|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: BCN Commercial |
$646.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO |
$173.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.74
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: BCN Commercial |
$646.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO |
$173.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.74
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$503.20
|
| Rate for Payer: Aetna Medicare |
$153.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$185.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$185.00
|
| Rate for Payer: BCBS Complete |
$407.85
|
| Rate for Payer: BCBS MAPPO |
$148.00
|
| Rate for Payer: BCBS Trust/PPO |
$486.68
|
| Rate for Payer: BCN Commercial |
$460.28
|
| Rate for Payer: BCN Medicare Advantage |
$148.00
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.00
|
| Rate for Payer: Healthscope Commercial |
$532.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$444.00
|
| Rate for Payer: Mclaren Medicaid |
$388.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.40
|
| Rate for Payer: Meridian Medicaid |
$407.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.20
|
| Rate for Payer: Nomi Health Commercial |
$485.44
|
| Rate for Payer: PACE Senior Care Partners |
$140.60
|
| Rate for Payer: PACE SWMI |
$148.00
|
| Rate for Payer: PHP Commercial |
$503.20
|
| Rate for Payer: PHP Medicare Advantage |
$148.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO |
$515.04
|
| Rate for Payer: Priority Health Medicare |
$149.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.64
|
| Rate for Payer: Railroad Medicare Medicare |
$148.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$520.96
|
| Rate for Payer: UHC Core |
$494.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.00
|
| Rate for Payer: UHC Exchange |
$148.00
|
| Rate for Payer: UHC Medicare Advantage |
$148.00
|
| Rate for Payer: UHCCP Medicaid |
$388.40
|
| Rate for Payer: VA VA |
$148.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$444.00
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$503.20
|
| Rate for Payer: BCBS Trust/PPO |
$483.25
|
| Rate for Payer: BCN Commercial |
$457.50
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.60
|
| Rate for Payer: Healthscope Commercial |
$532.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$444.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.20
|
| Rate for Payer: Nomi Health Commercial |
$485.44
|
| Rate for Payer: PHP Commercial |
$503.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO |
$515.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$520.96
|
| Rate for Payer: UHC Core |
$494.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$444.00
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$1,443.32 |
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: Aetna Medicare |
$25.14
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$24.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.32
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$24.17
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$34.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.17
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.38
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: PACE SWMI |
$24.17
|
| Rate for Payer: PHP Medicare Advantage |
$24.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health HMO/PPO |
$35.79
|
| Rate for Payer: Priority Health Medicare |
$24.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.17
|
| Rate for Payer: UHC Exchange |
$24.17
|
| Rate for Payer: UHC Medicare Advantage |
$24.17
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$315.68 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCN Commercial |
$315.68
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Mclaren Medicaid |
$55.17
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO |
$121.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.01
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna Commercial |
$256.70
|
| Rate for Payer: Aetna Medicare |
$78.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.38
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$75.50
|
| Rate for Payer: BCBS Trust/PPO |
$248.27
|
| Rate for Payer: BCN Commercial |
$234.80
|
| Rate for Payer: BCN Medicare Advantage |
$75.50
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$259.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.50
|
| Rate for Payer: Healthscope Commercial |
$271.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.70
|
| Rate for Payer: Nomi Health Commercial |
$247.64
|
| Rate for Payer: PACE Senior Care Partners |
$71.72
|
| Rate for Payer: PACE SWMI |
$75.50
|
| Rate for Payer: PHP Commercial |
$256.70
|
| Rate for Payer: PHP Medicare Advantage |
$75.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO |
$262.74
|
| Rate for Payer: Priority Health Medicare |
$76.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.34
|
| Rate for Payer: Railroad Medicare Medicare |
$75.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.76
|
| Rate for Payer: UHC Core |
$252.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.50
|
| Rate for Payer: UHC Exchange |
$75.50
|
| Rate for Payer: UHC Medicare Advantage |
$75.50
|
| Rate for Payer: VA VA |
$75.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.50
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$315.68 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCN Commercial |
$315.68
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Mclaren Medicaid |
$55.17
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO |
$121.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.01
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna Commercial |
$256.70
|
| Rate for Payer: BCBS Trust/PPO |
$246.52
|
| Rate for Payer: BCN Commercial |
$233.39
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$259.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Healthscope Commercial |
$271.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.70
|
| Rate for Payer: Nomi Health Commercial |
$247.64
|
| Rate for Payer: PHP Commercial |
$256.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO |
$262.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.76
|
| Rate for Payer: UHC Core |
$252.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.50
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$2,220.97 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: Aetna Medicare |
$231.50
|
| 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: Priority Health Choice Medicaid |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.95
|
| Rate for Payer: Priority Health HMO/PPO |
$139.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.83
|
| Rate for Payer: UHCCP Medicaid |
$63.90
|
|
|
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 |
$360.75 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna Commercial |
$471.75
|
| Rate for Payer: BCBS Trust/PPO |
$453.05
|
| Rate for Payer: BCN Commercial |
$428.90
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$477.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Healthscope Commercial |
$499.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: Nomi Health Commercial |
$455.10
|
| Rate for Payer: PHP Commercial |
$471.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO |
$482.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.40
|
| Rate for Payer: UHC Core |
$463.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.25
|
|
|
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 |
$1,669.96 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$221.37
|
| 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: 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: 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 |
$146.42
|
| Rate for Payer: Priority Health Medicare |
$214.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Exchange |
$212.86
|
| 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
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna Commercial |
$471.75
|
| Rate for Payer: Aetna Medicare |
$144.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.44
|
| Rate for Payer: BCBS Complete |
$407.85
|
| Rate for Payer: BCBS MAPPO |
$138.75
|
| Rate for Payer: BCBS Trust/PPO |
$456.27
|
| Rate for Payer: BCN Commercial |
$431.51
|
| Rate for Payer: BCN Medicare Advantage |
$138.75
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$477.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.75
|
| Rate for Payer: Healthscope Commercial |
$499.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.25
|
| Rate for Payer: Mclaren Medicaid |
$388.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.69
|
| Rate for Payer: Meridian Medicaid |
$407.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: Nomi Health Commercial |
$455.10
|
| Rate for Payer: PACE Senior Care Partners |
$131.81
|
| Rate for Payer: PACE SWMI |
$138.75
|
| Rate for Payer: PHP Commercial |
$471.75
|
| Rate for Payer: PHP Medicare Advantage |
$138.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO |
$482.85
|
| Rate for Payer: Priority Health Medicare |
$140.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.85
|
| Rate for Payer: Railroad Medicare Medicare |
$138.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.40
|
| Rate for Payer: UHC Core |
$463.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.75
|
| Rate for Payer: UHC Exchange |
$138.75
|
| Rate for Payer: UHC Medicare Advantage |
$138.75
|
| Rate for Payer: UHCCP Medicaid |
$388.40
|
| Rate for Payer: VA VA |
$138.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.25
|
|
|
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 |
$1,669.96 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$221.37
|
| 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: 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: 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 |
$146.42
|
| Rate for Payer: Priority Health Medicare |
$214.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Exchange |
$212.86
|
| 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 |
$1,789.88 |
| 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: 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 |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| 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: 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: 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 |
$220.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO |
$59.80
|
| Rate for Payer: Priority Health HMO/PPO |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$123.64
|
| Rate for Payer: Priority Health Medicare |
$123.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Exchange |
$122.42
|
| Rate for Payer: UHC Exchange |
$122.42
|
| 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 |
$1,789.88 |
| 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: 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 |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| 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: 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: 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 |
$115.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health HMO/PPO |
$34.37
|
| Rate for Payer: Priority Health HMO/PPO |
$34.37
|
| Rate for Payer: Priority Health Medicare |
$88.79
|
| Rate for Payer: Priority Health Medicare |
$88.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Exchange |
$87.91
|
| Rate for Payer: UHC Exchange |
$87.91
|
| 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 |
$1,950.48 |
| 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: 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 |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| 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: 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: 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 |
$96.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health HMO/PPO |
$95.11
|
| Rate for Payer: Priority Health HMO/PPO |
$95.11
|
| Rate for Payer: Priority Health Medicare |
$167.56
|
| Rate for Payer: Priority Health Medicare |
$167.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Exchange |
$165.90
|
| Rate for Payer: UHC Exchange |
$165.90
|
| 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 |
$1,092.00 |
| 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: 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| 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: 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: 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 |
$650.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health HMO/PPO |
$95.11
|
| Rate for Payer: Priority Health HMO/PPO |
$95.11
|
| Rate for Payer: Priority Health Medicare |
$177.76
|
| Rate for Payer: Priority Health Medicare |
$177.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Exchange |
$176.00
|
| Rate for Payer: UHC Exchange |
$176.00
|
| 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 |
$1,551.62 |
| Rate for Payer: Aetna Commercial |
$298.22
|
| Rate for Payer: Aetna Medicare |
$231.45
|
| 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: 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: 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 |
$362.18
|
| Rate for Payer: Priority Health Medicare |
$224.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.55
|
| Rate for Payer: UHC Exchange |
$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 |
$1,408.45 |
| Rate for Payer: Aetna Commercial |
$440.46
|
| Rate for Payer: Aetna Medicare |
$341.85
|
| 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: 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: 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 |
$533.96
|
| Rate for Payer: Priority Health Medicare |
$331.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.70
|
| Rate for Payer: UHC Exchange |
$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 |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$396.89
|
| Rate for Payer: Aetna Medicare |
$308.04
|
| 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: 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: 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 |
$482.37
|
| Rate for Payer: Priority Health Medicare |
$299.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.19
|
| Rate for Payer: UHC Exchange |
$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 |
$3,231.61 |
| Rate for Payer: Aetna Commercial |
$1,070.27
|
| Rate for Payer: Aetna Medicare |
$830.66
|
| 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: 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: 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 |
$1,300.84
|
| Rate for Payer: Priority Health Medicare |
$806.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,300.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.71
|
| Rate for Payer: UHC Exchange |
$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 |
$4,413.95 |
| Rate for Payer: Aetna Commercial |
$611.36
|
| Rate for Payer: Aetna Medicare |
$474.49
|
| 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: 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: 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 |
$740.30
|
| Rate for Payer: Priority Health Medicare |
$460.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$740.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.24
|
| Rate for Payer: UHC Exchange |
$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 |
$3,277.57 |
| Rate for Payer: Aetna Commercial |
$545.86
|
| Rate for Payer: Aetna Medicare |
$423.65
|
| 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: 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: 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 |
$664.77
|
| Rate for Payer: Priority Health Medicare |
$411.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$664.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.36
|
| Rate for Payer: UHC Exchange |
$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 |
$3,959.61 |
| Rate for Payer: Aetna Commercial |
$604.70
|
| Rate for Payer: Aetna Medicare |
$469.32
|
| 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: 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: 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 |
$731.25
|
| Rate for Payer: Priority Health Medicare |
$455.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.27
|
| Rate for Payer: UHC Exchange |
$451.27
|
| Rate for Payer: UHC Medicare Advantage |
$451.27
|
| Rate for Payer: UHCCP Medicaid |
$294.37
|
|
