rate for Payer: BCN Medicare Advantage |
$115.86
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$166.84
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.86
|
| Rate for Payer: Healthscope Commercial |
$139.03
|
| Rate for Payer: Healthscope Whirlpool |
$139.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.65
|
| Rate for Payer: Nomi Health Commercial |
$139.03
|
| Rate for Payer: PACE SWMI |
$115.86
|
| Rate for Payer: PHP Medicare Advantage |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health Medicare |
$115.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.86
|
| Rate for Payer: UHC Medicare Advantage |
$115.86
|
| Rate for Payer: UHCCP DNSP |
$115.86
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
43235
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$469.95 |
| Max. Negotiated Rate |
$723.00 |
| Rate for Payer: Aetna Commercial |
$650.70
|
| Rate for Payer: ASR ASR |
$701.31
|
| Rate for Payer: ASR Commercial |
$701.31
|
| Rate for Payer: BCBS Trust/PPO |
$589.17
|
| Rate for Payer: BCN Commercial |
$560.54
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$679.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.40
|
| Rate for Payer: Healthscope Commercial |
$723.00
|
| Rate for Payer: Healthscope Whirlpool |
$701.31
|
| Rate for Payer: Mclaren Commercial |
$650.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.55
|
| Rate for Payer: Nomi Health Commercial |
$592.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.24
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 43237
|
| Min. Negotiated Rate |
$183.70 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna Commercial |
$246.16
|
| Rate for Payer: Aetna Medicare |
$183.70
|
| Rate for Payer: BCBS Complete |
$368.00
|
| Rate for Payer: BCBS MAPPO |
$183.70
|
| Rate for Payer: BCN Medicare Advantage |
$183.70
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$264.53
|
| Rate for Payer: Cofinity Commercial |
$246.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.70
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Healthscope Whirlpool |
$220.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.88
|
| Rate for Payer: Nomi Health Commercial |
$220.44
|
| Rate for Payer: PACE SWMI |
$183.70
|
| Rate for Payer: PHP Medicare Advantage |
$183.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.00
|
| Rate for Payer: Priority Health Medicare |
$183.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.70
|
| Rate for Payer: UHC Medicare Advantage |
$183.70
|
| Rate for Payer: UHCCP DNSP |
$183.70
|
|
|
PR ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS 43330
|
| Min. Negotiated Rate |
$946.80 |
| Max. Negotiated Rate |
$1,872.27 |
| Rate for Payer: Aetna Commercial |
$1,742.25
|
| Rate for Payer: Aetna Medicare |
$1,300.19
|
| Rate for Payer: BCBS Complete |
$946.80
|
| Rate for Payer: BCBS MAPPO |
$1,300.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,300.19
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cofinity Commercial |
$1,872.27
|
| Rate for Payer: Cofinity Commercial |
$1,742.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,300.19
|
| Rate for Payer: Healthscope Commercial |
$1,560.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,560.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,365.20
|
| Rate for Payer: Nomi Health Commercial |
$1,560.23
|
| Rate for Payer: PACE SWMI |
$1,300.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,300.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.55
|
| Rate for Payer: Priority Health Medicare |
$1,300.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,300.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.19
|
| Rate for Payer: UHCCP DNSP |
$1,300.19
|
|
|
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 |
$1,291.21
|
| 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: Healthscope Commercial |
$1,549.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,549.45
|
| 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 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: UHCCP DNSP |
$1,291.21
|
|
|
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
|
|
|
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 |
$185.87
|
| 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 |
$267.65
|
| Rate for Payer: Cofinity Commercial |
$249.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.87
|
| Rate for Payer: Healthscope Commercial |
$223.04
|
| Rate for Payer: Healthscope Whirlpool |
$223.04
|
| 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 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: UHCCP DNSP |
$185.87
|
|
|
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 |
$112.15
|
| 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: Healthscope Commercial |
$134.58
|
| Rate for Payer: Healthscope Whirlpool |
$134.58
|
| 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 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: UHCCP DNSP |
$112.15
|
|
|
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 |
$124.89
|
| 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: Healthscope Commercial |
$149.87
|
| Rate for Payer: Healthscope Whirlpool |
$149.87
|
| 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 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: UHCCP DNSP |
$124.89
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$684.45 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$947.70
|
| Rate for Payer: ASR ASR |
$1,021.41
|
| Rate for Payer: ASR Commercial |
$1,021.41
|
| Rate for Payer: BCBS Trust/PPO |
$858.09
|
| Rate for Payer: BCN Commercial |
$816.39
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$989.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.40
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,021.41
|
| Rate for Payer: Mclaren Commercial |
$947.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.05
|
| Rate for Payer: Nomi Health Commercial |
$863.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$926.64
|
|
|
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 |
$134.68
|
| 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: Healthscope Commercial |
$161.62
|
| Rate for Payer: Healthscope Whirlpool |
$161.62
|
| 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 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: UHCCP DNSP |
$134.68
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
43215
|
| Min. Negotiated Rate |
$684.45 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Aetna Commercial |
$947.70
|
| Rate for Payer: Aetna Medicare |
$1,850.10
|
| 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: ASR ASR |
$1,021.41
|
| Rate for Payer: ASR Commercial |
$1,021.41
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCBS Trust/PPO |
$862.30
|
| Rate for Payer: BCN Commercial |
$816.39
|
| 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 |
$989.82
|
| 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 |
$1,053.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,021.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,850.10
|
| Rate for Payer: Mclaren Commercial |
$947.70
|
| 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: Nomi Health Commercial |
$863.46
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$2,035.11
|
| Rate for Payer: PHP Medicaid |
$991.65
|
| 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 |
$684.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$922.64
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health Narrow Network |
$738.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$926.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$2,867.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP DNSP |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
|
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 |
$134.68
|
| 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: Healthscope Commercial |
$161.62
|
| Rate for Payer: Healthscope Whirlpool |
$161.62
|
| 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 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: UHCCP DNSP |
$134.68
|
|
|
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 |
$150.91
|
| 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: Healthscope Commercial |
$181.09
|
| Rate for Payer: Healthscope Whirlpool |
$181.09
|
| 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 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: UHCCP DNSP |
$150.91
|
|
|
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 |
$83.07
|
| 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: Healthscope Commercial |
$99.68
|
| Rate for Payer: Healthscope Whirlpool |
$99.68
|
| 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 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: UHCCP DNSP |
$83.07
|
|
|
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 |
$146.36
|
| 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: Healthscope Commercial |
$175.63
|
| Rate for Payer: Healthscope Whirlpool |
$175.63
|
| 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 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: UHCCP DNSP |
$146.36
|
|
