|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$28,890.00 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: Aetna Medicare |
$231.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.42
|
| Rate for Payer: BCBS Complete |
$67.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,220.97
|
| Rate for Payer: BCN Commercial |
$611.51
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Mclaren Medicaid |
$63.90
|
| Rate for Payer: Meridian Medicaid |
$67.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,890.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.68
|
| Rate for Payer: Priority Health Narrow Network |
$279.68
|
| Rate for Payer: Priority Health SBD |
$139.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.43
|
| Rate for Payer: UHC Exchange |
$133.43
|
| Rate for Payer: UHCCP Medicaid |
$63.90
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$240.08 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Commercial |
$471.75
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.75
|
| 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 |
$583.28
|
| Rate for Payer: BCN Commercial |
$583.28
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$477.30
|
| Rate for Payer: Cofinity Commercial |
$388.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$388.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$499.50
|
| 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 |
$471.75
|
| 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 |
$471.75
|
| 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 |
$360.75
|
| 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 |
$349.65
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.08
|
| 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 R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$33,818.00 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$221.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.52
|
| Rate for Payer: BCBS Complete |
$69.78
|
| Rate for Payer: BCBS MAPPO |
$212.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.96
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: BCN Medicare Advantage |
$212.86
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Cofinity Commercial |
$285.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.86
|
| Rate for Payer: Healthscope Commercial |
$393.79
|
| Rate for Payer: Healthscope Commercial |
$340.58
|
| Rate for Payer: Mclaren Medicaid |
$66.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.50
|
| Rate for Payer: Meridian Medicaid |
$69.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,818.00
|
| Rate for Payer: Nomi Health Commercial |
$255.43
|
| Rate for Payer: PACE SWMI |
$212.86
|
| Rate for Payer: PHP Medicare Advantage |
$212.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.41
|
| Rate for Payer: Priority Health Medicare |
$212.86
|
| Rate for Payer: Priority Health Narrow Network |
$332.41
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Exchange |
$374.94
|
| Rate for Payer: UHC Medicare Advantage |
$212.86
|
| Rate for Payer: UHCCP Medicaid |
$66.46
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$349.65 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna Commercial |
$471.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.75
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$388.50
|
| Rate for Payer: Cofinity Commercial |
$477.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$388.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Healthscope Commercial |
$499.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: PHP Commercial |
$471.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health SBD |
$349.65
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$33,818.00 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$221.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.52
|
| Rate for Payer: BCBS Complete |
$69.78
|
| Rate for Payer: BCBS MAPPO |
$212.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.96
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: BCN Medicare Advantage |
$212.86
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Cofinity Commercial |
$285.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.86
|
| Rate for Payer: Healthscope Commercial |
$393.79
|
| Rate for Payer: Healthscope Commercial |
$340.58
|
| Rate for Payer: Mclaren Medicaid |
$66.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.50
|
| Rate for Payer: Meridian Medicaid |
$69.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,818.00
|
| Rate for Payer: Nomi Health Commercial |
$255.43
|
| Rate for Payer: PACE SWMI |
$212.86
|
| Rate for Payer: PHP Medicare Advantage |
$212.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.41
|
| Rate for Payer: Priority Health Medicare |
$212.86
|
| Rate for Payer: Priority Health Narrow Network |
$332.41
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Exchange |
$374.94
|
| Rate for Payer: UHC Medicare Advantage |
$212.86
|
| Rate for Payer: UHCCP Medicaid |
$66.46
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$19,406.00 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$127.32
|
| Rate for Payer: Aetna Medicare |
$127.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.04
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS MAPPO |
$122.42
|
| Rate for Payer: BCBS MAPPO |
$122.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$199.86
|
| Rate for Payer: BCN Commercial |
$199.86
|
| Rate for Payer: BCN Medicare Advantage |
$122.42
|
| Rate for Payer: BCN Medicare Advantage |
$122.42
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.42
|
| Rate for Payer: Healthscope Commercial |
$195.87
|
| Rate for Payer: Healthscope Commercial |
$226.48
|
| Rate for Payer: Healthscope Commercial |
$195.87
|
| Rate for Payer: Healthscope Commercial |
$226.48
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.54
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,406.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,406.00
|
| Rate for Payer: Nomi Health Commercial |
$146.90
|
| Rate for Payer: Nomi Health Commercial |
$146.90
|
| Rate for Payer: PACE SWMI |
$122.42
|
| Rate for Payer: PACE SWMI |
$122.42
|
| Rate for Payer: PHP Medicare Advantage |
$122.42
|
| Rate for Payer: PHP Medicare Advantage |
$122.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.58
|
| Rate for Payer: Priority Health Medicare |
$122.42
|
| Rate for Payer: Priority Health Medicare |
$122.42
|
| Rate for Payer: Priority Health Narrow Network |
$192.58
|
| Rate for Payer: Priority Health Narrow Network |
$192.58
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Exchange |
$289.00
|
| Rate for Payer: UHC Exchange |
$289.00
|
| Rate for Payer: UHC Medicare Advantage |
$122.42
|
| Rate for Payer: UHC Medicare Advantage |
$122.42
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$13,887.00 |
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Medicare |
$91.43
|
| Rate for Payer: Aetna Medicare |
$91.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.80
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$143.67
|
| Rate for Payer: BCN Commercial |
$143.67
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.91
|
| Rate for Payer: Healthscope Commercial |
$140.66
|
| Rate for Payer: Healthscope Commercial |
$162.63
|
| Rate for Payer: Healthscope Commercial |
$140.66
|
| Rate for Payer: Healthscope Commercial |
$162.63
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.31
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,887.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,887.00
|
| Rate for Payer: Nomi Health Commercial |
$105.49
|
| Rate for Payer: Nomi Health Commercial |
$105.49
|
| Rate for Payer: PACE SWMI |
$87.91
|
| Rate for Payer: PACE SWMI |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.37
|
| Rate for Payer: Priority Health Medicare |
$87.91
|
| Rate for Payer: Priority Health Medicare |
$87.91
|
| Rate for Payer: Priority Health Narrow Network |
$139.37
|
| Rate for Payer: Priority Health Narrow Network |
$139.37
|
| Rate for Payer: Priority Health SBD |
$34.37
|
| Rate for Payer: Priority Health SBD |
$34.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Exchange |
$144.29
|
| Rate for Payer: UHC Exchange |
$144.29
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$26,366.00 |
| Rate for Payer: Aetna Commercial |
$222.31
|
| Rate for Payer: Aetna Commercial |
$222.31
|
| Rate for Payer: Aetna Medicare |
$172.54
|
| Rate for Payer: Aetna Medicare |
$172.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.31
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.90
|
| Rate for Payer: Healthscope Commercial |
$265.44
|
| Rate for Payer: Healthscope Commercial |
$306.92
|
| Rate for Payer: Healthscope Commercial |
$265.44
|
| Rate for Payer: Healthscope Commercial |
$306.92
|
| Rate for Payer: Mclaren Medicaid |
$43.03
|
| Rate for Payer: Mclaren Medicaid |
$43.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.20
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,366.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,366.00
|
| Rate for Payer: Nomi Health Commercial |
$199.08
|
| Rate for Payer: Nomi Health Commercial |
$199.08
|
| Rate for Payer: PACE SWMI |
$165.90
|
| Rate for Payer: PACE SWMI |
$165.90
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.79
|
| Rate for Payer: Priority Health Medicare |
$165.90
|
| Rate for Payer: Priority Health Medicare |
$165.90
|
| Rate for Payer: Priority Health Narrow Network |
$261.79
|
| Rate for Payer: Priority Health Narrow Network |
$261.79
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Exchange |
$213.01
|
| Rate for Payer: UHC Exchange |
$213.01
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$27,864.00 |
| Rate for Payer: Aetna Commercial |
$235.84
|
| Rate for Payer: Aetna Commercial |
$235.84
|
| Rate for Payer: Aetna Medicare |
$183.04
|
| Rate for Payer: Aetna Medicare |
$183.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.84
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: BCN Commercial |
$286.36
|
| Rate for Payer: BCN Commercial |
$286.36
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$281.60
|
| Rate for Payer: Healthscope Commercial |
$325.60
|
| Rate for Payer: Healthscope Commercial |
$281.60
|
| Rate for Payer: Healthscope Commercial |
$325.60
|
| Rate for Payer: Mclaren Medicaid |
$43.03
|
| Rate for Payer: Mclaren Medicaid |
$43.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.80
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,864.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,864.00
|
| Rate for Payer: Nomi Health Commercial |
$211.20
|
| Rate for Payer: Nomi Health Commercial |
$211.20
|
| Rate for Payer: PACE SWMI |
$176.00
|
| Rate for Payer: PACE SWMI |
$176.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.32
|
| Rate for Payer: Priority Health Medicare |
$176.00
|
| Rate for Payer: Priority Health Medicare |
$176.00
|
| Rate for Payer: Priority Health Narrow Network |
$277.32
|
| Rate for Payer: Priority Health Narrow Network |
$277.32
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: Priority Health SBD |
$95.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Exchange |
$150.03
|
| Rate for Payer: UHC Exchange |
$150.03
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$40,761.00 |
| Rate for Payer: Aetna Commercial |
$298.22
|
| Rate for Payer: Aetna Medicare |
$231.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.47
|
| Rate for Payer: BCBS Complete |
$153.65
|
| Rate for Payer: BCBS MAPPO |
$222.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.62
|
| Rate for Payer: BCN Commercial |
$329.86
|
| Rate for Payer: BCN Medicare Advantage |
$222.55
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$320.47
|
| Rate for Payer: Cofinity Commercial |
$298.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.55
|
| Rate for Payer: Healthscope Commercial |
$356.08
|
| Rate for Payer: Healthscope Commercial |
$411.72
|
| Rate for Payer: Mclaren Medicaid |
$146.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.68
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,761.00
|
| Rate for Payer: Nomi Health Commercial |
$267.06
|
| Rate for Payer: PACE SWMI |
$222.55
|
| Rate for Payer: PHP Medicare Advantage |
$222.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.18
|
| Rate for Payer: Priority Health Medicare |
$222.55
|
| Rate for Payer: Priority Health Narrow Network |
$362.18
|
| Rate for Payer: Priority Health SBD |
$362.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.55
|
| Rate for Payer: UHC Medicare Advantage |
$222.55
|
| Rate for Payer: UHCCP Medicaid |
$146.33
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$214.92 |
| Max. Negotiated Rate |
$60,622.00 |
| Rate for Payer: Aetna Commercial |
$440.46
|
| Rate for Payer: Aetna Medicare |
$341.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.33
|
| Rate for Payer: BCBS Complete |
$225.67
|
| Rate for Payer: BCBS MAPPO |
$328.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.45
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: BCN Medicare Advantage |
$328.70
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cofinity Commercial |
$473.33
|
| Rate for Payer: Cofinity Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.70
|
| Rate for Payer: Healthscope Commercial |
$525.92
|
| Rate for Payer: Healthscope Commercial |
$608.10
|
| Rate for Payer: Mclaren Medicaid |
$214.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.14
|
| Rate for Payer: Meridian Medicaid |
$225.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,622.00
|
| Rate for Payer: Nomi Health Commercial |
$394.44
|
| Rate for Payer: PACE SWMI |
$328.70
|
| Rate for Payer: PHP Medicare Advantage |
$328.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.96
|
| Rate for Payer: Priority Health Medicare |
$328.70
|
| Rate for Payer: Priority Health Narrow Network |
$533.96
|
| Rate for Payer: Priority Health SBD |
$533.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.70
|
| Rate for Payer: UHC Medicare Advantage |
$328.70
|
| Rate for Payer: UHCCP Medicaid |
$214.92
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$54,794.00 |
| Rate for Payer: Aetna Commercial |
$396.89
|
| Rate for Payer: Aetna Medicare |
$308.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.51
|
| Rate for Payer: BCBS Complete |
$203.52
|
| Rate for Payer: BCBS MAPPO |
$296.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: BCN Commercial |
$442.25
|
| Rate for Payer: BCN Medicare Advantage |
$296.19
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$426.51
|
| Rate for Payer: Cofinity Commercial |
$396.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.19
|
| Rate for Payer: Healthscope Commercial |
$473.90
|
| Rate for Payer: Healthscope Commercial |
$547.95
|
| Rate for Payer: Mclaren Medicaid |
$193.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.00
|
| Rate for Payer: Meridian Medicaid |
$203.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,794.00
|
| Rate for Payer: Nomi Health Commercial |
$355.43
|
| Rate for Payer: PACE SWMI |
$296.19
|
| Rate for Payer: PHP Medicare Advantage |
$296.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$482.37
|
| Rate for Payer: Priority Health Medicare |
$296.19
|
| Rate for Payer: Priority Health Narrow Network |
$482.37
|
| Rate for Payer: Priority Health SBD |
$482.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.19
|
| Rate for Payer: UHC Medicare Advantage |
$296.19
|
| Rate for Payer: UHCCP Medicaid |
$193.83
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,607.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$148,046.00 |
| Rate for Payer: Aetna Commercial |
$1,070.27
|
| Rate for Payer: Aetna Medicare |
$830.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.14
|
| Rate for Payer: BCBS Complete |
$547.05
|
| Rate for Payer: BCBS MAPPO |
$798.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,231.61
|
| Rate for Payer: BCN Commercial |
$1,192.37
|
| Rate for Payer: BCN Medicare Advantage |
$798.71
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.14
|
| Rate for Payer: Cofinity Commercial |
$1,070.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.71
|
| Rate for Payer: Healthscope Commercial |
$1,277.94
|
| Rate for Payer: Healthscope Commercial |
$1,477.61
|
| Rate for Payer: Mclaren Medicaid |
$521.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.65
|
| Rate for Payer: Meridian Medicaid |
$547.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148,046.00
|
| Rate for Payer: Nomi Health Commercial |
$958.45
|
| Rate for Payer: PACE SWMI |
$798.71
|
| Rate for Payer: PHP Medicare Advantage |
$798.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,300.84
|
| Rate for Payer: Priority Health Medicare |
$798.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,300.84
|
| Rate for Payer: Priority Health SBD |
$1,300.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.71
|
| Rate for Payer: UHC Medicare Advantage |
$798.71
|
| Rate for Payer: UHCCP Medicaid |
$521.00
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$297.77 |
| Max. Negotiated Rate |
$84,168.00 |
| Rate for Payer: Aetna Commercial |
$611.36
|
| Rate for Payer: Aetna Medicare |
$474.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.99
|
| Rate for Payer: BCBS Complete |
$312.66
|
| Rate for Payer: BCBS MAPPO |
$456.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,413.95
|
| Rate for Payer: BCN Commercial |
$678.28
|
| Rate for Payer: BCN Medicare Advantage |
$456.24
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$656.99
|
| Rate for Payer: Cofinity Commercial |
$611.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$456.24
|
| Rate for Payer: Healthscope Commercial |
$729.98
|
| Rate for Payer: Healthscope Commercial |
$844.04
|
| Rate for Payer: Mclaren Medicaid |
$297.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.05
|
| Rate for Payer: Meridian Medicaid |
$312.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84,168.00
|
| Rate for Payer: Nomi Health Commercial |
$547.49
|
| Rate for Payer: PACE SWMI |
$456.24
|
| Rate for Payer: PHP Medicare Advantage |
$456.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.30
|
| Rate for Payer: Priority Health Medicare |
$456.24
|
| Rate for Payer: Priority Health Narrow Network |
$740.30
|
| Rate for Payer: Priority Health SBD |
$740.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.24
|
| Rate for Payer: UHC Medicare Advantage |
$456.24
|
| Rate for Payer: UHCCP Medicaid |
$297.77
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$75,575.00 |
| Rate for Payer: Aetna Commercial |
$545.86
|
| Rate for Payer: Aetna Medicare |
$423.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.60
|
| Rate for Payer: BCBS Complete |
$279.78
|
| Rate for Payer: BCBS MAPPO |
$407.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,277.57
|
| Rate for Payer: BCN Commercial |
$609.87
|
| Rate for Payer: BCN Medicare Advantage |
$407.36
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$586.60
|
| Rate for Payer: Cofinity Commercial |
$545.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.36
|
| Rate for Payer: Healthscope Commercial |
$651.78
|
| Rate for Payer: Healthscope Commercial |
$753.62
|
| Rate for Payer: Mclaren Medicaid |
$266.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.73
|
| Rate for Payer: Meridian Medicaid |
$279.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75,575.00
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: PACE SWMI |
$407.36
|
| Rate for Payer: PHP Medicare Advantage |
$407.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$664.77
|
| Rate for Payer: Priority Health Medicare |
$407.36
|
| Rate for Payer: Priority Health Narrow Network |
$664.77
|
| Rate for Payer: Priority Health SBD |
$664.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.36
|
| Rate for Payer: UHC Medicare Advantage |
$407.36
|
| Rate for Payer: UHCCP Medicaid |
$266.46
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$294.37 |
| Max. Negotiated Rate |
$83,525.00 |
| Rate for Payer: Aetna Commercial |
$604.70
|
| Rate for Payer: Aetna Medicare |
$469.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.83
|
| Rate for Payer: BCBS Complete |
$309.09
|
| Rate for Payer: BCBS MAPPO |
$451.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,959.61
|
| Rate for Payer: BCN Commercial |
$672.91
|
| Rate for Payer: BCN Medicare Advantage |
$451.27
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$649.83
|
| Rate for Payer: Cofinity Commercial |
$604.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.27
|
| Rate for Payer: Healthscope Commercial |
$722.03
|
| Rate for Payer: Healthscope Commercial |
$834.85
|
| Rate for Payer: Mclaren Medicaid |
$294.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$473.83
|
| Rate for Payer: Meridian Medicaid |
$309.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83,525.00
|
| Rate for Payer: Nomi Health Commercial |
$541.52
|
| Rate for Payer: PACE SWMI |
$451.27
|
| Rate for Payer: PHP Medicare Advantage |
$451.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.25
|
| Rate for Payer: Priority Health Medicare |
$451.27
|
| Rate for Payer: Priority Health Narrow Network |
$731.25
|
| Rate for Payer: Priority Health SBD |
$731.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.27
|
| Rate for Payer: UHC Medicare Advantage |
$451.27
|
| Rate for Payer: UHCCP Medicaid |
$294.37
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$92,727.00 |
| Rate for Payer: Aetna Commercial |
$673.87
|
| Rate for Payer: Aetna Medicare |
$523.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.16
|
| Rate for Payer: BCBS Complete |
$344.64
|
| Rate for Payer: BCBS MAPPO |
$502.89
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: BCN Medicare Advantage |
$502.89
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$724.16
|
| Rate for Payer: Cofinity Commercial |
$673.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.89
|
| Rate for Payer: Healthscope Commercial |
$804.62
|
| Rate for Payer: Healthscope Commercial |
$930.35
|
| Rate for Payer: Mclaren Medicaid |
$328.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.03
|
| Rate for Payer: Meridian Medicaid |
$344.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,727.00
|
| Rate for Payer: Nomi Health Commercial |
$603.47
|
| Rate for Payer: PACE SWMI |
$502.89
|
| Rate for Payer: PHP Medicare Advantage |
$502.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.75
|
| Rate for Payer: Priority Health Medicare |
$502.89
|
| Rate for Payer: Priority Health Narrow Network |
$814.75
|
| Rate for Payer: Priority Health SBD |
$814.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.89
|
| Rate for Payer: UHC Medicare Advantage |
$502.89
|
| Rate for Payer: UHCCP Medicaid |
$328.23
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$15,495.00 |
| Rate for Payer: Aetna Commercial |
$133.84
|
| Rate for Payer: Aetna Medicare |
$103.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.83
|
| Rate for Payer: BCBS Complete |
$70.46
|
| Rate for Payer: BCBS MAPPO |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$658.26
|
| Rate for Payer: BCN Commercial |
$152.47
|
| Rate for Payer: BCN Medicare Advantage |
$99.88
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$143.83
|
| Rate for Payer: Cofinity Commercial |
$133.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$159.81
|
| Rate for Payer: Healthscope Commercial |
$184.78
|
| Rate for Payer: Mclaren Medicaid |
$67.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.87
|
| Rate for Payer: Meridian Medicaid |
$70.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,495.00
|
| Rate for Payer: Nomi Health Commercial |
$119.86
|
| Rate for Payer: PACE SWMI |
$99.88
|
| Rate for Payer: PHP Medicare Advantage |
$99.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.57
|
| Rate for Payer: Priority Health Medicare |
$99.88
|
| Rate for Payer: Priority Health Narrow Network |
$141.57
|
| Rate for Payer: Priority Health SBD |
$141.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.88
|
| Rate for Payer: UHC Medicare Advantage |
$99.88
|
| Rate for Payer: UHCCP Medicaid |
$67.10
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$39,310.00 |
| Rate for Payer: Aetna Commercial |
$285.21
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.49
|
| Rate for Payer: BCBS Complete |
$149.62
|
| Rate for Payer: BCBS MAPPO |
$212.84
|
| Rate for Payer: BCBS Trust/PPO |
$946.19
|
| Rate for Payer: BCN Commercial |
$322.53
|
| Rate for Payer: BCN Medicare Advantage |
$212.84
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cofinity Commercial |
$306.49
|
| Rate for Payer: Cofinity Commercial |
$285.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.84
|
| Rate for Payer: Healthscope Commercial |
$393.75
|
| Rate for Payer: Healthscope Commercial |
$340.54
|
| Rate for Payer: Mclaren Medicaid |
$142.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.48
|
| Rate for Payer: Meridian Medicaid |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,310.00
|
| Rate for Payer: Nomi Health Commercial |
$255.41
|
| Rate for Payer: PACE SWMI |
$212.84
|
| Rate for Payer: PHP Medicare Advantage |
$212.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.73
|
| Rate for Payer: Priority Health Medicare |
$212.84
|
| Rate for Payer: Priority Health Narrow Network |
$396.73
|
| Rate for Payer: Priority Health SBD |
$396.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.84
|
| Rate for Payer: UHC Exchange |
$350.11
|
| Rate for Payer: UHC Medicare Advantage |
$212.84
|
| Rate for Payer: UHCCP Medicaid |
$142.50
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$423.71
|
|
|
Service Code
|
NDC 11980018005
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.94 |
| Max. Negotiated Rate |
$381.34 |
| Rate for Payer: Aetna Commercial |
$360.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.41
|
| Rate for Payer: Cash Price |
$338.97
|
| Rate for Payer: Cofinity Commercial |
$296.60
|
| Rate for Payer: Cofinity Commercial |
$364.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.97
|
| Rate for Payer: Healthscope Commercial |
$381.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.15
|
| Rate for Payer: PHP Commercial |
$360.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.41
|
| Rate for Payer: Priority Health SBD |
$266.94
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$423.71
|
|
|
Service Code
|
NDC 11980018005
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.48 |
| Max. Negotiated Rate |
$381.34 |
| Rate for Payer: Aetna Commercial |
$360.15
|
| Rate for Payer: Aetna Medicare |
$211.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.41
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: Cash Price |
$338.97
|
| Rate for Payer: Cofinity Commercial |
$296.60
|
| Rate for Payer: Cofinity Commercial |
$364.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.97
|
| Rate for Payer: Healthscope Commercial |
$381.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.15
|
| Rate for Payer: PHP Commercial |
$360.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.41
|
| Rate for Payer: Priority Health SBD |
$266.94
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$103.01
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: Aetna Medicare |
$51.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cofinity Commercial |
$72.11
|
| Rate for Payer: Cofinity Commercial |
$88.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.41
|
| Rate for Payer: Healthscope Commercial |
$92.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.56
|
| Rate for Payer: PHP Commercial |
$87.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.96
|
| Rate for Payer: Priority Health SBD |
$64.90
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$103.01
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.90 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cofinity Commercial |
$72.11
|
| Rate for Payer: Cofinity Commercial |
$88.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.41
|
| Rate for Payer: Healthscope Commercial |
$92.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.56
|
| Rate for Payer: PHP Commercial |
$87.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.96
|
| Rate for Payer: Priority Health SBD |
$64.90
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$7.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Commercial |
$686.44
|
| Rate for Payer: Aetna Medicare |
$403.79
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.93
|
| Rate for Payer: BCBS Complete |
$323.03
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.08
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$646.06
|
| Rate for Payer: Cash Price |
$646.06
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$694.52
|
| Rate for Payer: Cofinity Commercial |
$565.31
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$565.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.06
|
| Rate for Payer: Healthscope Commercial |
$7.19
|
| Rate for Payer: Healthscope Commercial |
$726.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.79
|
| Rate for Payer: PHP Commercial |
$686.44
|
| Rate for Payer: PHP Commercial |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$524.93
|
| Rate for Payer: Priority Health SBD |
$508.78
|
| Rate for Payer: Priority Health SBD |
$5.03
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$7.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna Commercial |
$686.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.93
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cash Price |
$646.06
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$565.31
|
| Rate for Payer: Cofinity Commercial |
$694.52
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$565.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$646.06
|
| Rate for Payer: Healthscope Commercial |
$7.19
|
| Rate for Payer: Healthscope Commercial |
$726.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.44
|
| Rate for Payer: PHP Commercial |
$6.79
|
| Rate for Payer: PHP Commercial |
$686.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$524.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.19
|
| Rate for Payer: Priority Health SBD |
$508.78
|
| Rate for Payer: Priority Health SBD |
$5.03
|
|
