|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: Aetna Medicare |
$392.00
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCN Commercial |
$16.44
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Mclaren Medicaid |
$6.60
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.61
|
| Rate for Payer: UHC Medicaid |
$6.60
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna Commercial |
$304.22
|
| Rate for Payer: Aetna Medicare |
$237.50
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCN Commercial |
$328.67
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Mclaren Medicaid |
$122.48
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.39
|
| Rate for Payer: UHC Medicaid |
$122.48
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$183.27 |
| Max. Negotiated Rate |
$637.15 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$305.00
|
| Rate for Payer: BCN Commercial |
$183.27
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.35
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: UHC Medicaid |
$15.55
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$245.17 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$155.50
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Aetna Commercial |
$264.35
|
| Rate for Payer: Aetna Medicare |
$80.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.19
|
| Rate for Payer: BCBS Complete |
$57.57
|
| Rate for Payer: BCBS MAPPO |
$77.75
|
| Rate for Payer: BCBS Trust/PPO |
$255.67
|
| Rate for Payer: BCN Commercial |
$255.67
|
| Rate for Payer: BCN Medicare Advantage |
$77.75
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$267.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.75
|
| Rate for Payer: Healthscope Commercial |
$279.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.25
|
| Rate for Payer: Mclaren Medicaid |
$54.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.64
|
| Rate for Payer: Meridian Medicaid |
$57.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.35
|
| Rate for Payer: Nomi Health Commercial |
$255.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: PACE Senior Care Partners |
$73.86
|
| Rate for Payer: PACE SWMI |
$77.75
|
| Rate for Payer: PHP Commercial |
$264.35
|
| Rate for Payer: PHP Medicare Advantage |
$77.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$270.57
|
| Rate for Payer: Priority Health Medicare |
$78.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.46
|
| Rate for Payer: Railroad Medicare Medicare |
$77.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.68
|
| Rate for Payer: UHC Core |
$259.69
|
| Rate for Payer: UHC Exchange |
$77.75
|
| Rate for Payer: UHC Medicaid |
$54.83
|
| Rate for Payer: UHC Medicare Advantage |
$77.75
|
| Rate for Payer: UHCCP Medicaid |
$54.83
|
| Rate for Payer: VA VA |
$77.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.25
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 93317
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$245.17 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$155.50
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$216.46 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Aetna Commercial |
$264.35
|
| Rate for Payer: BCBS Trust/PPO |
$256.85
|
| Rate for Payer: BCN Commercial |
$256.85
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$267.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.80
|
| Rate for Payer: Healthscope Commercial |
$279.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.35
|
| Rate for Payer: Nomi Health Commercial |
$255.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: PHP Commercial |
$264.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$270.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.68
|
| Rate for Payer: UHC Core |
$259.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.25
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$149.40 |
| Max. Negotiated Rate |
$630.42 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: BCN Commercial |
$149.40
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.99
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$320.26
|
| Rate for Payer: Aetna Medicare |
$286.00
|
| Rate for Payer: BCN Commercial |
$347.09
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$329.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$329.90
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$261.75 |
| Rate for Payer: Aetna Commercial |
$184.71
|
| Rate for Payer: Aetna Commercial |
$184.71
|
| Rate for Payer: Aetna Medicare |
$174.50
|
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.68
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$145.41 |
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.20
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$272.39 |
| Rate for Payer: Aetna Commercial |
$248.38
|
| Rate for Payer: Aetna Commercial |
$248.38
|
| Rate for Payer: Aetna Medicare |
$76.00
|
| Rate for Payer: Aetna Medicare |
$233.00
|
| Rate for Payer: BCN Commercial |
$272.39
|
| Rate for Payer: BCN Commercial |
$272.39
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$258.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$258.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.91
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$289.33 |
| Rate for Payer: Aetna Commercial |
$262.11
|
| Rate for Payer: Aetna Commercial |
$262.11
|
| Rate for Payer: Aetna Medicare |
$515.00
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$772.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.99
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$311.32
|
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$140.01
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Mclaren Medicaid |
$133.34
|
| Rate for Payer: Meridian Medicaid |
$140.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.90
|
| Rate for Payer: UHC Medicaid |
$133.34
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Aetna Commercial |
$463.16
|
| Rate for Payer: Aetna Medicare |
$541.50
|
| Rate for Payer: BCBS Complete |
$206.43
|
| Rate for Payer: BCN Commercial |
$502.46
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Mclaren Medicaid |
$196.60
|
| Rate for Payer: Meridian Medicaid |
$206.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$812.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$540.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$540.34
|
| Rate for Payer: UHC Medicaid |
$196.60
|
| Rate for Payer: UHCCP Medicaid |
$196.60
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$487.31 |
| Rate for Payer: Aetna Commercial |
$416.54
|
| Rate for Payer: Aetna Medicare |
$244.50
|
| Rate for Payer: BCBS Complete |
$187.19
|
| Rate for Payer: BCN Commercial |
$453.17
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Mclaren Medicaid |
$178.28
|
| Rate for Payer: Meridian Medicaid |
$187.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$487.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.31
|
| Rate for Payer: UHC Medicaid |
$178.28
|
| Rate for Payer: UHCCP Medicaid |
$178.28
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$482.23 |
| Max. Negotiated Rate |
$2,013.75 |
| Rate for Payer: Aetna Commercial |
$1,124.07
|
| Rate for Payer: Aetna Medicare |
$1,342.50
|
| Rate for Payer: BCBS Complete |
$506.34
|
| Rate for Payer: BCN Commercial |
$1,218.06
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Mclaren Medicaid |
$482.23
|
| Rate for Payer: Meridian Medicaid |
$506.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,013.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,309.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,309.88
|
| Rate for Payer: UHC Medicaid |
$482.23
|
| Rate for Payer: UHCCP Medicaid |
$482.23
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$275.41 |
| Max. Negotiated Rate |
$748.64 |
| Rate for Payer: Aetna Commercial |
$640.79
|
| Rate for Payer: Aetna Medicare |
$496.50
|
| Rate for Payer: BCBS Complete |
$289.18
|
| Rate for Payer: BCN Commercial |
$696.17
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Mclaren Medicaid |
$275.41
|
| Rate for Payer: Meridian Medicaid |
$289.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$744.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$748.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$748.64
|
| Rate for Payer: UHC Medicaid |
$275.41
|
| Rate for Payer: UHCCP Medicaid |
$275.41
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$245.38 |
| Max. Negotiated Rate |
$694.50 |
| Rate for Payer: Aetna Commercial |
$574.93
|
| Rate for Payer: Aetna Medicare |
$463.00
|
| Rate for Payer: BCBS Complete |
$257.65
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Mclaren Medicaid |
$245.38
|
| Rate for Payer: Meridian Medicaid |
$257.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$669.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$669.92
|
| Rate for Payer: UHC Medicaid |
$245.38
|
| Rate for Payer: UHCCP Medicaid |
$245.38
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$276.26 |
| Max. Negotiated Rate |
$740.08 |
| Rate for Payer: Aetna Commercial |
$637.46
|
| Rate for Payer: Aetna Medicare |
$373.00
|
| Rate for Payer: BCBS Complete |
$290.07
|
| Rate for Payer: BCN Commercial |
$688.21
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Mclaren Medicaid |
$276.26
|
| Rate for Payer: Meridian Medicaid |
$290.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$740.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$740.08
|
| Rate for Payer: UHC Medicaid |
$276.26
|
| Rate for Payer: UHCCP Medicaid |
$276.26
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$849.75 |
| Rate for Payer: Aetna Commercial |
$704.51
|
| Rate for Payer: Aetna Medicare |
$566.50
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCN Commercial |
$767.39
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Mclaren Medicaid |
$304.38
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$849.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$825.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.23
|
| Rate for Payer: UHC Medicaid |
$304.38
|
| Rate for Payer: UHCCP Medicaid |
$304.38
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: Aetna Commercial |
$116.64
|
| Rate for Payer: Aetna Medicare |
$118.50
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCN Commercial |
$156.86
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Mclaren Medicaid |
$56.45
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.66
|
| Rate for Payer: UHC Medicaid |
$56.45
|
| Rate for Payer: UHCCP Medicaid |
$56.45
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$126.74 |
| Max. Negotiated Rate |
$771.00 |
| Rate for Payer: Aetna Commercial |
$300.25
|
| Rate for Payer: Aetna Medicare |
$514.00
|
| Rate for Payer: BCBS Complete |
$133.08
|
| Rate for Payer: BCN Commercial |
$333.15
|
| Rate for Payer: Cash Price |
$822.40
|
| Rate for Payer: Cash Price |
$822.40
|
| Rate for Payer: Mclaren Medicaid |
$126.74
|
| Rate for Payer: Meridian Medicaid |
$133.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$771.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$405.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.92
|
| Rate for Payer: UHC Medicaid |
$126.74
|
| Rate for Payer: UHCCP Medicaid |
$126.74
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,895.04
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$334.10 |
| Max. Negotiated Rate |
$1,705.54 |
| Rate for Payer: Aetna Commercial |
$1,610.78
|
| Rate for Payer: Aetna Medicare |
$492.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$592.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$592.20
|
| Rate for Payer: BCBS Complete |
$350.77
|
| Rate for Payer: BCBS MAPPO |
$473.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.91
|
| Rate for Payer: BCN Commercial |
$1,557.91
|
| Rate for Payer: BCN Medicare Advantage |
$473.76
|
| Rate for Payer: Cash Price |
$1,516.03
|
| Rate for Payer: Cofinity Commercial |
$1,629.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,516.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.76
|
| Rate for Payer: Healthscope Commercial |
$1,705.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,421.28
|
| Rate for Payer: Mclaren Medicaid |
$334.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.45
|
| Rate for Payer: Meridian Medicaid |
$350.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$544.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$521.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,610.78
|
| Rate for Payer: Nomi Health Commercial |
$1,553.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,421.28
|
| Rate for Payer: PACE Senior Care Partners |
$450.07
|
| Rate for Payer: PACE SWMI |
$473.76
|
| Rate for Payer: PHP Commercial |
$1,610.78
|
| Rate for Payer: PHP Medicare Advantage |
$473.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$334.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,648.68
|
| Rate for Payer: Priority Health Medicare |
$478.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.95
|
| Rate for Payer: Railroad Medicare Medicare |
$473.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,667.64
|
| Rate for Payer: UHC Core |
$1,582.36
|
| Rate for Payer: UHC Exchange |
$473.76
|
| Rate for Payer: UHC Medicaid |
$334.10
|
| Rate for Payer: UHC Medicare Advantage |
$473.76
|
| Rate for Payer: UHCCP Medicaid |
$334.10
|
| Rate for Payer: VA VA |
$473.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,421.28
|
|
