|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$512.85 |
| Max. Negotiated Rate |
$789.00 |
| Rate for Payer: Aetna Commercial |
$710.10
|
| Rate for Payer: ASR ASR |
$765.33
|
| Rate for Payer: ASR Commercial |
$765.33
|
| Rate for Payer: BCBS Trust/PPO |
$642.96
|
| Rate for Payer: BCN Commercial |
$611.71
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$741.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.20
|
| Rate for Payer: Healthscope Commercial |
$789.00
|
| Rate for Payer: Healthscope Whirlpool |
$765.33
|
| Rate for Payer: Mclaren Commercial |
$710.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.65
|
| Rate for Payer: Nomi Health Commercial |
$646.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$694.32
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 43202
|
| Min. Negotiated Rate |
$96.99 |
| Max. Negotiated Rate |
$512.85 |
| Rate for Payer: Aetna Commercial |
$129.97
|
| Rate for Payer: Aetna Medicare |
$96.99
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$96.99
|
| Rate for Payer: BCN Medicare Advantage |
$96.99
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$139.67
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.99
|
| Rate for Payer: Healthscope Commercial |
$116.39
|
| Rate for Payer: Healthscope Whirlpool |
$116.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.84
|
| Rate for Payer: Nomi Health Commercial |
$116.39
|
| Rate for Payer: PACE SWMI |
$96.99
|
| Rate for Payer: PHP Medicare Advantage |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$96.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.99
|
| Rate for Payer: UHC Medicare Advantage |
$96.99
|
| Rate for Payer: UHCCP DNSP |
$96.99
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$96.99 |
| Max. Negotiated Rate |
$512.85 |
| Rate for Payer: Aetna Commercial |
$129.97
|
| Rate for Payer: Aetna Medicare |
$96.99
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$96.99
|
| Rate for Payer: BCN Medicare Advantage |
$96.99
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$139.67
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.99
|
| Rate for Payer: Healthscope Commercial |
$116.39
|
| Rate for Payer: Healthscope Whirlpool |
$116.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.84
|
| Rate for Payer: Nomi Health Commercial |
$116.39
|
| Rate for Payer: PACE SWMI |
$96.99
|
| Rate for Payer: PHP Medicare Advantage |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$96.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.99
|
| Rate for Payer: UHC Medicare Advantage |
$96.99
|
| Rate for Payer: UHCCP DNSP |
$96.99
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
43202
|
| Min. Negotiated Rate |
$512.85 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Aetna Commercial |
$710.10
|
| 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 |
$765.33
|
| Rate for Payer: ASR Commercial |
$765.33
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCBS Trust/PPO |
$646.11
|
| Rate for Payer: BCN Commercial |
$611.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$741.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$789.00
|
| Rate for Payer: Healthscope Whirlpool |
$765.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,850.10
|
| Rate for Payer: Mclaren Commercial |
$710.10
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.65
|
| Rate for Payer: Nomi Health Commercial |
$646.98
|
| 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 |
$512.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.32
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health Narrow Network |
$553.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$694.32
|
| 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 TRANSORAL W SUBMUCOUS INJ
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 43201
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$321.75 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna Medicare |
$97.96
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS MAPPO |
$97.96
|
| Rate for Payer: BCN Medicare Advantage |
$97.96
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$141.06
|
| Rate for Payer: Cofinity Commercial |
$131.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.96
|
| Rate for Payer: Healthscope Commercial |
$117.55
|
| Rate for Payer: Healthscope Whirlpool |
$117.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.86
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: PACE SWMI |
$97.96
|
| Rate for Payer: PHP Medicare Advantage |
$97.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health Medicare |
$97.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.96
|
| Rate for Payer: UHC Medicare Advantage |
$97.96
|
| Rate for Payer: UHCCP DNSP |
$97.96
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43227
|
| Min. Negotiated Rate |
$155.47 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$208.33
|
| Rate for Payer: Aetna Medicare |
$155.47
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$155.47
|
| Rate for Payer: BCN Medicare Advantage |
$155.47
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$223.88
|
| Rate for Payer: Cofinity Commercial |
$208.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.47
|
| Rate for Payer: Healthscope Commercial |
$186.56
|
| Rate for Payer: Healthscope Whirlpool |
$186.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.24
|
| Rate for Payer: Nomi Health Commercial |
$186.56
|
| Rate for Payer: PACE SWMI |
$155.47
|
| Rate for Payer: PHP Medicare Advantage |
$155.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$155.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.47
|
| Rate for Payer: UHC Medicare Advantage |
$155.47
|
| Rate for Payer: UHCCP DNSP |
$155.47
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43204
|
| Min. Negotiated Rate |
$127.54 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$170.90
|
| Rate for Payer: Aetna Medicare |
$127.54
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$127.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.54
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$183.66
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.54
|
| Rate for Payer: Healthscope Commercial |
$153.05
|
| Rate for Payer: Healthscope Whirlpool |
$153.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.92
|
| Rate for Payer: Nomi Health Commercial |
$153.05
|
| Rate for Payer: PACE SWMI |
$127.54
|
| Rate for Payer: PHP Medicare Advantage |
$127.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$127.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.54
|
| Rate for Payer: UHC Medicare Advantage |
$127.54
|
| Rate for Payer: UHCCP DNSP |
$127.54
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 43229
|
| Min. Negotiated Rate |
$185.28 |
| Max. Negotiated Rate |
$415.35 |
| Rate for Payer: Aetna Commercial |
$248.28
|
| Rate for Payer: Aetna Medicare |
$185.28
|
| Rate for Payer: BCBS Complete |
$255.60
|
| Rate for Payer: BCBS MAPPO |
$185.28
|
| Rate for Payer: BCN Medicare Advantage |
$185.28
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$266.80
|
| Rate for Payer: Cofinity Commercial |
$248.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.28
|
| Rate for Payer: Healthscope Commercial |
$222.34
|
| Rate for Payer: Healthscope Whirlpool |
$222.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.54
|
| Rate for Payer: Nomi Health Commercial |
$222.34
|
| Rate for Payer: PACE SWMI |
$185.28
|
| Rate for Payer: PHP Medicare Advantage |
$185.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.35
|
| Rate for Payer: Priority Health Medicare |
$185.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.28
|
| Rate for Payer: UHC Medicare Advantage |
$185.28
|
| Rate for Payer: UHCCP DNSP |
$185.28
|
|
|
PR ESOPHAGOSCOPY,INSERT TUBE/STENT
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
HCPCS 43219
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$972.40 |
| Rate for Payer: Aetna Medicare |
$748.00
|
| Rate for Payer: BCBS Complete |
$598.40
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$972.40
|
|
|
PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 43232
|
| Min. Negotiated Rate |
$186.32 |
| Max. Negotiated Rate |
$672.10 |
| Rate for Payer: Aetna Commercial |
$249.67
|
| Rate for Payer: Aetna Medicare |
$186.32
|
| Rate for Payer: BCBS Complete |
$413.60
|
| Rate for Payer: BCBS MAPPO |
$186.32
|
| Rate for Payer: BCN Medicare Advantage |
$186.32
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cofinity Commercial |
$268.30
|
| Rate for Payer: Cofinity Commercial |
$249.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.32
|
| Rate for Payer: Healthscope Commercial |
$223.58
|
| Rate for Payer: Healthscope Whirlpool |
$223.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.64
|
| Rate for Payer: Nomi Health Commercial |
$223.58
|
| Rate for Payer: PACE SWMI |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$186.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.10
|
| Rate for Payer: Priority Health Medicare |
$186.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.32
|
| Rate for Payer: UHC Medicare Advantage |
$186.32
|
| Rate for Payer: UHCCP DNSP |
$186.32
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 43195
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$255.67 |
| Rate for Payer: Aetna Commercial |
$237.92
|
| Rate for Payer: Aetna Medicare |
$177.55
|
| Rate for Payer: BCBS Complete |
$152.40
|
| Rate for Payer: BCBS MAPPO |
$177.55
|
| Rate for Payer: BCN Medicare Advantage |
$177.55
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$255.67
|
| Rate for Payer: Cofinity Commercial |
$237.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.55
|
| Rate for Payer: Healthscope Commercial |
$213.06
|
| Rate for Payer: Healthscope Whirlpool |
$213.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.43
|
| Rate for Payer: Nomi Health Commercial |
$213.06
|
| Rate for Payer: PACE SWMI |
$177.55
|
| Rate for Payer: PHP Medicare Advantage |
$177.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health Medicare |
$177.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.55
|
| Rate for Payer: UHC Medicare Advantage |
$177.55
|
| Rate for Payer: UHCCP DNSP |
$177.55
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 43191
|
| Min. Negotiated Rate |
$148.97 |
| Max. Negotiated Rate |
$261.30 |
| Rate for Payer: Aetna Commercial |
$199.62
|
| Rate for Payer: Aetna Medicare |
$148.97
|
| Rate for Payer: BCBS Complete |
$160.80
|
| Rate for Payer: BCBS MAPPO |
$148.97
|
| Rate for Payer: BCN Medicare Advantage |
$148.97
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$214.52
|
| Rate for Payer: Cofinity Commercial |
$199.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.97
|
| Rate for Payer: Healthscope Commercial |
$178.76
|
| Rate for Payer: Healthscope Whirlpool |
$178.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.42
|
| Rate for Payer: Nomi Health Commercial |
$178.76
|
| Rate for Payer: PACE SWMI |
$148.97
|
| Rate for Payer: PHP Medicare Advantage |
$148.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health Medicare |
$148.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.97
|
| Rate for Payer: UHC Medicare Advantage |
$148.97
|
| Rate for Payer: UHCCP DNSP |
$148.97
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 43192
|
| Min. Negotiated Rate |
$137.60 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$217.08
|
| Rate for Payer: Aetna Medicare |
$162.00
|
| Rate for Payer: BCBS Complete |
$137.60
|
| Rate for Payer: BCBS MAPPO |
$162.00
|
| Rate for Payer: BCN Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.00
|
| Rate for Payer: Healthscope Commercial |
$194.40
|
| Rate for Payer: Healthscope Whirlpool |
$194.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.10
|
| Rate for Payer: Nomi Health Commercial |
$194.40
|
| Rate for Payer: PACE SWMI |
$162.00
|
| Rate for Payer: PHP Medicare Advantage |
$162.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.60
|
| Rate for Payer: Priority Health Medicare |
$162.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.00
|
| Rate for Payer: UHC Medicare Advantage |
$162.00
|
| Rate for Payer: UHCCP DNSP |
$162.00
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$162.47 |
| Max. Negotiated Rate |
$345.15 |
| Rate for Payer: Aetna Commercial |
$217.71
|
| Rate for Payer: Aetna Medicare |
$162.47
|
| Rate for Payer: BCBS Complete |
$212.40
|
| Rate for Payer: BCBS MAPPO |
$162.47
|
| Rate for Payer: BCN Medicare Advantage |
$162.47
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$233.96
|
| Rate for Payer: Cofinity Commercial |
$217.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.47
|
| Rate for Payer: Healthscope Commercial |
$194.96
|
| Rate for Payer: Healthscope Whirlpool |
$194.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.59
|
| Rate for Payer: Nomi Health Commercial |
$194.96
|
| Rate for Payer: PACE SWMI |
$162.47
|
| Rate for Payer: PHP Medicare Advantage |
$162.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.15
|
| Rate for Payer: Priority Health Medicare |
$162.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.47
|
| Rate for Payer: UHC Medicare Advantage |
$162.47
|
| Rate for Payer: UHCCP DNSP |
$162.47
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$184.75 |
| Max. Negotiated Rate |
$312.65 |
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Medicare |
$184.75
|
| Rate for Payer: BCBS Complete |
$192.40
|
| Rate for Payer: BCBS MAPPO |
$184.75
|
| Rate for Payer: BCN Medicare Advantage |
$184.75
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cofinity Commercial |
$266.04
|
| Rate for Payer: Cofinity Commercial |
$247.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.75
|
| Rate for Payer: Healthscope Commercial |
$221.70
|
| Rate for Payer: Healthscope Whirlpool |
$221.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.99
|
| Rate for Payer: Nomi Health Commercial |
$221.70
|
| Rate for Payer: PACE SWMI |
$184.75
|
| Rate for Payer: PHP Medicare Advantage |
$184.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.65
|
| Rate for Payer: Priority Health Medicare |
$184.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.75
|
| Rate for Payer: UHC Medicare Advantage |
$184.75
|
| Rate for Payer: UHCCP DNSP |
$184.75
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$180.61 |
| Max. Negotiated Rate |
$373.10 |
| Rate for Payer: Aetna Commercial |
$242.02
|
| Rate for Payer: Aetna Medicare |
$180.61
|
| Rate for Payer: BCBS Complete |
$229.60
|
| Rate for Payer: BCBS MAPPO |
$180.61
|
| Rate for Payer: BCN Medicare Advantage |
$180.61
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$260.08
|
| Rate for Payer: Cofinity Commercial |
$242.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.61
|
| Rate for Payer: Healthscope Commercial |
$216.73
|
| Rate for Payer: Healthscope Whirlpool |
$216.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.64
|
| Rate for Payer: Nomi Health Commercial |
$216.73
|
| Rate for Payer: PACE SWMI |
$180.61
|
| Rate for Payer: PHP Medicare Advantage |
$180.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Medicare |
$180.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.61
|
| Rate for Payer: UHC Medicare Advantage |
$180.61
|
| Rate for Payer: UHCCP DNSP |
$180.61
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$525.04 |
| Max. Negotiated Rate |
$859.30 |
| Rate for Payer: Aetna Commercial |
$703.55
|
| Rate for Payer: Aetna Medicare |
$525.04
|
| Rate for Payer: BCBS Complete |
$528.80
|
| Rate for Payer: BCBS MAPPO |
$525.04
|
| Rate for Payer: BCN Medicare Advantage |
$525.04
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$756.06
|
| Rate for Payer: Cofinity Commercial |
$703.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$525.04
|
| Rate for Payer: Healthscope Commercial |
$630.05
|
| Rate for Payer: Healthscope Whirlpool |
$630.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.29
|
| Rate for Payer: Nomi Health Commercial |
$630.05
|
| Rate for Payer: PACE SWMI |
$525.04
|
| Rate for Payer: PHP Medicare Advantage |
$525.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health Medicare |
$525.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$525.04
|
| Rate for Payer: UHC Medicare Advantage |
$525.04
|
| Rate for Payer: UHCCP DNSP |
$525.04
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$955.60 |
| Max. Negotiated Rate |
$1,552.85 |
| Rate for Payer: Aetna Commercial |
$1,379.42
|
| Rate for Payer: Aetna Medicare |
$1,029.42
|
| Rate for Payer: BCBS Complete |
$955.60
|
| Rate for Payer: BCBS MAPPO |
$1,029.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,029.42
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cofinity Commercial |
$1,482.36
|
| Rate for Payer: Cofinity Commercial |
$1,379.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,029.42
|
| Rate for Payer: Healthscope Commercial |
$1,235.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,235.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,080.89
|
| Rate for Payer: Nomi Health Commercial |
$1,235.30
|
| Rate for Payer: PACE SWMI |
$1,029.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,029.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.85
|
| Rate for Payer: Priority Health Medicare |
$1,029.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,029.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,029.42
|
| Rate for Payer: UHCCP DNSP |
$1,029.42
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$1,271.45 |
| Max. Negotiated Rate |
$2,299.05 |
| Rate for Payer: Aetna Commercial |
$1,703.74
|
| Rate for Payer: Aetna Medicare |
$1,271.45
|
| Rate for Payer: BCBS Complete |
$1,414.80
|
| Rate for Payer: BCBS MAPPO |
$1,271.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,271.45
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.89
|
| Rate for Payer: Cofinity Commercial |
$1,703.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,271.45
|
| Rate for Payer: Healthscope Commercial |
$1,525.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,525.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,335.02
|
| Rate for Payer: Nomi Health Commercial |
$1,525.74
|
| Rate for Payer: PACE SWMI |
$1,271.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,271.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health Medicare |
$1,271.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,271.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,271.45
|
| Rate for Payer: UHCCP DNSP |
$1,271.45
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$1,256.47 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Aetna Commercial |
$1,683.67
|
| Rate for Payer: Aetna Medicare |
$1,256.47
|
| Rate for Payer: BCBS Complete |
$1,310.40
|
| Rate for Payer: BCBS MAPPO |
$1,256.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,256.47
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cofinity Commercial |
$1,809.32
|
| Rate for Payer: Cofinity Commercial |
$1,683.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,256.47
|
| Rate for Payer: Healthscope Commercial |
$1,507.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,507.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.29
|
| Rate for Payer: Nomi Health Commercial |
$1,507.76
|
| Rate for Payer: PACE SWMI |
$1,256.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,256.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health Medicare |
$1,256.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,256.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,256.47
|
| Rate for Payer: UHCCP DNSP |
$1,256.47
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$158.75 |
| Rate for Payer: Aetna Commercial |
$147.72
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$110.24
|
| Rate for Payer: BCN Medicare Advantage |
$110.24
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$147.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.24
|
| Rate for Payer: Healthscope Commercial |
$132.29
|
| Rate for Payer: Healthscope Whirlpool |
$132.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.75
|
| Rate for Payer: Nomi Health Commercial |
$132.29
|
| Rate for Payer: PACE SWMI |
$110.24
|
| Rate for Payer: PHP Medicare Advantage |
$110.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$110.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.24
|
| Rate for Payer: UHC Medicare Advantage |
$110.24
|
| Rate for Payer: UHCCP DNSP |
$110.24
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$497.10 |
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Medicare |
$345.21
|
| Rate for Payer: Aetna Medicare |
$345.21
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Healthscope Commercial |
$414.25
|
| Rate for Payer: Healthscope Commercial |
$414.25
|
| Rate for Payer: Healthscope Whirlpool |
$414.25
|
| Rate for Payer: Healthscope Whirlpool |
$414.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Medicare |
$345.21
|
| Rate for Payer: Priority Health Medicare |
$345.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UHCCP DNSP |
$345.21
|
| Rate for Payer: UHCCP DNSP |
$345.21
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Aetna Medicare |
$126.28
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$181.84
|
| Rate for Payer: Cofinity Commercial |
$169.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Healthscope Commercial |
$151.54
|
| Rate for Payer: Healthscope Whirlpool |
$151.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.59
|
| Rate for Payer: Nomi Health Commercial |
$151.54
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$126.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.28
|
| Rate for Payer: UHC Medicare Advantage |
$126.28
|
| Rate for Payer: UHCCP DNSP |
$126.28
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$132.28 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$177.26
|
| Rate for Payer: Aetna Medicare |
$132.28
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$132.28
|
| Rate for Payer: BCN Medicare Advantage |
$132.28
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$190.48
|
| Rate for Payer: Cofinity Commercial |
$177.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.28
|
| Rate for Payer: Healthscope Commercial |
$158.74
|
| Rate for Payer: Healthscope Whirlpool |
$158.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.89
|
| Rate for Payer: Nomi Health Commercial |
$158.74
|
| Rate for Payer: PACE SWMI |
$132.28
|
| Rate for Payer: PHP Medicare Advantage |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$132.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.28
|
| Rate for Payer: UHC Medicare Advantage |
$132.28
|
| Rate for Payer: UHCCP DNSP |
$132.28
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,658.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$2,663.20 |
| Max. Negotiated Rate |
$4,327.70 |
| Rate for Payer: Aetna Commercial |
$3,779.36
|
| Rate for Payer: Aetna Medicare |
$2,820.42
|
| Rate for Payer: BCBS Complete |
$2,663.20
|
| Rate for Payer: BCBS MAPPO |
$2,820.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,820.42
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cofinity Commercial |
$4,061.40
|
| Rate for Payer: Cofinity Commercial |
$3,779.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,820.42
|
| Rate for Payer: Healthscope Commercial |
$3,384.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,384.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,961.44
|
| Rate for Payer: Nomi Health Commercial |
$3,384.50
|
| Rate for Payer: PACE SWMI |
$2,820.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,820.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,327.70
|
| Rate for Payer: Priority Health Medicare |
$2,820.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,820.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,820.42
|
| Rate for Payer: UHCCP DNSP |
$2,820.42
|
|
