|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 93930
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$27,645.00 |
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Medicare |
$184.17
|
| Rate for Payer: Aetna Medicare |
$184.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.30
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$177.09
|
| Rate for Payer: BCBS MAPPO |
$177.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCN Commercial |
$286.85
|
| Rate for Payer: BCN Commercial |
$286.85
|
| Rate for Payer: BCN Medicare Advantage |
$177.09
|
| Rate for Payer: BCN Medicare Advantage |
$177.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$255.01
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$255.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.09
|
| Rate for Payer: Healthscope Commercial |
$283.34
|
| Rate for Payer: Healthscope Commercial |
$327.62
|
| Rate for Payer: Healthscope Commercial |
$283.34
|
| Rate for Payer: Healthscope Commercial |
$327.62
|
| Rate for Payer: Mclaren Medicaid |
$23.86
|
| Rate for Payer: Mclaren Medicaid |
$23.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.94
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,645.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,645.00
|
| Rate for Payer: Nomi Health Commercial |
$212.51
|
| Rate for Payer: Nomi Health Commercial |
$212.51
|
| Rate for Payer: PACE SWMI |
$177.09
|
| Rate for Payer: PACE SWMI |
$177.09
|
| Rate for Payer: PHP Medicare Advantage |
$177.09
|
| Rate for Payer: PHP Medicare Advantage |
$177.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.68
|
| Rate for Payer: Priority Health Medicare |
$177.09
|
| Rate for Payer: Priority Health Medicare |
$177.09
|
| Rate for Payer: Priority Health Narrow Network |
$268.68
|
| Rate for Payer: Priority Health Narrow Network |
$268.68
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.09
|
| Rate for Payer: UHC Exchange |
$214.33
|
| Rate for Payer: UHC Exchange |
$214.33
|
| Rate for Payer: UHC Medicare Advantage |
$177.09
|
| Rate for Payer: UHC Medicare Advantage |
$177.09
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 93931
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$17,411.00 |
| Rate for Payer: Aetna Commercial |
$147.13
|
| Rate for Payer: Aetna Commercial |
$147.13
|
| Rate for Payer: Aetna Medicare |
$114.19
|
| Rate for Payer: Aetna Medicare |
$114.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.13
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$109.80
|
| Rate for Payer: BCBS MAPPO |
$109.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Commercial |
$180.81
|
| Rate for Payer: BCN Commercial |
$180.81
|
| Rate for Payer: BCN Medicare Advantage |
$109.80
|
| Rate for Payer: BCN Medicare Advantage |
$109.80
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$158.11
|
| Rate for Payer: Cofinity Commercial |
$147.13
|
| Rate for Payer: Cofinity Commercial |
$147.13
|
| Rate for Payer: Cofinity Commercial |
$158.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.80
|
| Rate for Payer: Healthscope Commercial |
$175.68
|
| Rate for Payer: Healthscope Commercial |
$203.13
|
| Rate for Payer: Healthscope Commercial |
$175.68
|
| Rate for Payer: Healthscope Commercial |
$203.13
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.29
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,411.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,411.00
|
| Rate for Payer: Nomi Health Commercial |
$131.76
|
| Rate for Payer: Nomi Health Commercial |
$131.76
|
| Rate for Payer: PACE SWMI |
$109.80
|
| Rate for Payer: PACE SWMI |
$109.80
|
| Rate for Payer: PHP Medicare Advantage |
$109.80
|
| Rate for Payer: PHP Medicare Advantage |
$109.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.81
|
| Rate for Payer: Priority Health Medicare |
$109.80
|
| Rate for Payer: Priority Health Medicare |
$109.80
|
| Rate for Payer: Priority Health Narrow Network |
$167.81
|
| Rate for Payer: Priority Health Narrow Network |
$167.81
|
| Rate for Payer: Priority Health SBD |
$31.21
|
| Rate for Payer: Priority Health SBD |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.80
|
| Rate for Payer: UHC Exchange |
$142.55
|
| Rate for Payer: UHC Exchange |
$142.55
|
| Rate for Payer: UHC Medicare Advantage |
$109.80
|
| Rate for Payer: UHC Medicare Advantage |
$109.80
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 93970
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$26,564.00 |
| Rate for Payer: Aetna Commercial |
$221.97
|
| Rate for Payer: Aetna Commercial |
$221.97
|
| Rate for Payer: Aetna Medicare |
$172.28
|
| Rate for Payer: Aetna Medicare |
$172.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.97
|
| Rate for Payer: BCBS Complete |
$21.47
|
| Rate for Payer: BCBS Complete |
$21.47
|
| Rate for Payer: BCBS MAPPO |
$165.65
|
| Rate for Payer: BCBS MAPPO |
$165.65
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCN Commercial |
$276.10
|
| Rate for Payer: BCN Commercial |
$276.10
|
| Rate for Payer: BCN Medicare Advantage |
$165.65
|
| Rate for Payer: BCN Medicare Advantage |
$165.65
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$221.97
|
| Rate for Payer: Cofinity Commercial |
$221.97
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.65
|
| Rate for Payer: Healthscope Commercial |
$265.04
|
| Rate for Payer: Healthscope Commercial |
$306.45
|
| Rate for Payer: Healthscope Commercial |
$265.04
|
| Rate for Payer: Healthscope Commercial |
$306.45
|
| Rate for Payer: Mclaren Medicaid |
$20.45
|
| Rate for Payer: Mclaren Medicaid |
$20.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.93
|
| Rate for Payer: Meridian Medicaid |
$21.47
|
| Rate for Payer: Meridian Medicaid |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,564.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,564.00
|
| Rate for Payer: Nomi Health Commercial |
$198.78
|
| Rate for Payer: Nomi Health Commercial |
$198.78
|
| Rate for Payer: PACE SWMI |
$165.65
|
| Rate for Payer: PACE SWMI |
$165.65
|
| Rate for Payer: PHP Medicare Advantage |
$165.65
|
| Rate for Payer: PHP Medicare Advantage |
$165.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.74
|
| Rate for Payer: Priority Health Medicare |
$165.65
|
| Rate for Payer: Priority Health Medicare |
$165.65
|
| Rate for Payer: Priority Health Narrow Network |
$253.74
|
| Rate for Payer: Priority Health Narrow Network |
$253.74
|
| Rate for Payer: Priority Health SBD |
$43.88
|
| Rate for Payer: Priority Health SBD |
$43.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.65
|
| Rate for Payer: UHC Exchange |
$255.70
|
| Rate for Payer: UHC Exchange |
$255.70
|
| Rate for Payer: UHC Medicare Advantage |
$165.65
|
| Rate for Payer: UHC Medicare Advantage |
$165.65
|
| Rate for Payer: UHCCP Medicaid |
$20.45
|
| Rate for Payer: UHCCP Medicaid |
$20.45
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 93971
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$16,832.00 |
| Rate for Payer: Aetna Commercial |
$142.08
|
| Rate for Payer: Aetna Commercial |
$142.08
|
| Rate for Payer: Aetna Medicare |
$110.27
|
| Rate for Payer: Aetna Medicare |
$110.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.08
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$106.03
|
| Rate for Payer: BCBS MAPPO |
$106.03
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Medicare Advantage |
$106.03
|
| Rate for Payer: BCN Medicare Advantage |
$106.03
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$152.68
|
| Rate for Payer: Cofinity Commercial |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$152.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.03
|
| Rate for Payer: Healthscope Commercial |
$169.65
|
| Rate for Payer: Healthscope Commercial |
$196.16
|
| Rate for Payer: Healthscope Commercial |
$169.65
|
| Rate for Payer: Healthscope Commercial |
$196.16
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.33
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,832.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,832.00
|
| Rate for Payer: Nomi Health Commercial |
$127.24
|
| Rate for Payer: Nomi Health Commercial |
$127.24
|
| Rate for Payer: PACE SWMI |
$106.03
|
| Rate for Payer: PACE SWMI |
$106.03
|
| Rate for Payer: PHP Medicare Advantage |
$106.03
|
| Rate for Payer: PHP Medicare Advantage |
$106.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.48
|
| Rate for Payer: Priority Health Medicare |
$106.03
|
| Rate for Payer: Priority Health Medicare |
$106.03
|
| Rate for Payer: Priority Health Narrow Network |
$161.48
|
| Rate for Payer: Priority Health Narrow Network |
$161.48
|
| Rate for Payer: Priority Health SBD |
$28.05
|
| Rate for Payer: Priority Health SBD |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.03
|
| Rate for Payer: UHC Exchange |
$168.97
|
| Rate for Payer: UHC Exchange |
$168.97
|
| Rate for Payer: UHC Medicare Advantage |
$106.03
|
| Rate for Payer: UHC Medicare Advantage |
$106.03
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
|
|
PR DURAL GRAFT SPINAL
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63710
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$193,457.00 |
| Rate for Payer: Aetna Commercial |
$1,421.75
|
| Rate for Payer: Aetna Medicare |
$1,103.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,421.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,527.85
|
| Rate for Payer: BCBS Complete |
$742.30
|
| Rate for Payer: BCBS MAPPO |
$1,061.01
|
| Rate for Payer: BCBS Trust/PPO |
$172.75
|
| Rate for Payer: BCN Commercial |
$1,749.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,061.01
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cofinity Commercial |
$1,527.85
|
| Rate for Payer: Cofinity Commercial |
$1,421.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,061.01
|
| Rate for Payer: Healthscope Commercial |
$1,962.87
|
| Rate for Payer: Healthscope Commercial |
$1,697.62
|
| Rate for Payer: Mclaren Medicaid |
$706.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,114.06
|
| Rate for Payer: Meridian Medicaid |
$742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193,457.00
|
| Rate for Payer: Nomi Health Commercial |
$1,273.21
|
| Rate for Payer: PACE SWMI |
$1,061.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,061.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$706.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,871.64
|
| Rate for Payer: Priority Health Medicare |
$1,061.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,871.64
|
| Rate for Payer: Priority Health SBD |
$1,871.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,171.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,061.01
|
| Rate for Payer: UHC Exchange |
$1,171.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,061.01
|
| Rate for Payer: UHCCP Medicaid |
$706.95
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR 1ST 60
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 92622
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$115.07 |
| Rate for Payer: Aetna Commercial |
$83.35
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.35
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$62.20
|
| Rate for Payer: BCN Medicare Advantage |
$62.20
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$83.35
|
| Rate for Payer: Cofinity Commercial |
$89.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.20
|
| Rate for Payer: Healthscope Commercial |
$115.07
|
| Rate for Payer: Healthscope Commercial |
$99.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.90
|
| Rate for Payer: Nomi Health Commercial |
$74.64
|
| Rate for Payer: PACE SWMI |
$62.20
|
| Rate for Payer: PHP Medicare Advantage |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.65
|
| Rate for Payer: Priority Health Medicare |
$62.20
|
| Rate for Payer: Priority Health Narrow Network |
$88.65
|
| Rate for Payer: Priority Health SBD |
$88.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.20
|
| Rate for Payer: UHC Medicare Advantage |
$62.20
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR EA ADL
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 92623
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$30.27 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.92
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$26.18
|
| Rate for Payer: Healthscope Commercial |
$30.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.52
|
| Rate for Payer: Priority Health Medicare |
$16.36
|
| Rate for Payer: Priority Health Narrow Network |
$23.52
|
| Rate for Payer: Priority Health SBD |
$23.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
|
|
PR DYSPORT
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 00385
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
|
|
PR EAR MOLD/INSERT
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS V5264
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$57.45
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.45
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR EAR PIERCING
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 69090
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.41
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Trust/PPO |
$248.83
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,492.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.24
|
| Rate for Payer: Priority Health Narrow Network |
$45.24
|
| Rate for Payer: Priority Health SBD |
$45.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Exchange |
$57.20
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 93010
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$2,320.82 |
| Rate for Payer: Aetna Commercial |
$10.25
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.82
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Mclaren Medicaid |
$5.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.00
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.30
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: Priority Health Narrow Network |
$11.30
|
| Rate for Payer: Priority Health SBD |
$11.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Exchange |
$19.20
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 93005
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$1,832.67 |
| Rate for Payer: Aetna Commercial |
$7.61
|
| Rate for Payer: Aetna Medicare |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.18
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$5.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,832.67
|
| Rate for Payer: BCN Commercial |
$7.46
|
| Rate for Payer: BCN Medicare Advantage |
$5.68
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Healthscope Commercial |
$9.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.00
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: PACE SWMI |
$5.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Medicare |
$5.68
|
| Rate for Payer: Priority Health Narrow Network |
$8.94
|
| Rate for Payer: Priority Health SBD |
$8.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.68
|
| Rate for Payer: UHC Exchange |
$22.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.68
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$2,085.00 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Aetna Medicare |
$13.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.20
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$13.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,966.86
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.33
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.33
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Healthscope Commercial |
$24.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.00
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PACE SWMI |
$13.33
|
| Rate for Payer: PHP Medicare Advantage |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.24
|
| Rate for Payer: Priority Health Medicare |
$13.33
|
| Rate for Payer: Priority Health Narrow Network |
$20.24
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.33
|
| Rate for Payer: UHC Exchange |
$51.10
|
| Rate for Payer: UHC Medicare Advantage |
$13.33
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS G6001
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$25,247.00 |
| Rate for Payer: Aetna Commercial |
$212.26
|
| Rate for Payer: Aetna Medicare |
$164.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.10
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$158.40
|
| Rate for Payer: BCN Commercial |
$263.39
|
| Rate for Payer: BCN Medicare Advantage |
$158.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$212.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$293.04
|
| Rate for Payer: Healthscope Commercial |
$253.44
|
| Rate for Payer: Mclaren Medicaid |
$20.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.32
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,247.00
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE SWMI |
$158.40
|
| Rate for Payer: PHP Medicare Advantage |
$158.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.16
|
| Rate for Payer: Priority Health Medicare |
$158.40
|
| Rate for Payer: Priority Health Narrow Network |
$277.16
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.40
|
| Rate for Payer: UHC Medicare Advantage |
$158.40
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$1,750.26 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.26
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$10.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.26
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: BCN Medicare Advantage |
$10.64
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$14.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.64
|
| Rate for Payer: Healthscope Commercial |
$17.02
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.17
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.00
|
| Rate for Payer: Nomi Health Commercial |
$12.77
|
| Rate for Payer: PACE SWMI |
$10.64
|
| Rate for Payer: PHP Medicare Advantage |
$10.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.53
|
| Rate for Payer: Priority Health Medicare |
$10.64
|
| Rate for Payer: Priority Health Narrow Network |
$15.53
|
| Rate for Payer: Priority Health SBD |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.64
|
| Rate for Payer: UHC Exchange |
$100.21
|
| Rate for Payer: UHC Medicare Advantage |
$10.64
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$140.58 |
| Max. Negotiated Rate |
$32,792.00 |
| Rate for Payer: Aetna Commercial |
$282.34
|
| Rate for Payer: Aetna Medicare |
$219.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.41
|
| Rate for Payer: BCBS Complete |
$147.61
|
| Rate for Payer: BCBS MAPPO |
$210.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.52
|
| Rate for Payer: BCN Commercial |
$321.06
|
| Rate for Payer: BCN Medicare Advantage |
$210.70
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$303.41
|
| Rate for Payer: Cofinity Commercial |
$282.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.70
|
| Rate for Payer: Healthscope Commercial |
$337.12
|
| Rate for Payer: Healthscope Commercial |
$389.80
|
| Rate for Payer: Mclaren Medicaid |
$140.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.24
|
| Rate for Payer: Meridian Medicaid |
$147.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,792.00
|
| Rate for Payer: Nomi Health Commercial |
$252.84
|
| Rate for Payer: PACE SWMI |
$210.70
|
| Rate for Payer: PHP Medicare Advantage |
$210.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.81
|
| Rate for Payer: Priority Health Medicare |
$210.70
|
| Rate for Payer: Priority Health Narrow Network |
$309.81
|
| Rate for Payer: Priority Health SBD |
$309.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.70
|
| Rate for Payer: UHC Medicare Advantage |
$210.70
|
| Rate for Payer: UHCCP Medicaid |
$140.58
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$35,774.00 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.15
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: BCN Commercial |
$646.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,774.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.47
|
| Rate for Payer: Priority Health Narrow Network |
$347.47
|
| Rate for Payer: Priority Health SBD |
$173.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.73
|
| Rate for Payer: UHC Exchange |
$338.73
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$372.96 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$503.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.80
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cofinity Commercial |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.60
|
| Rate for Payer: Healthscope Commercial |
$532.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.20
|
| Rate for Payer: PHP Commercial |
$503.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health SBD |
$372.96
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Commercial |
$503.20
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.31
|
| Rate for Payer: BCN Commercial |
$1,457.31
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Cofinity Commercial |
$414.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$532.80
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.20
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$503.20
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$372.96
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,512.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$302.45
|
| Rate for Payer: VA VA |
$537.21
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$35,774.00 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.15
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: BCN Commercial |
$646.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,774.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.47
|
| Rate for Payer: Priority Health Narrow Network |
$347.47
|
| Rate for Payer: Priority Health SBD |
$173.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.73
|
| Rate for Payer: UHC Exchange |
$338.73
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$3,779.00 |
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: Aetna Medicare |
$25.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$24.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.32
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$24.17
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.17
|
| Rate for Payer: Healthscope Commercial |
$44.71
|
| Rate for Payer: Healthscope Commercial |
$38.67
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.38
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,779.00
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: PACE SWMI |
$24.17
|
| Rate for Payer: PHP Medicare Advantage |
$24.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.79
|
| Rate for Payer: Priority Health Medicare |
$24.17
|
| Rate for Payer: Priority Health Narrow Network |
$35.79
|
| Rate for Payer: Priority Health SBD |
$35.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.17
|
| Rate for Payer: UHC Exchange |
$68.88
|
| Rate for Payer: UHC Medicare Advantage |
$24.17
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna Commercial |
$256.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.30
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$211.40
|
| Rate for Payer: Cofinity Commercial |
$259.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Healthscope Commercial |
$271.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.70
|
| Rate for Payer: PHP Commercial |
$256.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health SBD |
$190.26
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$24,920.00 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.32
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCN Commercial |
$315.68
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Mclaren Medicaid |
$55.17
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,920.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.01
|
| Rate for Payer: Priority Health Narrow Network |
$242.01
|
| Rate for Payer: Priority Health SBD |
$121.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.75
|
| Rate for Payer: UHC Exchange |
$268.75
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$24,920.00 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.32
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCN Commercial |
$315.68
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Mclaren Medicaid |
$55.17
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,920.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.01
|
| Rate for Payer: Priority Health Narrow Network |
$242.01
|
| Rate for Payer: Priority Health SBD |
$121.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.75
|
| Rate for Payer: UHC Exchange |
$268.75
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$569.97 |
| Rate for Payer: Aetna Commercial |
$256.70
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.30
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS Trust/PPO |
$569.97
|
| Rate for Payer: BCN Commercial |
$569.97
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$211.40
|
| Rate for Payer: Cofinity Commercial |
$259.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Healthscope Commercial |
$271.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.70
|
| Rate for Payer: PHP Commercial |
$256.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health SBD |
$190.26
|
| Rate for Payer: UHC Exchange |
$223.48
|
|
