|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 93978
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$199.98
|
| Rate for Payer: Aetna Commercial |
$199.98
|
| Rate for Payer: BCBS Complete |
$156.00
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Trust/PPO |
$430.56
|
| Rate for Payer: BCBS Trust/PPO |
$430.56
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$50.30
|
| Rate for Payer: Priority Health SBD |
$242.99
|
| Rate for Payer: Priority Health SBD |
$242.99
|
| Rate for Payer: UMR Bronson Commercial |
$179.40
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 93979
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$157.64 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS Trust/PPO |
$84.00
|
| Rate for Payer: BCBS Trust/PPO |
$84.00
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.54
|
| Rate for Payer: Priority Health SBD |
$157.64
|
| Rate for Payer: Priority Health SBD |
$157.64
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
| Rate for Payer: UMR Bronson Commercial |
$124.20
|
|
|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 93975
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$424.90 |
| Rate for Payer: Aetna Commercial |
$294.18
|
| Rate for Payer: Aetna Commercial |
$294.18
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$424.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.67
|
| Rate for Payer: Priority Health Narrow Network |
$73.67
|
| Rate for Payer: Priority Health Narrow Network |
$73.67
|
| Rate for Payer: Priority Health SBD |
$358.42
|
| Rate for Payer: Priority Health SBD |
$358.42
|
| Rate for Payer: UMR Bronson Commercial |
$279.22
|
| Rate for Payer: UMR Bronson Commercial |
$116.38
|
|
|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 93976
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$547.85 |
| Rate for Payer: Aetna Commercial |
$154.25
|
| Rate for Payer: Aetna Commercial |
$154.25
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$50.30
|
| Rate for Payer: Priority Health SBD |
$213.34
|
| Rate for Payer: Priority Health SBD |
$213.34
|
| Rate for Payer: UMR Bronson Commercial |
$81.42
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 93925
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$323.39 |
| Rate for Payer: Aetna Commercial |
$268.26
|
| Rate for Payer: Aetna Commercial |
$268.26
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.41
|
| Rate for Payer: Priority Health Narrow Network |
$49.41
|
| Rate for Payer: Priority Health Narrow Network |
$49.41
|
| Rate for Payer: Priority Health SBD |
$323.39
|
| Rate for Payer: Priority Health SBD |
$323.39
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93926
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$416.83 |
| Rate for Payer: Aetna Commercial |
$137.57
|
| Rate for Payer: Aetna Commercial |
$137.57
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.09
|
| Rate for Payer: Priority Health Narrow Network |
$30.09
|
| Rate for Payer: Priority Health Narrow Network |
$30.09
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 93930
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$278.60 |
| Rate for Payer: Aetna Commercial |
$218.52
|
| Rate for Payer: Aetna Commercial |
$218.52
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$50.30
|
| Rate for Payer: Priority Health SBD |
$263.65
|
| Rate for Payer: Priority Health SBD |
$263.65
|
| Rate for Payer: UMR Bronson Commercial |
$183.08
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 93931
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$166.18 |
| Rate for Payer: Aetna Commercial |
$136.50
|
| Rate for Payer: Aetna Commercial |
$136.50
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.54
|
| Rate for Payer: Priority Health SBD |
$166.18
|
| Rate for Payer: Priority Health SBD |
$166.18
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 93970
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$206.98
|
| Rate for Payer: Aetna Commercial |
$206.98
|
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.02
|
| Rate for Payer: Priority Health Narrow Network |
$44.02
|
| Rate for Payer: Priority Health SBD |
$253.76
|
| Rate for Payer: Priority Health SBD |
$253.76
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
| Rate for Payer: UMR Bronson Commercial |
$190.44
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 93971
|
| Min. Negotiated Rate |
$28.30 |
| Max. Negotiated Rate |
$191.80 |
| Rate for Payer: Aetna Commercial |
$130.22
|
| Rate for Payer: Aetna Commercial |
$130.22
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.30
|
| Rate for Payer: Priority Health Narrow Network |
$28.30
|
| Rate for Payer: Priority Health Narrow Network |
$28.30
|
| Rate for Payer: Priority Health SBD |
$160.80
|
| Rate for Payer: Priority Health SBD |
$160.80
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
|
|
PR DURAL GRAFT SPINAL
|
Professional
|
Both
|
$4,992.00
|
|
|
Service Code
|
HCPCS 63710
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$3,494.40 |
| Rate for Payer: Aetna Commercial |
$1,398.53
|
| Rate for Payer: BCBS Complete |
$736.03
|
| Rate for Payer: BCBS Trust/PPO |
$172.75
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Meridian Medicaid |
$736.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$700.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,494.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,841.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,841.36
|
| Rate for Payer: Priority Health SBD |
$1,841.36
|
| Rate for Payer: UMR Bronson Commercial |
$2,296.32
|
|
|
PR DYSPORT
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 00385
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
|
PR EAR MOLD/INSERT
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS V5264
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$57.45 |
| Rate for Payer: Aetna Commercial |
$57.45
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: UMR Bronson Commercial |
$32.20
|
|
|
PR EAR PIERCING
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 69090
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$248.83 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$248.83
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.85
|
| Rate for Payer: Priority Health Narrow Network |
$43.85
|
| Rate for Payer: Priority Health SBD |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$32.20
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 93010
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$2,320.82 |
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.82
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.34
|
| Rate for Payer: Priority Health Narrow Network |
$11.34
|
| Rate for Payer: Priority Health SBD |
$11.34
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 93005
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$1,832.67 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,832.67
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Narrow Network |
$8.99
|
| Rate for Payer: Priority Health SBD |
$8.99
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$19.23 |
| Max. Negotiated Rate |
$1,966.86 |
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,966.86
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.33
|
| Rate for Payer: Priority Health Narrow Network |
$20.33
|
| Rate for Payer: Priority Health SBD |
$20.33
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$1,750.26 |
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.26
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Cash Price |
$596.80
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.60
|
| Rate for Payer: Priority Health Narrow Network |
$15.60
|
| Rate for Payer: Priority Health SBD |
$15.60
|
| Rate for Payer: UMR Bronson Commercial |
$343.16
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$140.15 |
| Max. Negotiated Rate |
$1,372.52 |
| Rate for Payer: Aetna Commercial |
$304.22
|
| Rate for Payer: BCBS Complete |
$147.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.52
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Meridian Medicaid |
$147.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.68
|
| Rate for Payer: Priority Health Narrow Network |
$310.68
|
| Rate for Payer: Priority Health SBD |
$310.68
|
| Rate for Payer: UMR Bronson Commercial |
$207.92
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$174.96 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: BCBS Complete |
$232.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.96
|
| Rate for Payer: Priority Health Narrow Network |
$174.96
|
| Rate for Payer: Priority Health SBD |
$350.39
|
| Rate for Payer: UMR Bronson Commercial |
$266.80
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$255.20 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna American Axle |
$377.00
|
| Rate for Payer: Aetna Commercial |
$493.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$406.00
|
| Rate for Payer: Cofinity Commercial |
$498.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.00
|
| Rate for Payer: Healthscope Commercial |
$522.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$406.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.00
|
| Rate for Payer: PHP Commercial |
$493.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health SBD |
$365.40
|
| Rate for Payer: UMR Bronson Commercial |
$255.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.00
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$174.96 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: BCBS Complete |
$232.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.96
|
| Rate for Payer: Priority Health Narrow Network |
$174.96
|
| Rate for Payer: Priority Health SBD |
$350.39
|
| Rate for Payer: UMR Bronson Commercial |
$266.80
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$1,595.78 |
| Rate for Payer: Aetna American Axle |
$377.00
|
| Rate for Payer: Aetna Commercial |
$493.00
|
| Rate for Payer: Aetna Medicare |
$509.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,595.78
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$406.00
|
| Rate for Payer: Cofinity Commercial |
$498.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$522.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$406.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.00
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.00
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$493.00
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.71
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.97
|
| Rate for Payer: Priority Health SBD |
$365.40
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.37
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: UMR Bronson Commercial |
$214.60
|
| Rate for Payer: VA VA |
$490.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.00
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$1,443.32 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.32
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.47
|
| Rate for Payer: Priority Health Narrow Network |
$35.47
|
| Rate for Payer: Priority Health SBD |
$35.47
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna American Axle |
$74.10
|
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health SBD |
$71.82
|
| Rate for Payer: UMR Bronson Commercial |
$50.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
