|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$182.13 |
| Max. Negotiated Rate |
$404.30 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$189.42
|
| Rate for Payer: BCBS Complete |
$248.80
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health Medicare |
$183.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Exchange |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Aetna Commercial |
$522.75
|
| Rate for Payer: BCBS Trust/PPO |
$502.02
|
| Rate for Payer: BCN Commercial |
$475.27
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$528.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Healthscope Commercial |
$553.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| Rate for Payer: PHP Commercial |
$522.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO |
$535.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.20
|
| Rate for Payer: UHC Core |
$513.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$183.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Exchange |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$1,482.54 |
| Rate for Payer: Aetna Commercial |
$522.75
|
| Rate for Payer: Aetna Medicare |
$159.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.19
|
| Rate for Payer: BCBS Complete |
$1,482.54
|
| Rate for Payer: BCBS MAPPO |
$153.75
|
| Rate for Payer: BCBS Trust/PPO |
$505.59
|
| Rate for Payer: BCN Commercial |
$478.16
|
| Rate for Payer: BCN Medicare Advantage |
$153.75
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$528.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.75
|
| Rate for Payer: Healthscope Commercial |
$553.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.25
|
| Rate for Payer: Mclaren Medicaid |
$1,411.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.44
|
| Rate for Payer: Meridian Medicaid |
$1,482.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| Rate for Payer: PACE Senior Care Partners |
$146.06
|
| Rate for Payer: PACE SWMI |
$153.75
|
| Rate for Payer: PHP Commercial |
$522.75
|
| Rate for Payer: PHP Medicare Advantage |
$153.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,411.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO |
$535.05
|
| Rate for Payer: Priority Health Medicare |
$155.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.05
|
| Rate for Payer: Railroad Medicare Medicare |
$153.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.20
|
| Rate for Payer: UHC Core |
$513.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.75
|
| Rate for Payer: UHC Exchange |
$153.75
|
| Rate for Payer: UHC Medicare Advantage |
$153.75
|
| Rate for Payer: UHCCP Medicaid |
$1,411.85
|
| Rate for Payer: VA VA |
$153.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.25
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$183.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Exchange |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$71.50 |
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
|
|
PR DTP/HIB VACCINE,IM
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 90720
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90702
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$63.50
|
| Rate for Payer: Aetna Medicare |
$49.29
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$47.39
|
| Rate for Payer: BCN Medicare Advantage |
$47.39
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$63.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.76
|
| Rate for Payer: Nomi Health Commercial |
$56.87
|
| Rate for Payer: PACE SWMI |
$47.39
|
| Rate for Payer: PHP Medicare Advantage |
$47.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health Medicare |
$47.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.39
|
| Rate for Payer: UHC Exchange |
$47.39
|
| Rate for Payer: UHC Medicare Advantage |
$47.39
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$810.42 |
| Max. Negotiated Rate |
$1,908.40 |
| Rate for Payer: Aetna Commercial |
$1,085.96
|
| Rate for Payer: Aetna Medicare |
$842.84
|
| Rate for Payer: BCBS Complete |
$1,174.40
|
| Rate for Payer: BCBS MAPPO |
$810.42
|
| Rate for Payer: BCN Medicare Advantage |
$810.42
|
| Rate for Payer: Cash Price |
$2,348.80
|
| Rate for Payer: Cash Price |
$2,348.80
|
| Rate for Payer: Cofinity Commercial |
$1,167.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$850.94
|
| Rate for Payer: Nomi Health Commercial |
$972.50
|
| Rate for Payer: PACE SWMI |
$810.42
|
| Rate for Payer: PHP Medicare Advantage |
$810.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.40
|
| Rate for Payer: Priority Health Medicare |
$818.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.42
|
| Rate for Payer: UHC Exchange |
$810.42
|
| Rate for Payer: UHC Medicare Advantage |
$810.42
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$6,281.00
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$1,742.24 |
| Max. Negotiated Rate |
$4,082.65 |
| Rate for Payer: Aetna Commercial |
$2,334.60
|
| Rate for Payer: Aetna Medicare |
$1,811.93
|
| Rate for Payer: BCBS Complete |
$2,512.40
|
| Rate for Payer: BCBS MAPPO |
$1,742.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,742.24
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cofinity Commercial |
$2,508.83
|
| Rate for Payer: Cofinity Commercial |
$2,334.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,742.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,829.35
|
| Rate for Payer: Nomi Health Commercial |
$2,090.69
|
| Rate for Payer: PACE SWMI |
$1,742.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,742.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,082.65
|
| Rate for Payer: Priority Health Medicare |
$1,759.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,742.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,742.24
|
| Rate for Payer: UHC Exchange |
$1,742.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.24
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 93985
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$318.56 |
| Rate for Payer: Aetna Commercial |
$296.43
|
| Rate for Payer: Aetna Medicare |
$230.07
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$221.22
|
| Rate for Payer: BCN Medicare Advantage |
$221.22
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$318.56
|
| Rate for Payer: Cofinity Commercial |
$296.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.28
|
| Rate for Payer: Nomi Health Commercial |
$265.46
|
| Rate for Payer: PACE SWMI |
$221.22
|
| Rate for Payer: PHP Medicare Advantage |
$221.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$223.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.22
|
| Rate for Payer: UHC Exchange |
$221.22
|
| Rate for Payer: UHC Medicare Advantage |
$221.22
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 93986
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$186.91 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: Aetna Medicare |
$134.99
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$129.80
|
| Rate for Payer: BCN Medicare Advantage |
$129.80
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$186.91
|
| Rate for Payer: Cofinity Commercial |
$173.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.29
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: PACE SWMI |
$129.80
|
| Rate for Payer: PHP Medicare Advantage |
$129.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$131.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.80
|
| Rate for Payer: UHC Exchange |
$129.80
|
| Rate for Payer: UHC Medicare Advantage |
$129.80
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 93880
|
| Min. Negotiated Rate |
$168.67 |
| Max. Negotiated Rate |
$288.60 |
| Rate for Payer: Aetna Commercial |
$226.02
|
| Rate for Payer: Aetna Medicare |
$175.42
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: BCBS MAPPO |
$168.67
|
| Rate for Payer: BCN Medicare Advantage |
$168.67
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$242.88
|
| Rate for Payer: Cofinity Commercial |
$226.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.10
|
| Rate for Payer: Nomi Health Commercial |
$202.40
|
| Rate for Payer: PACE SWMI |
$168.67
|
| Rate for Payer: PHP Medicare Advantage |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health Medicare |
$170.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.67
|
| Rate for Payer: UHC Exchange |
$168.67
|
| Rate for Payer: UHC Medicare Advantage |
$168.67
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 93882
|
| Min. Negotiated Rate |
$110.47 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Aetna Commercial |
$148.03
|
| Rate for Payer: Aetna Medicare |
$114.89
|
| Rate for Payer: BCBS Complete |
$127.20
|
| Rate for Payer: BCBS MAPPO |
$110.47
|
| Rate for Payer: BCN Medicare Advantage |
$110.47
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cofinity Commercial |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$148.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.99
|
| Rate for Payer: Nomi Health Commercial |
$132.56
|
| Rate for Payer: PACE SWMI |
$110.47
|
| Rate for Payer: PHP Medicare Advantage |
$110.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.70
|
| Rate for Payer: Priority Health Medicare |
$111.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.47
|
| Rate for Payer: UHC Exchange |
$110.47
|
| Rate for Payer: UHC Medicare Advantage |
$110.47
|
|
|
PR DUPLEX SCAN HEMODIALYSIS ACCESS
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 93990
|
| Min. Negotiated Rate |
$130.18 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Aetna Commercial |
$174.44
|
| Rate for Payer: Aetna Commercial |
$174.44
|
| Rate for Payer: Aetna Medicare |
$135.39
|
| Rate for Payer: Aetna Medicare |
$135.39
|
| Rate for Payer: BCBS Complete |
$138.80
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$130.18
|
| Rate for Payer: BCBS MAPPO |
$130.18
|
| Rate for Payer: BCN Medicare Advantage |
$130.18
|
| Rate for Payer: BCN Medicare Advantage |
$130.18
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Cofinity Commercial |
$187.46
|
| Rate for Payer: Cofinity Commercial |
$174.44
|
| Rate for Payer: Cofinity Commercial |
$187.46
|
| Rate for Payer: Cofinity Commercial |
$174.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.69
|
| Rate for Payer: Nomi Health Commercial |
$156.22
|
| Rate for Payer: Nomi Health Commercial |
$156.22
|
| Rate for Payer: PACE SWMI |
$130.18
|
| Rate for Payer: PACE SWMI |
$130.18
|
| Rate for Payer: PHP Medicare Advantage |
$130.18
|
| Rate for Payer: PHP Medicare Advantage |
$130.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$131.48
|
| Rate for Payer: Priority Health Medicare |
$131.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.18
|
| Rate for Payer: UHC Exchange |
$130.18
|
| Rate for Payer: UHC Exchange |
$130.18
|
| Rate for Payer: UHC Medicare Advantage |
$130.18
|
| Rate for Payer: UHC Medicare Advantage |
$130.18
|
|
|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 93978
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Aetna Commercial |
$217.23
|
| Rate for Payer: Aetna Commercial |
$217.23
|
| Rate for Payer: Aetna Medicare |
$168.59
|
| Rate for Payer: Aetna Medicare |
$168.59
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$162.11
|
| Rate for Payer: BCBS MAPPO |
$162.11
|
| Rate for Payer: BCN Medicare Advantage |
$162.11
|
| Rate for Payer: BCN Medicare Advantage |
$162.11
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Cofinity Commercial |
$217.23
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Cofinity Commercial |
$217.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.22
|
| Rate for Payer: Nomi Health Commercial |
$194.53
|
| Rate for Payer: Nomi Health Commercial |
$194.53
|
| Rate for Payer: PACE SWMI |
$162.11
|
| Rate for Payer: PACE SWMI |
$162.11
|
| Rate for Payer: PHP Medicare Advantage |
$162.11
|
| Rate for Payer: PHP Medicare Advantage |
$162.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Medicare |
$163.73
|
| Rate for Payer: Priority Health Medicare |
$163.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.11
|
| Rate for Payer: UHC Exchange |
$162.11
|
| Rate for Payer: UHC Exchange |
$162.11
|
| Rate for Payer: UHC Medicare Advantage |
$162.11
|
| Rate for Payer: UHC Medicare Advantage |
$162.11
|
|
|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 93979
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$178.75 |
| Rate for Payer: Aetna Commercial |
$140.53
|
| Rate for Payer: Aetna Commercial |
$140.53
|
| Rate for Payer: Aetna Medicare |
$109.06
|
| Rate for Payer: Aetna Medicare |
$109.06
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$104.87
|
| Rate for Payer: BCBS MAPPO |
$104.87
|
| Rate for Payer: BCN Medicare Advantage |
$104.87
|
| Rate for Payer: BCN Medicare Advantage |
$104.87
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$140.53
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$140.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.11
|
| Rate for Payer: Nomi Health Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$125.84
|
| Rate for Payer: PACE SWMI |
$104.87
|
| Rate for Payer: PACE SWMI |
$104.87
|
| Rate for Payer: PHP Medicare Advantage |
$104.87
|
| Rate for Payer: PHP Medicare Advantage |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Medicare |
$105.92
|
| Rate for Payer: Priority Health Medicare |
$105.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.87
|
| Rate for Payer: UHC Exchange |
$104.87
|
| Rate for Payer: UHC Exchange |
$104.87
|
| Rate for Payer: UHC Medicare Advantage |
$104.87
|
| Rate for Payer: UHC Medicare Advantage |
$104.87
|
|
|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 93975
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$337.68 |
| Rate for Payer: Aetna Commercial |
$314.23
|
| Rate for Payer: Aetna Commercial |
$314.23
|
| Rate for Payer: Aetna Medicare |
$243.88
|
| Rate for Payer: Aetna Medicare |
$243.88
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS Complete |
$247.60
|
| Rate for Payer: BCBS MAPPO |
$234.50
|
| Rate for Payer: BCBS MAPPO |
$234.50
|
| Rate for Payer: BCN Medicare Advantage |
$234.50
|
| Rate for Payer: BCN Medicare Advantage |
$234.50
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Cash Price |
$495.20
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cofinity Commercial |
$337.68
|
| Rate for Payer: Cofinity Commercial |
$314.23
|
| Rate for Payer: Cofinity Commercial |
$337.68
|
| Rate for Payer: Cofinity Commercial |
$314.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.22
|
| Rate for Payer: Nomi Health Commercial |
$281.40
|
| Rate for Payer: Nomi Health Commercial |
$281.40
|
| Rate for Payer: PACE SWMI |
$234.50
|
| Rate for Payer: PACE SWMI |
$234.50
|
| Rate for Payer: PHP Medicare Advantage |
$234.50
|
| Rate for Payer: PHP Medicare Advantage |
$234.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.35
|
| Rate for Payer: Priority Health Medicare |
$236.84
|
| Rate for Payer: Priority Health Medicare |
$236.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.50
|
| Rate for Payer: UHC Exchange |
$234.50
|
| Rate for Payer: UHC Exchange |
$234.50
|
| Rate for Payer: UHC Medicare Advantage |
$234.50
|
| Rate for Payer: UHC Medicare Advantage |
$234.50
|
|
|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 93976
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$204.88 |
| Rate for Payer: Aetna Commercial |
$190.66
|
| Rate for Payer: Aetna Commercial |
$190.66
|
| Rate for Payer: Aetna Medicare |
$147.97
|
| Rate for Payer: Aetna Medicare |
$147.97
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS MAPPO |
$142.28
|
| Rate for Payer: BCBS MAPPO |
$142.28
|
| Rate for Payer: BCN Medicare Advantage |
$142.28
|
| Rate for Payer: BCN Medicare Advantage |
$142.28
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$204.88
|
| Rate for Payer: Cofinity Commercial |
$190.66
|
| Rate for Payer: Cofinity Commercial |
$204.88
|
| Rate for Payer: Cofinity Commercial |
$190.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.39
|
| Rate for Payer: Nomi Health Commercial |
$170.74
|
| Rate for Payer: Nomi Health Commercial |
$170.74
|
| Rate for Payer: PACE SWMI |
$142.28
|
| Rate for Payer: PACE SWMI |
$142.28
|
| Rate for Payer: PHP Medicare Advantage |
$142.28
|
| Rate for Payer: PHP Medicare Advantage |
$142.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.95
|
| Rate for Payer: Priority Health Medicare |
$143.70
|
| Rate for Payer: Priority Health Medicare |
$143.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.28
|
| Rate for Payer: UHC Exchange |
$142.28
|
| Rate for Payer: UHC Exchange |
$142.28
|
| Rate for Payer: UHC Medicare Advantage |
$142.28
|
| Rate for Payer: UHC Medicare Advantage |
$142.28
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 93925
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$304.96 |
| Rate for Payer: Aetna Commercial |
$283.79
|
| Rate for Payer: Aetna Commercial |
$283.79
|
| Rate for Payer: Aetna Medicare |
$220.25
|
| Rate for Payer: Aetna Medicare |
$220.25
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Complete |
$171.20
|
| Rate for Payer: BCBS MAPPO |
$211.78
|
| Rate for Payer: BCBS MAPPO |
$211.78
|
| Rate for Payer: BCN Medicare Advantage |
$211.78
|
| Rate for Payer: BCN Medicare Advantage |
$211.78
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$304.96
|
| Rate for Payer: Cofinity Commercial |
$283.79
|
| Rate for Payer: Cofinity Commercial |
$304.96
|
| Rate for Payer: Cofinity Commercial |
$283.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.37
|
| Rate for Payer: Nomi Health Commercial |
$254.14
|
| Rate for Payer: Nomi Health Commercial |
$254.14
|
| Rate for Payer: PACE SWMI |
$211.78
|
| Rate for Payer: PACE SWMI |
$211.78
|
| Rate for Payer: PHP Medicare Advantage |
$211.78
|
| Rate for Payer: PHP Medicare Advantage |
$211.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.20
|
| Rate for Payer: Priority Health Medicare |
$213.90
|
| Rate for Payer: Priority Health Medicare |
$213.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.78
|
| Rate for Payer: UHC Exchange |
$211.78
|
| Rate for Payer: UHC Exchange |
$211.78
|
| Rate for Payer: UHC Medicare Advantage |
$211.78
|
| Rate for Payer: UHC Medicare Advantage |
$211.78
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 93926
|
| Min. Negotiated Rate |
$127.27 |
| Max. Negotiated Rate |
$217.10 |
| Rate for Payer: Aetna Commercial |
$170.54
|
| Rate for Payer: Aetna Commercial |
$170.54
|
| Rate for Payer: Aetna Medicare |
$132.36
|
| Rate for Payer: Aetna Medicare |
$132.36
|
| Rate for Payer: BCBS Complete |
$133.60
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$127.27
|
| Rate for Payer: BCBS MAPPO |
$127.27
|
| Rate for Payer: BCN Medicare Advantage |
$127.27
|
| Rate for Payer: BCN Medicare Advantage |
$127.27
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cofinity Commercial |
$183.27
|
| Rate for Payer: Cofinity Commercial |
$170.54
|
| Rate for Payer: Cofinity Commercial |
$183.27
|
| Rate for Payer: Cofinity Commercial |
$170.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.63
|
| Rate for Payer: Nomi Health Commercial |
$152.72
|
| Rate for Payer: Nomi Health Commercial |
$152.72
|
| Rate for Payer: PACE SWMI |
$127.27
|
| Rate for Payer: PACE SWMI |
$127.27
|
| Rate for Payer: PHP Medicare Advantage |
$127.27
|
| Rate for Payer: PHP Medicare Advantage |
$127.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$128.54
|
| Rate for Payer: Priority Health Medicare |
$128.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.27
|
| Rate for Payer: UHC Exchange |
$127.27
|
| Rate for Payer: UHC Exchange |
$127.27
|
| Rate for Payer: UHC Medicare Advantage |
$127.27
|
| Rate for Payer: UHC Medicare Advantage |
$127.27
|
|
