|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Medicare |
$15.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: BCBS MAPPO |
$14.67
|
| Rate for Payer: BCN Commercial |
$16.89
|
| Rate for Payer: BCN Medicare Advantage |
$14.67
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$27.14
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.85
|
| Rate for Payer: Nomi Health Commercial |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PACE SWMI |
$14.67
|
| Rate for Payer: PHP Medicare Advantage |
$14.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$14.67
|
| Rate for Payer: Priority Health SBD |
$20.35
|
| Rate for Payer: Priority Health Tiered Network |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$14.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.45
|
| Rate for Payer: UHC Core |
$26.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.67
|
| Rate for Payer: UHC Exchange |
$26.45
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS G6001
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$295.50 |
| Rate for Payer: Aetna Commercial |
$173.52
|
| Rate for Payer: Aetna Medicare |
$197.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: BCBS Complete |
$157.60
|
| Rate for Payer: BCN Commercial |
$264.43
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.50
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.83
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCN Commercial |
$16.44
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Mclaren Medicaid |
$6.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.62
|
| Rate for Payer: Nomi Health Commercial |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.00
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.61
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Priority Health Tiered Network |
$15.61
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.93
|
| Rate for Payer: UHC Core |
$18.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.32
|
| Rate for Payer: UHC Exchange |
$18.93
|
| Rate for Payer: UHC Medicaid |
$6.60
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$374.41 |
| Rate for Payer: Aetna Commercial |
$255.93
|
| Rate for Payer: Aetna Medicare |
$198.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.03
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$190.99
|
| Rate for Payer: BCN Commercial |
$328.67
|
| Rate for Payer: BCN Medicare Advantage |
$190.99
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$275.03
|
| Rate for Payer: Cofinity Commercial |
$255.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.99
|
| Rate for Payer: Healthscope Commercial |
$353.33
|
| Rate for Payer: Healthscope Commercial |
$305.58
|
| Rate for Payer: Mclaren Medicaid |
$122.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.54
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$210.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.92
|
| Rate for Payer: Nomi Health Commercial |
$229.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.25
|
| Rate for Payer: PACE SWMI |
$190.99
|
| Rate for Payer: PHP Medicare Advantage |
$190.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$312.39
|
| Rate for Payer: Priority Health Medicare |
$190.99
|
| Rate for Payer: Priority Health SBD |
$312.39
|
| Rate for Payer: Priority Health Tiered Network |
$312.39
|
| Rate for Payer: Railroad Medicare Medicare |
$190.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.41
|
| Rate for Payer: UHC Core |
$374.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$190.99
|
| Rate for Payer: UHC Exchange |
$374.41
|
| Rate for Payer: UHC Medicaid |
$122.48
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$183.27 |
| Max. Negotiated Rate |
$918.12 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$305.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.15
|
| Rate for Payer: BCN Commercial |
$183.27
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$348.35
|
| Rate for Payer: Priority Health SBD |
$348.35
|
| Rate for Payer: Priority Health Tiered Network |
$348.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.12
|
| Rate for Payer: UHC Core |
$918.12
|
| Rate for Payer: UHC Exchange |
$918.12
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$32.62
|
| Rate for Payer: Aetna Medicare |
$25.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.05
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$24.34
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$24.34
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$32.62
|
| Rate for Payer: Cofinity Commercial |
$35.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$38.94
|
| Rate for Payer: Healthscope Commercial |
$45.03
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.56
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.79
|
| Rate for Payer: Nomi Health Commercial |
$29.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: PACE SWMI |
$24.34
|
| Rate for Payer: PHP Medicare Advantage |
$24.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$24.34
|
| Rate for Payer: Priority Health SBD |
$35.50
|
| Rate for Payer: Priority Health Tiered Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.68
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.34
|
| Rate for Payer: UHC Exchange |
$44.68
|
| Rate for Payer: UHC Medicaid |
$15.55
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$426.97 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$155.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.32
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$245.17
|
| Rate for Payer: Priority Health SBD |
$245.17
|
| Rate for Payer: Priority Health Tiered Network |
$245.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.97
|
| Rate for Payer: UHC Core |
$426.97
|
| Rate for Payer: UHC Exchange |
$426.97
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$571.45 |
| Rate for Payer: Aetna Commercial |
$264.35
|
| Rate for Payer: Aetna Medicare |
$155.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.15
|
| Rate for Payer: BCBS Complete |
$124.40
|
| Rate for Payer: BCBS Trust/PPO |
$571.45
|
| Rate for Payer: BCN Commercial |
$571.45
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Advantage |
$217.70
|
| Rate for Payer: Cofinity Commercial |
$267.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.80
|
| Rate for Payer: Healthscope Commercial |
$279.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: PHP Commercial |
$264.35
|
| Rate for Payer: Priority Health SBD |
$195.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.15
|
| Rate for Payer: UHC Core |
$162.03
|
| Rate for Payer: UHC Exchange |
$122.22
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 93317
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$426.97 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$155.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.32
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$245.17
|
| Rate for Payer: Priority Health SBD |
$245.17
|
| Rate for Payer: Priority Health Tiered Network |
$245.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.97
|
| Rate for Payer: UHC Core |
$426.97
|
| Rate for Payer: UHC Exchange |
$426.97
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$195.93 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Aetna Commercial |
$264.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.15
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Advantage |
$217.70
|
| Rate for Payer: Cofinity Commercial |
$267.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.80
|
| Rate for Payer: Healthscope Commercial |
$279.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: PHP Commercial |
$264.35
|
| Rate for Payer: Priority Health SBD |
$195.93
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$149.40 |
| Max. Negotiated Rate |
$878.37 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.42
|
| Rate for Payer: BCN Commercial |
$149.40
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$283.99
|
| Rate for Payer: Priority Health SBD |
$283.99
|
| Rate for Payer: Priority Health Tiered Network |
$283.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$878.37
|
| Rate for Payer: UHC Core |
$878.37
|
| Rate for Payer: UHC Exchange |
$878.37
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$225.88 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$302.68
|
| Rate for Payer: Aetna Medicare |
$234.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.68
|
| Rate for Payer: BCBS MAPPO |
$225.88
|
| Rate for Payer: BCN Commercial |
$347.09
|
| Rate for Payer: BCN Medicare Advantage |
$225.88
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cofinity Commercial |
$325.27
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.88
|
| Rate for Payer: Healthscope Commercial |
$361.41
|
| Rate for Payer: Healthscope Commercial |
$417.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$248.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.18
|
| Rate for Payer: Nomi Health Commercial |
$271.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.00
|
| Rate for Payer: PACE SWMI |
$225.88
|
| Rate for Payer: PHP Medicare Advantage |
$225.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$329.90
|
| Rate for Payer: Priority Health Medicare |
$225.88
|
| Rate for Payer: Priority Health SBD |
$329.90
|
| Rate for Payer: Priority Health Tiered Network |
$329.90
|
| Rate for Payer: Railroad Medicare Medicare |
$225.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.92
|
| Rate for Payer: UHC Core |
$381.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$225.88
|
| Rate for Payer: UHC Exchange |
$381.92
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$128.92 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$172.75
|
| Rate for Payer: Aetna Commercial |
$172.75
|
| Rate for Payer: Aetna Medicare |
$134.08
|
| Rate for Payer: Aetna Medicare |
$134.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.75
|
| Rate for Payer: BCBS MAPPO |
$128.92
|
| Rate for Payer: BCBS MAPPO |
$128.92
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: BCN Medicare Advantage |
$128.92
|
| Rate for Payer: BCN Medicare Advantage |
$128.92
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$185.64
|
| Rate for Payer: Cofinity Commercial |
$172.75
|
| Rate for Payer: Cofinity Commercial |
$172.75
|
| Rate for Payer: Cofinity Commercial |
$185.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.92
|
| Rate for Payer: Healthscope Commercial |
$238.50
|
| Rate for Payer: Healthscope Commercial |
$238.50
|
| Rate for Payer: Healthscope Commercial |
$206.27
|
| Rate for Payer: Healthscope Commercial |
$206.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.06
|
| Rate for Payer: Nomi Health Commercial |
$154.70
|
| Rate for Payer: Nomi Health Commercial |
$154.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.25
|
| Rate for Payer: PACE SWMI |
$128.92
|
| Rate for Payer: PACE SWMI |
$128.92
|
| Rate for Payer: PHP Medicare Advantage |
$128.92
|
| Rate for Payer: PHP Medicare Advantage |
$128.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$191.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$191.68
|
| Rate for Payer: Priority Health Medicare |
$128.92
|
| Rate for Payer: Priority Health Medicare |
$128.92
|
| Rate for Payer: Priority Health SBD |
$191.68
|
| Rate for Payer: Priority Health SBD |
$191.68
|
| Rate for Payer: Priority Health Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Tiered Network |
$191.68
|
| Rate for Payer: Railroad Medicare Medicare |
$128.92
|
| Rate for Payer: Railroad Medicare Medicare |
$128.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.92
|
| Rate for Payer: UHC Core |
$216.92
|
| Rate for Payer: UHC Core |
$216.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.92
|
| Rate for Payer: UHC Exchange |
$216.92
|
| Rate for Payer: UHC Exchange |
$216.92
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$224.25 |
| Rate for Payer: Aetna Commercial |
$126.23
|
| Rate for Payer: Aetna Commercial |
$126.23
|
| Rate for Payer: Aetna Medicare |
$97.97
|
| Rate for Payer: Aetna Medicare |
$97.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.23
|
| Rate for Payer: BCBS MAPPO |
$94.20
|
| Rate for Payer: BCBS MAPPO |
$94.20
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: BCN Medicare Advantage |
$94.20
|
| Rate for Payer: BCN Medicare Advantage |
$94.20
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$135.65
|
| Rate for Payer: Cofinity Commercial |
$126.23
|
| Rate for Payer: Cofinity Commercial |
$126.23
|
| Rate for Payer: Cofinity Commercial |
$135.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.20
|
| Rate for Payer: Healthscope Commercial |
$174.27
|
| Rate for Payer: Healthscope Commercial |
$174.27
|
| Rate for Payer: Healthscope Commercial |
$150.72
|
| Rate for Payer: Healthscope Commercial |
$150.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.87
|
| Rate for Payer: Nomi Health Commercial |
$113.04
|
| Rate for Payer: Nomi Health Commercial |
$113.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.25
|
| Rate for Payer: PACE SWMI |
$94.20
|
| Rate for Payer: PACE SWMI |
$94.20
|
| Rate for Payer: PHP Medicare Advantage |
$94.20
|
| Rate for Payer: PHP Medicare Advantage |
$94.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$138.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$138.20
|
| Rate for Payer: Priority Health Medicare |
$94.20
|
| Rate for Payer: Priority Health Medicare |
$94.20
|
| Rate for Payer: Priority Health SBD |
$138.20
|
| Rate for Payer: Priority Health SBD |
$138.20
|
| Rate for Payer: Priority Health Tiered Network |
$138.20
|
| Rate for Payer: Priority Health Tiered Network |
$138.20
|
| Rate for Payer: Railroad Medicare Medicare |
$94.20
|
| Rate for Payer: Railroad Medicare Medicare |
$94.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.10
|
| Rate for Payer: UHC Core |
$151.10
|
| Rate for Payer: UHC Core |
$151.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.20
|
| Rate for Payer: UHC Exchange |
$151.10
|
| Rate for Payer: UHC Exchange |
$151.10
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$349.50 |
| Rate for Payer: Aetna Commercial |
$233.00
|
| Rate for Payer: Aetna Commercial |
$233.00
|
| Rate for Payer: Aetna Medicare |
$180.84
|
| Rate for Payer: Aetna Medicare |
$180.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.00
|
| Rate for Payer: BCBS MAPPO |
$173.88
|
| Rate for Payer: BCBS MAPPO |
$173.88
|
| Rate for Payer: BCN Commercial |
$272.39
|
| Rate for Payer: BCN Commercial |
$272.39
|
| Rate for Payer: BCN Medicare Advantage |
$173.88
|
| Rate for Payer: BCN Medicare Advantage |
$173.88
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$250.39
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Cofinity Commercial |
$250.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.88
|
| Rate for Payer: Healthscope Commercial |
$321.68
|
| Rate for Payer: Healthscope Commercial |
$321.68
|
| Rate for Payer: Healthscope Commercial |
$278.21
|
| Rate for Payer: Healthscope Commercial |
$278.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.66
|
| Rate for Payer: Nomi Health Commercial |
$208.66
|
| Rate for Payer: Nomi Health Commercial |
$208.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.50
|
| Rate for Payer: PACE SWMI |
$173.88
|
| Rate for Payer: PACE SWMI |
$173.88
|
| Rate for Payer: PHP Medicare Advantage |
$173.88
|
| Rate for Payer: PHP Medicare Advantage |
$173.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$258.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$258.91
|
| Rate for Payer: Priority Health Medicare |
$173.88
|
| Rate for Payer: Priority Health Medicare |
$173.88
|
| Rate for Payer: Priority Health SBD |
$258.91
|
| Rate for Payer: Priority Health SBD |
$258.91
|
| Rate for Payer: Priority Health Tiered Network |
$258.91
|
| Rate for Payer: Priority Health Tiered Network |
$258.91
|
| Rate for Payer: Railroad Medicare Medicare |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$173.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.52
|
| Rate for Payer: UHC Core |
$292.52
|
| Rate for Payer: UHC Core |
$292.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.88
|
| Rate for Payer: UHC Exchange |
$292.52
|
| Rate for Payer: UHC Exchange |
$292.52
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$184.32 |
| Max. Negotiated Rate |
$340.99 |
| Rate for Payer: Aetna Commercial |
$246.99
|
| Rate for Payer: Aetna Commercial |
$246.99
|
| Rate for Payer: Aetna Medicare |
$191.69
|
| Rate for Payer: Aetna Medicare |
$191.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.99
|
| Rate for Payer: BCBS MAPPO |
$184.32
|
| Rate for Payer: BCBS MAPPO |
$184.32
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: BCN Medicare Advantage |
$184.32
|
| Rate for Payer: BCN Medicare Advantage |
$184.32
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$265.42
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$265.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.32
|
| Rate for Payer: Healthscope Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$294.91
|
| Rate for Payer: Healthscope Commercial |
$294.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.64
|
| Rate for Payer: Nomi Health Commercial |
$221.18
|
| Rate for Payer: Nomi Health Commercial |
$221.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$772.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.50
|
| Rate for Payer: PACE SWMI |
$184.32
|
| Rate for Payer: PACE SWMI |
$184.32
|
| Rate for Payer: PHP Medicare Advantage |
$184.32
|
| Rate for Payer: PHP Medicare Advantage |
$184.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$274.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$274.99
|
| Rate for Payer: Priority Health Medicare |
$184.32
|
| Rate for Payer: Priority Health Medicare |
$184.32
|
| Rate for Payer: Priority Health SBD |
$274.99
|
| Rate for Payer: Priority Health SBD |
$274.99
|
| Rate for Payer: Priority Health Tiered Network |
$274.99
|
| Rate for Payer: Priority Health Tiered Network |
$274.99
|
| Rate for Payer: Railroad Medicare Medicare |
$184.32
|
| Rate for Payer: Railroad Medicare Medicare |
$184.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.30
|
| Rate for Payer: UHC Core |
$319.30
|
| Rate for Payer: UHC Core |
$319.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.32
|
| Rate for Payer: UHC Exchange |
$319.30
|
| Rate for Payer: UHC Exchange |
$319.30
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$280.54
|
| Rate for Payer: Aetna Medicare |
$217.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: BCBS Complete |
$140.01
|
| Rate for Payer: BCBS MAPPO |
$209.36
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: BCN Medicare Advantage |
$209.36
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$301.48
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.36
|
| Rate for Payer: Healthscope Commercial |
$387.32
|
| Rate for Payer: Healthscope Commercial |
$334.98
|
| Rate for Payer: Mclaren Medicaid |
$133.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.83
|
| Rate for Payer: Meridian Medicaid |
$140.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.61
|
| Rate for Payer: Nomi Health Commercial |
$251.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.00
|
| Rate for Payer: PACE SWMI |
$209.36
|
| Rate for Payer: PHP Medicare Advantage |
$209.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$367.90
|
| Rate for Payer: Priority Health Medicare |
$209.36
|
| Rate for Payer: Priority Health SBD |
$367.90
|
| Rate for Payer: Priority Health Tiered Network |
$367.90
|
| Rate for Payer: Railroad Medicare Medicare |
$209.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.25
|
| Rate for Payer: UHC Core |
$415.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.36
|
| Rate for Payer: UHC Exchange |
$415.25
|
| Rate for Payer: UHC Medicaid |
$133.34
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Aetna Commercial |
$415.95
|
| Rate for Payer: Aetna Medicare |
$322.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.99
|
| Rate for Payer: BCBS Complete |
$206.43
|
| Rate for Payer: BCBS MAPPO |
$310.41
|
| Rate for Payer: BCN Commercial |
$502.46
|
| Rate for Payer: BCN Medicare Advantage |
$310.41
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cofinity Commercial |
$446.99
|
| Rate for Payer: Cofinity Commercial |
$415.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.41
|
| Rate for Payer: Healthscope Commercial |
$574.26
|
| Rate for Payer: Healthscope Commercial |
$496.66
|
| Rate for Payer: Mclaren Medicaid |
$196.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.93
|
| Rate for Payer: Meridian Medicaid |
$206.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$341.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.22
|
| Rate for Payer: Nomi Health Commercial |
$372.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$812.25
|
| Rate for Payer: PACE SWMI |
$310.41
|
| Rate for Payer: PHP Medicare Advantage |
$310.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$540.34
|
| Rate for Payer: Priority Health Medicare |
$310.41
|
| Rate for Payer: Priority Health SBD |
$540.34
|
| Rate for Payer: Priority Health Tiered Network |
$540.34
|
| Rate for Payer: Railroad Medicare Medicare |
$310.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.38
|
| Rate for Payer: UHC Core |
$614.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$310.41
|
| Rate for Payer: UHC Exchange |
$614.38
|
| Rate for Payer: UHC Medicaid |
$196.60
|
| Rate for Payer: UHCCP Medicaid |
$196.60
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$552.55 |
| Rate for Payer: Aetna Commercial |
$376.98
|
| Rate for Payer: Aetna Medicare |
$292.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.12
|
| Rate for Payer: BCBS Complete |
$187.19
|
| Rate for Payer: BCBS MAPPO |
$281.33
|
| Rate for Payer: BCN Commercial |
$453.17
|
| Rate for Payer: BCN Medicare Advantage |
$281.33
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cofinity Commercial |
$405.12
|
| Rate for Payer: Cofinity Commercial |
$376.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.33
|
| Rate for Payer: Healthscope Commercial |
$520.46
|
| Rate for Payer: Healthscope Commercial |
$450.13
|
| Rate for Payer: Mclaren Medicaid |
$178.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.40
|
| Rate for Payer: Meridian Medicaid |
$187.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$309.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.94
|
| Rate for Payer: Nomi Health Commercial |
$337.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.75
|
| Rate for Payer: PACE SWMI |
$281.33
|
| Rate for Payer: PHP Medicare Advantage |
$281.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$487.31
|
| Rate for Payer: Priority Health Medicare |
$281.33
|
| Rate for Payer: Priority Health SBD |
$487.31
|
| Rate for Payer: Priority Health Tiered Network |
$487.31
|
| Rate for Payer: Railroad Medicare Medicare |
$281.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.55
|
| Rate for Payer: UHC Core |
$552.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$281.33
|
| Rate for Payer: UHC Exchange |
$552.55
|
| Rate for Payer: UHC Medicaid |
$178.28
|
| Rate for Payer: UHCCP Medicaid |
$178.28
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$482.23 |
| Max. Negotiated Rate |
$2,013.75 |
| Rate for Payer: Aetna Commercial |
$1,022.25
|
| Rate for Payer: Aetna Medicare |
$793.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.53
|
| Rate for Payer: BCBS Complete |
$506.34
|
| Rate for Payer: BCBS MAPPO |
$762.87
|
| Rate for Payer: BCN Commercial |
$1,218.06
|
| Rate for Payer: BCN Medicare Advantage |
$762.87
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cofinity Commercial |
$1,098.53
|
| Rate for Payer: Cofinity Commercial |
$1,022.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.87
|
| Rate for Payer: Healthscope Commercial |
$1,411.31
|
| Rate for Payer: Healthscope Commercial |
$1,220.59
|
| Rate for Payer: Mclaren Medicaid |
$482.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.01
|
| Rate for Payer: Meridian Medicaid |
$506.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$839.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.46
|
| Rate for Payer: Nomi Health Commercial |
$915.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,013.75
|
| Rate for Payer: PACE SWMI |
$762.87
|
| Rate for Payer: PHP Medicare Advantage |
$762.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.88
|
| Rate for Payer: Priority Health Medicare |
$762.87
|
| Rate for Payer: Priority Health SBD |
$1,309.88
|
| Rate for Payer: Priority Health Tiered Network |
$1,309.88
|
| Rate for Payer: Railroad Medicare Medicare |
$762.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,496.77
|
| Rate for Payer: UHC Core |
$1,496.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$762.87
|
| Rate for Payer: UHC Exchange |
$1,496.77
|
| Rate for Payer: UHC Medicaid |
$482.23
|
| Rate for Payer: UHCCP Medicaid |
$482.23
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$275.41 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: Aetna Commercial |
$583.25
|
| Rate for Payer: Aetna Medicare |
$452.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.77
|
| Rate for Payer: BCBS Complete |
$289.18
|
| Rate for Payer: BCBS MAPPO |
$435.26
|
| Rate for Payer: BCN Commercial |
$696.17
|
| Rate for Payer: BCN Medicare Advantage |
$435.26
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$626.77
|
| Rate for Payer: Cofinity Commercial |
$583.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.26
|
| Rate for Payer: Healthscope Commercial |
$805.23
|
| Rate for Payer: Healthscope Commercial |
$696.42
|
| Rate for Payer: Mclaren Medicaid |
$275.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$457.02
|
| Rate for Payer: Meridian Medicaid |
$289.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$478.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.68
|
| Rate for Payer: Nomi Health Commercial |
$522.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$744.75
|
| Rate for Payer: PACE SWMI |
$435.26
|
| Rate for Payer: PHP Medicare Advantage |
$435.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$748.64
|
| Rate for Payer: Priority Health Medicare |
$435.26
|
| Rate for Payer: Priority Health SBD |
$748.64
|
| Rate for Payer: Priority Health Tiered Network |
$748.64
|
| Rate for Payer: Railroad Medicare Medicare |
$435.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$853.40
|
| Rate for Payer: UHC Core |
$853.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$435.26
|
| Rate for Payer: UHC Exchange |
$853.40
|
| Rate for Payer: UHC Medicaid |
$275.41
|
| Rate for Payer: UHCCP Medicaid |
$275.41
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$245.38 |
| Max. Negotiated Rate |
$766.47 |
| Rate for Payer: Aetna Commercial |
$519.29
|
| Rate for Payer: Aetna Medicare |
$403.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.04
|
| Rate for Payer: BCBS Complete |
$257.65
|
| Rate for Payer: BCBS MAPPO |
$387.53
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$387.53
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cofinity Commercial |
$558.04
|
| Rate for Payer: Cofinity Commercial |
$519.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.53
|
| Rate for Payer: Healthscope Commercial |
$716.93
|
| Rate for Payer: Healthscope Commercial |
$620.05
|
| Rate for Payer: Mclaren Medicaid |
$245.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.91
|
| Rate for Payer: Meridian Medicaid |
$257.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$426.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$755.75
|
| Rate for Payer: Nomi Health Commercial |
$465.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.50
|
| Rate for Payer: PACE SWMI |
$387.53
|
| Rate for Payer: PHP Medicare Advantage |
$387.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$669.92
|
| Rate for Payer: Priority Health Medicare |
$387.53
|
| Rate for Payer: Priority Health SBD |
$669.92
|
| Rate for Payer: Priority Health Tiered Network |
$669.92
|
| Rate for Payer: Railroad Medicare Medicare |
$387.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$766.47
|
| Rate for Payer: UHC Core |
$766.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$387.53
|
| Rate for Payer: UHC Exchange |
$766.47
|
| Rate for Payer: UHC Medicaid |
$245.38
|
| Rate for Payer: UHCCP Medicaid |
$245.38
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$276.26 |
| Max. Negotiated Rate |
$847.66 |
| Rate for Payer: Aetna Commercial |
$585.07
|
| Rate for Payer: Aetna Medicare |
$454.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.73
|
| Rate for Payer: BCBS Complete |
$290.07
|
| Rate for Payer: BCBS MAPPO |
$436.62
|
| Rate for Payer: BCN Commercial |
$688.21
|
| Rate for Payer: BCN Medicare Advantage |
$436.62
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cofinity Commercial |
$628.73
|
| Rate for Payer: Cofinity Commercial |
$585.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.62
|
| Rate for Payer: Healthscope Commercial |
$807.75
|
| Rate for Payer: Healthscope Commercial |
$698.59
|
| Rate for Payer: Mclaren Medicaid |
$276.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.45
|
| Rate for Payer: Meridian Medicaid |
$290.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$480.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.25
|
| Rate for Payer: Nomi Health Commercial |
$523.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.50
|
| Rate for Payer: PACE SWMI |
$436.62
|
| Rate for Payer: PHP Medicare Advantage |
$436.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$740.08
|
| Rate for Payer: Priority Health Medicare |
$436.62
|
| Rate for Payer: Priority Health SBD |
$740.08
|
| Rate for Payer: Priority Health Tiered Network |
$740.08
|
| Rate for Payer: Railroad Medicare Medicare |
$436.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.66
|
| Rate for Payer: UHC Core |
$847.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$436.62
|
| Rate for Payer: UHC Exchange |
$847.66
|
| Rate for Payer: UHC Medicaid |
$276.26
|
| Rate for Payer: UHCCP Medicaid |
$276.26
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$938.14 |
| Rate for Payer: Aetna Commercial |
$645.20
|
| Rate for Payer: Aetna Medicare |
$500.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.35
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCBS MAPPO |
$481.49
|
| Rate for Payer: BCN Commercial |
$767.39
|
| Rate for Payer: BCN Medicare Advantage |
$481.49
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cofinity Commercial |
$693.35
|
| Rate for Payer: Cofinity Commercial |
$645.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.49
|
| Rate for Payer: Healthscope Commercial |
$890.76
|
| Rate for Payer: Healthscope Commercial |
$770.38
|
| Rate for Payer: Mclaren Medicaid |
$304.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.56
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$529.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.27
|
| Rate for Payer: Nomi Health Commercial |
$577.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$849.75
|
| Rate for Payer: PACE SWMI |
$481.49
|
| Rate for Payer: PHP Medicare Advantage |
$481.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$825.23
|
| Rate for Payer: Priority Health Medicare |
$481.49
|
| Rate for Payer: Priority Health SBD |
$825.23
|
| Rate for Payer: Priority Health Tiered Network |
$825.23
|
| Rate for Payer: Railroad Medicare Medicare |
$481.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$938.14
|
| Rate for Payer: UHC Core |
$938.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$481.49
|
| Rate for Payer: UHC Exchange |
$938.14
|
| Rate for Payer: UHC Medicaid |
$304.38
|
| Rate for Payer: UHCCP Medicaid |
$304.38
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$181.09 |
| Rate for Payer: Aetna Commercial |
$117.34
|
| Rate for Payer: Aetna Medicare |
$91.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.10
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS MAPPO |
$87.57
|
| Rate for Payer: BCN Commercial |
$156.86
|
| Rate for Payer: BCN Medicare Advantage |
$87.57
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$126.10
|
| Rate for Payer: Cofinity Commercial |
$117.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.57
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Healthscope Commercial |
$140.11
|
| Rate for Payer: Mclaren Medicaid |
$56.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.95
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.95
|
| Rate for Payer: Nomi Health Commercial |
$105.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PACE SWMI |
$87.57
|
| Rate for Payer: PHP Medicare Advantage |
$87.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$144.66
|
| Rate for Payer: Priority Health Medicare |
$87.57
|
| Rate for Payer: Priority Health SBD |
$144.66
|
| Rate for Payer: Priority Health Tiered Network |
$144.66
|
| Rate for Payer: Railroad Medicare Medicare |
$87.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.09
|
| Rate for Payer: UHC Core |
$181.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.57
|
| Rate for Payer: UHC Exchange |
$181.09
|
| Rate for Payer: UHC Medicaid |
$56.45
|
| Rate for Payer: UHCCP Medicaid |
$56.45
|
|
