|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$1,750.26 |
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.26
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health Narrow Network |
$15.60
|
| Rate for Payer: Priority Health SBD |
$15.60
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$140.15 |
| Max. Negotiated Rate |
$1,372.52 |
| Rate for Payer: Aetna Commercial |
$304.22
|
| Rate for Payer: BCBS Complete |
$147.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.52
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Mclaren Medicaid |
$140.15
|
| Rate for Payer: Meridian Medicaid |
$147.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.68
|
| Rate for Payer: Priority Health Narrow Network |
$310.68
|
| Rate for Payer: Priority Health SBD |
$310.68
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$268.51 |
| Max. Negotiated Rate |
$1,461.94 |
| Rate for Payer: Aetna Commercial |
$493.00
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.94
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$406.00
|
| Rate for Payer: Cofinity Commercial |
$498.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$522.00
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.00
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$493.00
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health SBD |
$365.40
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna Commercial |
$493.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$406.00
|
| Rate for Payer: Cofinity Commercial |
$498.80
|
| Rate for Payer: Healthscope Commercial |
$522.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.00
|
| Rate for Payer: PHP Commercial |
$493.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health SBD |
$365.40
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$174.96 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: BCBS Complete |
$232.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.96
|
| Rate for Payer: Priority Health Narrow Network |
$174.96
|
| Rate for Payer: Priority Health SBD |
$350.39
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$174.96 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: BCBS Complete |
$232.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.96
|
| Rate for Payer: Priority Health Narrow Network |
$174.96
|
| Rate for Payer: Priority Health SBD |
$350.39
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$1,443.32 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.32
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Mclaren Medicaid |
$16.19
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.47
|
| Rate for Payer: Priority Health Narrow Network |
$35.47
|
| Rate for Payer: Priority Health SBD |
$35.47
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health SBD |
$71.82
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$595.61 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS Trust/PPO |
$595.61
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health SBD |
$71.82
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$141.38 |
| Max. Negotiated Rate |
$2,220.97 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: BCBS Complete |
$181.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,220.97
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.38
|
| Rate for Payer: Priority Health Narrow Network |
$141.38
|
| Rate for Payer: Priority Health SBD |
$282.78
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$342.72 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna Commercial |
$462.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.60
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cofinity Commercial |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$467.84
|
| Rate for Payer: Healthscope Commercial |
$489.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.40
|
| Rate for Payer: PHP Commercial |
$462.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.80
|
| Rate for Payer: Priority Health SBD |
$342.72
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$231.17 |
| Max. Negotiated Rate |
$1,504.47 |
| Rate for Payer: Aetna Commercial |
$462.40
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$604.82
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cofinity Commercial |
$467.84
|
| Rate for Payer: Cofinity Commercial |
$380.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$489.60
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$462.40
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$462.40
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$342.72
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$231.17
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$147.54 |
| Max. Negotiated Rate |
$1,669.96 |
| Rate for Payer: Aetna Commercial |
$320.26
|
| Rate for Payer: BCBS Complete |
$217.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.96
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.54
|
| Rate for Payer: Priority Health Narrow Network |
$147.54
|
| Rate for Payer: Priority Health SBD |
$333.84
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$147.54 |
| Max. Negotiated Rate |
$1,669.96 |
| Rate for Payer: Aetna Commercial |
$320.26
|
| Rate for Payer: BCBS Complete |
$217.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.96
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Cash Price |
$435.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.54
|
| Rate for Payer: Priority Health Narrow Network |
$147.54
|
| Rate for Payer: Priority Health SBD |
$333.84
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$184.71
|
| Rate for Payer: Aetna Commercial |
$184.71
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.53
|
| Rate for Payer: Priority Health Narrow Network |
$60.53
|
| Rate for Payer: Priority Health Narrow Network |
$60.53
|
| Rate for Payer: Priority Health SBD |
$193.40
|
| Rate for Payer: Priority Health SBD |
$193.40
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.52
|
| Rate for Payer: Priority Health Narrow Network |
$34.52
|
| Rate for Payer: Priority Health Narrow Network |
$34.52
|
| Rate for Payer: Priority Health SBD |
$139.03
|
| Rate for Payer: Priority Health SBD |
$139.03
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$95.04 |
| Max. Negotiated Rate |
$1,950.48 |
| Rate for Payer: Aetna Commercial |
$248.38
|
| Rate for Payer: Aetna Commercial |
$248.38
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$177.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.04
|
| Rate for Payer: Priority Health Narrow Network |
$95.04
|
| Rate for Payer: Priority Health Narrow Network |
$95.04
|
| Rate for Payer: Priority Health SBD |
$261.98
|
| Rate for Payer: Priority Health SBD |
$261.98
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$95.04 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$262.11
|
| Rate for Payer: Aetna Commercial |
$262.11
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS Complete |
$392.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.04
|
| Rate for Payer: Priority Health Narrow Network |
$95.04
|
| Rate for Payer: Priority Health Narrow Network |
$95.04
|
| Rate for Payer: Priority Health SBD |
$277.10
|
| Rate for Payer: Priority Health SBD |
$277.10
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$1,551.62 |
| Rate for Payer: Aetna Commercial |
$311.32
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.62
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Mclaren Medicaid |
$145.05
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.07
|
| Rate for Payer: Priority Health Narrow Network |
$359.07
|
| Rate for Payer: Priority Health SBD |
$359.07
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$1,408.45 |
| Rate for Payer: Aetna Commercial |
$463.16
|
| Rate for Payer: BCBS Complete |
$224.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.45
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Mclaren Medicaid |
$213.85
|
| Rate for Payer: Meridian Medicaid |
$224.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$532.49
|
| Rate for Payer: Priority Health Narrow Network |
$532.49
|
| Rate for Payer: Priority Health SBD |
$532.49
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$193.19 |
| Max. Negotiated Rate |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$416.54
|
| Rate for Payer: BCBS Complete |
$202.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Mclaren Medicaid |
$193.19
|
| Rate for Payer: Meridian Medicaid |
$202.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.42
|
| Rate for Payer: Priority Health Narrow Network |
$481.42
|
| Rate for Payer: Priority Health SBD |
$481.42
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,556.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$3,231.61 |
| Rate for Payer: Aetna Commercial |
$1,124.07
|
| Rate for Payer: BCBS Complete |
$547.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,231.61
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Mclaren Medicaid |
$521.00
|
| Rate for Payer: Meridian Medicaid |
$547.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,789.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,297.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,297.98
|
| Rate for Payer: Priority Health SBD |
$1,297.98
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$3,277.57 |
| Rate for Payer: Aetna Commercial |
$574.93
|
| Rate for Payer: BCBS Complete |
$279.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,277.57
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Mclaren Medicaid |
$266.25
|
| Rate for Payer: Meridian Medicaid |
$279.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$663.88
|
| Rate for Payer: Priority Health Narrow Network |
$663.88
|
| Rate for Payer: Priority Health SBD |
$663.88
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$292.88 |
| Max. Negotiated Rate |
$3,959.61 |
| Rate for Payer: Aetna Commercial |
$637.46
|
| Rate for Payer: BCBS Complete |
$307.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,959.61
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Mclaren Medicaid |
$292.88
|
| Rate for Payer: Meridian Medicaid |
$307.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$292.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.51
|
| Rate for Payer: Priority Health Narrow Network |
$732.51
|
| Rate for Payer: Priority Health SBD |
$732.51
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$813.37 |
| Rate for Payer: Aetna Commercial |
$704.51
|
| Rate for Payer: BCBS Complete |
$342.64
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Mclaren Medicaid |
$326.32
|
| Rate for Payer: Meridian Medicaid |
$342.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$754.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.37
|
| Rate for Payer: Priority Health Narrow Network |
$813.37
|
| Rate for Payer: Priority Health SBD |
$813.37
|
|
