|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 93930
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$263.90 |
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Medicare |
$184.17
|
| Rate for Payer: Aetna Medicare |
$184.17
|
| Rate for Payer: BCBS Complete |
$162.40
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$177.09
|
| Rate for Payer: BCBS MAPPO |
$177.09
|
| Rate for Payer: BCN Medicare Advantage |
$177.09
|
| Rate for Payer: BCN Medicare Advantage |
$177.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$255.01
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$255.01
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.94
|
| Rate for Payer: Nomi Health Commercial |
$212.51
|
| Rate for Payer: Nomi Health Commercial |
$212.51
|
| Rate for Payer: PACE SWMI |
$177.09
|
| Rate for Payer: PACE SWMI |
$177.09
|
| Rate for Payer: PHP Medicare Advantage |
$177.09
|
| Rate for Payer: PHP Medicare Advantage |
$177.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$178.86
|
| Rate for Payer: Priority Health Medicare |
$178.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.09
|
| Rate for Payer: UHC Exchange |
$177.09
|
| Rate for Payer: UHC Exchange |
$177.09
|
| Rate for Payer: UHC Medicare Advantage |
$177.09
|
| Rate for Payer: UHC Medicare Advantage |
$177.09
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 93931
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna Commercial |
$147.13
|
| Rate for Payer: Aetna Commercial |
$147.13
|
| Rate for Payer: Aetna Medicare |
$114.19
|
| Rate for Payer: Aetna Medicare |
$114.19
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$109.80
|
| Rate for Payer: BCBS MAPPO |
$109.80
|
| Rate for Payer: BCN Medicare Advantage |
$109.80
|
| Rate for Payer: BCN Medicare Advantage |
$109.80
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$158.11
|
| Rate for Payer: Cofinity Commercial |
$147.13
|
| Rate for Payer: Cofinity Commercial |
$158.11
|
| Rate for Payer: Cofinity Commercial |
$147.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.29
|
| Rate for Payer: Nomi Health Commercial |
$131.76
|
| Rate for Payer: Nomi Health Commercial |
$131.76
|
| Rate for Payer: PACE SWMI |
$109.80
|
| Rate for Payer: PACE SWMI |
$109.80
|
| Rate for Payer: PHP Medicare Advantage |
$109.80
|
| Rate for Payer: PHP Medicare Advantage |
$109.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$110.90
|
| Rate for Payer: Priority Health Medicare |
$110.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.80
|
| Rate for Payer: UHC Exchange |
$109.80
|
| Rate for Payer: UHC Exchange |
$109.80
|
| Rate for Payer: UHC Medicare Advantage |
$109.80
|
| Rate for Payer: UHC Medicare Advantage |
$109.80
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 93970
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna Commercial |
$221.97
|
| Rate for Payer: Aetna Commercial |
$221.97
|
| Rate for Payer: Aetna Medicare |
$172.28
|
| Rate for Payer: Aetna Medicare |
$172.28
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS Complete |
$168.80
|
| Rate for Payer: BCBS MAPPO |
$165.65
|
| Rate for Payer: BCBS MAPPO |
$165.65
|
| Rate for Payer: BCN Medicare Advantage |
$165.65
|
| Rate for Payer: BCN Medicare Advantage |
$165.65
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$221.97
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$221.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.93
|
| Rate for Payer: Nomi Health Commercial |
$198.78
|
| Rate for Payer: Nomi Health Commercial |
$198.78
|
| Rate for Payer: PACE SWMI |
$165.65
|
| Rate for Payer: PACE SWMI |
$165.65
|
| Rate for Payer: PHP Medicare Advantage |
$165.65
|
| Rate for Payer: PHP Medicare Advantage |
$165.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.30
|
| Rate for Payer: Priority Health Medicare |
$167.31
|
| Rate for Payer: Priority Health Medicare |
$167.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.65
|
| Rate for Payer: UHC Exchange |
$165.65
|
| Rate for Payer: UHC Exchange |
$165.65
|
| Rate for Payer: UHC Medicare Advantage |
$165.65
|
| Rate for Payer: UHC Medicare Advantage |
$165.65
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 93971
|
| Min. Negotiated Rate |
$106.03 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial |
$142.08
|
| Rate for Payer: Aetna Commercial |
$142.08
|
| Rate for Payer: Aetna Medicare |
$110.27
|
| Rate for Payer: Aetna Medicare |
$110.27
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$106.03
|
| Rate for Payer: BCBS MAPPO |
$106.03
|
| Rate for Payer: BCN Medicare Advantage |
$106.03
|
| Rate for Payer: BCN Medicare Advantage |
$106.03
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$152.68
|
| Rate for Payer: Cofinity Commercial |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$152.68
|
| Rate for Payer: Cofinity Commercial |
$142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.33
|
| Rate for Payer: Nomi Health Commercial |
$127.24
|
| Rate for Payer: Nomi Health Commercial |
$127.24
|
| Rate for Payer: PACE SWMI |
$106.03
|
| Rate for Payer: PACE SWMI |
$106.03
|
| Rate for Payer: PHP Medicare Advantage |
$106.03
|
| Rate for Payer: PHP Medicare Advantage |
$106.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$107.09
|
| Rate for Payer: Priority Health Medicare |
$107.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.03
|
| Rate for Payer: UHC Exchange |
$106.03
|
| Rate for Payer: UHC Exchange |
$106.03
|
| Rate for Payer: UHC Medicare Advantage |
$106.03
|
| Rate for Payer: UHC Medicare Advantage |
$106.03
|
|
|
PR DURAL GRAFT SPINAL
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63710
|
| Min. Negotiated Rate |
$1,061.01 |
| Max. Negotiated Rate |
$3,309.80 |
| Rate for Payer: Aetna Commercial |
$1,421.75
|
| Rate for Payer: Aetna Medicare |
$1,103.45
|
| Rate for Payer: BCBS Complete |
$2,036.80
|
| Rate for Payer: BCBS MAPPO |
$1,061.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,061.01
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cofinity Commercial |
$1,527.85
|
| Rate for Payer: Cofinity Commercial |
$1,421.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,061.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,114.06
|
| Rate for Payer: Nomi Health Commercial |
$1,273.21
|
| Rate for Payer: PACE SWMI |
$1,061.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,061.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health Medicare |
$1,071.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,061.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,061.01
|
| Rate for Payer: UHC Exchange |
$1,061.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,061.01
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR 1ST 60
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 92622
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$107.90 |
| Rate for Payer: Aetna Commercial |
$83.35
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$62.20
|
| Rate for Payer: BCN Medicare Advantage |
$62.20
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$89.57
|
| Rate for Payer: Cofinity Commercial |
$83.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.31
|
| Rate for Payer: Nomi Health Commercial |
$74.64
|
| Rate for Payer: PACE SWMI |
$62.20
|
| Rate for Payer: PHP Medicare Advantage |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health Medicare |
$62.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHC Medicare Advantage |
$62.20
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR EA ADL
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 92623
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
|
|
PR DYSPORT
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 00385
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
|
|
PR EAR MOLD/INSERT
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS V5264
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR EAR PIERCING
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 69090
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 93010
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Commercial |
$10.25
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Exchange |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 93005
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$7.61
|
| Rate for Payer: Aetna Medicare |
$5.91
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$5.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.68
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.96
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: PACE SWMI |
$5.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.68
|
| Rate for Payer: UHC Exchange |
$5.68
|
| Rate for Payer: UHC Medicare Advantage |
$5.68
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Aetna Medicare |
$13.86
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$13.33
|
| Rate for Payer: BCN Medicare Advantage |
$13.33
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PACE SWMI |
$13.33
|
| Rate for Payer: PHP Medicare Advantage |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health Medicare |
$13.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.33
|
| Rate for Payer: UHC Exchange |
$13.33
|
| Rate for Payer: UHC Medicare Advantage |
$13.33
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS G6001
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$212.26
|
| Rate for Payer: Aetna Medicare |
$164.74
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$158.40
|
| Rate for Payer: BCN Medicare Advantage |
$158.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$212.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.32
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE SWMI |
$158.40
|
| Rate for Payer: PHP Medicare Advantage |
$158.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$159.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.40
|
| Rate for Payer: UHC Exchange |
$158.40
|
| Rate for Payer: UHC Medicare Advantage |
$158.40
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$494.65 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$11.07
|
| Rate for Payer: BCBS Complete |
$304.40
|
| Rate for Payer: BCBS MAPPO |
$10.64
|
| Rate for Payer: BCN Medicare Advantage |
$10.64
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$14.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.17
|
| Rate for Payer: Nomi Health Commercial |
$12.77
|
| Rate for Payer: PACE SWMI |
$10.64
|
| Rate for Payer: PHP Medicare Advantage |
$10.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.65
|
| Rate for Payer: Priority Health Medicare |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.64
|
| Rate for Payer: UHC Exchange |
$10.64
|
| Rate for Payer: UHC Medicare Advantage |
$10.64
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$303.41 |
| Rate for Payer: Aetna Commercial |
$282.34
|
| Rate for Payer: Aetna Medicare |
$219.13
|
| Rate for Payer: BCBS Complete |
$184.40
|
| Rate for Payer: BCBS MAPPO |
$210.70
|
| Rate for Payer: BCN Medicare Advantage |
$210.70
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$303.41
|
| Rate for Payer: Cofinity Commercial |
$282.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.24
|
| Rate for Payer: Nomi Health Commercial |
$252.84
|
| Rate for Payer: PACE SWMI |
$210.70
|
| Rate for Payer: PHP Medicare Advantage |
$210.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health Medicare |
$212.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.70
|
| Rate for Payer: UHC Exchange |
$210.70
|
| Rate for Payer: UHC Medicare Advantage |
$210.70
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$236.80 |
| Max. Negotiated Rate |
$384.80 |
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: BCBS Complete |
$236.80
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$236.80 |
| Max. Negotiated Rate |
$384.80 |
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: BCBS Complete |
$236.80
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
|
|
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 |
$416.27
|
| 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 |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.40
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| 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 |
$396.42
|
| 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 |
$396.42
|
| 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 |
$24.17 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: Aetna Medicare |
$25.14
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: BCBS MAPPO |
$24.17
|
| Rate for Payer: BCN Medicare Advantage |
$24.17
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.38
|
| 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 Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health Medicare |
$24.41
|
| 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
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$196.30 |
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
|
|
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 IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$196.30 |
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
|
|
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 |
$234.81
|
| 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 |
$86.83
|
| 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 |
$76.25
|
| 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
|
|
