|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 93975
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$422.59 |
| Rate for Payer: Aetna Commercial |
$322.75
|
| Rate for Payer: Aetna Commercial |
$322.75
|
| Rate for Payer: Aetna Medicare |
$240.86
|
| Rate for Payer: Aetna Medicare |
$240.86
|
| Rate for Payer: BCBS MAPPO |
$240.86
|
| Rate for Payer: BCBS MAPPO |
$240.86
|
| Rate for Payer: BCN Commercial |
$388.92
|
| Rate for Payer: BCN Commercial |
$388.92
|
| Rate for Payer: BCN Medicare Advantage |
$240.86
|
| Rate for Payer: BCN Medicare Advantage |
$240.86
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$322.75
|
| Rate for Payer: Cofinity Commercial |
$346.84
|
| Rate for Payer: Cofinity Commercial |
$322.75
|
| Rate for Payer: Cofinity Commercial |
$346.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.86
|
| Rate for Payer: Healthscope Commercial |
$289.03
|
| Rate for Payer: Healthscope Commercial |
$289.03
|
| Rate for Payer: Healthscope Whirlpool |
$289.03
|
| Rate for Payer: Healthscope Whirlpool |
$289.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$264.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$264.95
|
| Rate for Payer: Nomi Health Commercial |
$289.03
|
| Rate for Payer: Nomi Health Commercial |
$289.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$478.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.50
|
| Rate for Payer: PACE SWMI |
$240.86
|
| Rate for Payer: PACE SWMI |
$240.86
|
| Rate for Payer: PHP Medicare Advantage |
$240.86
|
| Rate for Payer: PHP Medicare Advantage |
$240.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$358.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$358.68
|
| Rate for Payer: Priority Health Medicare |
$240.86
|
| Rate for Payer: Priority Health Medicare |
$240.86
|
| Rate for Payer: Priority Health Narrow Network |
$358.68
|
| Rate for Payer: Priority Health Narrow Network |
$358.68
|
| Rate for Payer: Railroad Medicare Medicare |
$240.86
|
| Rate for Payer: Railroad Medicare Medicare |
$240.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$422.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$422.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$240.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$240.86
|
| Rate for Payer: UHC Exchange |
$422.59
|
| Rate for Payer: UHC Exchange |
$422.59
|
| Rate for Payer: UHCCP DNSP |
$240.86
|
| Rate for Payer: UHCCP DNSP |
$240.86
|
|
|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 93976
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna Commercial |
$194.54
|
| Rate for Payer: Aetna Commercial |
$194.54
|
| Rate for Payer: Aetna Medicare |
$145.18
|
| Rate for Payer: Aetna Medicare |
$145.18
|
| Rate for Payer: BCBS MAPPO |
$145.18
|
| Rate for Payer: BCBS MAPPO |
$145.18
|
| Rate for Payer: BCN Commercial |
$235.55
|
| Rate for Payer: BCN Commercial |
$235.55
|
| Rate for Payer: BCN Medicare Advantage |
$145.18
|
| Rate for Payer: BCN Medicare Advantage |
$145.18
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$529.60
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$529.60
|
| Rate for Payer: Cofinity Commercial |
$194.54
|
| Rate for Payer: Cofinity Commercial |
$209.06
|
| Rate for Payer: Cofinity Commercial |
$194.54
|
| Rate for Payer: Cofinity Commercial |
$209.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.18
|
| Rate for Payer: Healthscope Commercial |
$174.22
|
| Rate for Payer: Healthscope Commercial |
$174.22
|
| Rate for Payer: Healthscope Whirlpool |
$174.22
|
| Rate for Payer: Healthscope Whirlpool |
$174.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.70
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: PACE SWMI |
$145.18
|
| Rate for Payer: PACE SWMI |
$145.18
|
| Rate for Payer: PHP Medicare Advantage |
$145.18
|
| Rate for Payer: PHP Medicare Advantage |
$145.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.22
|
| Rate for Payer: Priority Health Medicare |
$145.18
|
| Rate for Payer: Priority Health Medicare |
$145.18
|
| Rate for Payer: Priority Health Narrow Network |
$217.22
|
| Rate for Payer: Priority Health Narrow Network |
$217.22
|
| Rate for Payer: Railroad Medicare Medicare |
$145.18
|
| Rate for Payer: Railroad Medicare Medicare |
$145.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.18
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHCCP DNSP |
$145.18
|
| Rate for Payer: UHCCP DNSP |
$145.18
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 93925
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$385.58 |
| Rate for Payer: Aetna Commercial |
$294.64
|
| Rate for Payer: Aetna Commercial |
$294.64
|
| Rate for Payer: Aetna Medicare |
$219.88
|
| Rate for Payer: Aetna Medicare |
$219.88
|
| Rate for Payer: BCBS MAPPO |
$219.88
|
| Rate for Payer: BCBS MAPPO |
$219.88
|
| Rate for Payer: BCN Commercial |
$352.57
|
| Rate for Payer: BCN Commercial |
$352.57
|
| Rate for Payer: BCN Medicare Advantage |
$219.88
|
| Rate for Payer: BCN Medicare Advantage |
$219.88
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$294.64
|
| Rate for Payer: Cofinity Commercial |
$316.63
|
| Rate for Payer: Cofinity Commercial |
$294.64
|
| Rate for Payer: Cofinity Commercial |
$316.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$263.86
|
| Rate for Payer: Healthscope Commercial |
$263.86
|
| Rate for Payer: Healthscope Whirlpool |
$263.86
|
| Rate for Payer: Healthscope Whirlpool |
$263.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$241.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$241.87
|
| Rate for Payer: Nomi Health Commercial |
$263.86
|
| Rate for Payer: Nomi Health Commercial |
$263.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PACE SWMI |
$219.88
|
| Rate for Payer: PACE SWMI |
$219.88
|
| Rate for Payer: PHP Medicare Advantage |
$219.88
|
| Rate for Payer: PHP Medicare Advantage |
$219.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$325.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$325.14
|
| Rate for Payer: Priority Health Medicare |
$219.88
|
| Rate for Payer: Priority Health Medicare |
$219.88
|
| Rate for Payer: Priority Health Narrow Network |
$325.14
|
| Rate for Payer: Priority Health Narrow Network |
$325.14
|
| Rate for Payer: Railroad Medicare Medicare |
$219.88
|
| Rate for Payer: Railroad Medicare Medicare |
$219.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$219.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$219.88
|
| Rate for Payer: UHC Exchange |
$385.58
|
| Rate for Payer: UHC Exchange |
$385.58
|
| Rate for Payer: UHCCP DNSP |
$219.88
|
| Rate for Payer: UHCCP DNSP |
$219.88
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 93926
|
| Min. Negotiated Rate |
$129.78 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna Commercial |
$173.91
|
| Rate for Payer: Aetna Commercial |
$173.91
|
| Rate for Payer: Aetna Medicare |
$129.78
|
| Rate for Payer: Aetna Medicare |
$129.78
|
| Rate for Payer: BCBS MAPPO |
$129.78
|
| Rate for Payer: BCBS MAPPO |
$129.78
|
| Rate for Payer: BCN Commercial |
$211.65
|
| Rate for Payer: BCN Commercial |
$211.65
|
| Rate for Payer: BCN Medicare Advantage |
$129.78
|
| Rate for Payer: BCN Medicare Advantage |
$129.78
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$173.91
|
| Rate for Payer: Cofinity Commercial |
$186.88
|
| Rate for Payer: Cofinity Commercial |
$173.91
|
| Rate for Payer: Cofinity Commercial |
$186.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.78
|
| Rate for Payer: Healthscope Commercial |
$155.74
|
| Rate for Payer: Healthscope Commercial |
$155.74
|
| Rate for Payer: Healthscope Whirlpool |
$155.74
|
| Rate for Payer: Healthscope Whirlpool |
$155.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.76
|
| Rate for Payer: Nomi Health Commercial |
$155.74
|
| Rate for Payer: Nomi Health Commercial |
$155.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.00
|
| Rate for Payer: PACE SWMI |
$129.78
|
| Rate for Payer: PACE SWMI |
$129.78
|
| Rate for Payer: PHP Medicare Advantage |
$129.78
|
| Rate for Payer: PHP Medicare Advantage |
$129.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$195.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$195.18
|
| Rate for Payer: Priority Health Medicare |
$129.78
|
| Rate for Payer: Priority Health Medicare |
$129.78
|
| Rate for Payer: Priority Health Narrow Network |
$195.18
|
| Rate for Payer: Priority Health Narrow Network |
$195.18
|
| Rate for Payer: Railroad Medicare Medicare |
$129.78
|
| Rate for Payer: Railroad Medicare Medicare |
$129.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.78
|
| Rate for Payer: UHC Exchange |
$228.23
|
| Rate for Payer: UHC Exchange |
$228.23
|
| Rate for Payer: UHCCP DNSP |
$129.78
|
| Rate for Payer: UHCCP DNSP |
$129.78
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 93930
|
| Min. Negotiated Rate |
$184.43 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$247.14
|
| Rate for Payer: Aetna Commercial |
$247.14
|
| Rate for Payer: Aetna Medicare |
$184.43
|
| Rate for Payer: Aetna Medicare |
$184.43
|
| Rate for Payer: BCBS MAPPO |
$184.43
|
| Rate for Payer: BCBS MAPPO |
$184.43
|
| Rate for Payer: BCN Commercial |
$293.81
|
| Rate for Payer: BCN Commercial |
$293.81
|
| Rate for Payer: BCN Medicare Advantage |
$184.43
|
| Rate for Payer: BCN Medicare Advantage |
$184.43
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$247.14
|
| Rate for Payer: Cofinity Commercial |
$265.58
|
| Rate for Payer: Cofinity Commercial |
$247.14
|
| Rate for Payer: Cofinity Commercial |
$265.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.43
|
| Rate for Payer: Healthscope Commercial |
$221.32
|
| Rate for Payer: Healthscope Commercial |
$221.32
|
| Rate for Payer: Healthscope Whirlpool |
$221.32
|
| Rate for Payer: Healthscope Whirlpool |
$221.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.87
|
| Rate for Payer: Nomi Health Commercial |
$221.32
|
| Rate for Payer: Nomi Health Commercial |
$221.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.50
|
| Rate for Payer: PACE SWMI |
$184.43
|
| Rate for Payer: PACE SWMI |
$184.43
|
| Rate for Payer: PHP Medicare Advantage |
$184.43
|
| Rate for Payer: PHP Medicare Advantage |
$184.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$270.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$270.95
|
| Rate for Payer: Priority Health Medicare |
$184.43
|
| Rate for Payer: Priority Health Medicare |
$184.43
|
| Rate for Payer: Priority Health Narrow Network |
$270.95
|
| Rate for Payer: Priority Health Narrow Network |
$270.95
|
| Rate for Payer: Railroad Medicare Medicare |
$184.43
|
| Rate for Payer: Railroad Medicare Medicare |
$184.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.43
|
| Rate for Payer: UHC Exchange |
$314.45
|
| Rate for Payer: UHC Exchange |
$314.45
|
| Rate for Payer: UHCCP DNSP |
$184.43
|
| Rate for Payer: UHCCP DNSP |
$184.43
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 93931
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$150.51
|
| Rate for Payer: Aetna Commercial |
$150.51
|
| Rate for Payer: Aetna Medicare |
$112.32
|
| Rate for Payer: Aetna Medicare |
$112.32
|
| Rate for Payer: BCBS MAPPO |
$112.32
|
| Rate for Payer: BCBS MAPPO |
$112.32
|
| Rate for Payer: BCN Commercial |
$182.26
|
| Rate for Payer: BCN Commercial |
$182.26
|
| Rate for Payer: BCN Medicare Advantage |
$112.32
|
| Rate for Payer: BCN Medicare Advantage |
$112.32
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$150.51
|
| Rate for Payer: Cofinity Commercial |
$161.74
|
| Rate for Payer: Cofinity Commercial |
$150.51
|
| Rate for Payer: Cofinity Commercial |
$161.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.32
|
| Rate for Payer: Healthscope Commercial |
$134.78
|
| Rate for Payer: Healthscope Commercial |
$134.78
|
| Rate for Payer: Healthscope Whirlpool |
$134.78
|
| Rate for Payer: Healthscope Whirlpool |
$134.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.55
|
| Rate for Payer: Nomi Health Commercial |
$134.78
|
| Rate for Payer: Nomi Health Commercial |
$134.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.00
|
| Rate for Payer: PACE SWMI |
$112.32
|
| Rate for Payer: PACE SWMI |
$112.32
|
| Rate for Payer: PHP Medicare Advantage |
$112.32
|
| Rate for Payer: PHP Medicare Advantage |
$112.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.09
|
| Rate for Payer: Priority Health Medicare |
$112.32
|
| Rate for Payer: Priority Health Medicare |
$112.32
|
| Rate for Payer: Priority Health Narrow Network |
$168.09
|
| Rate for Payer: Priority Health Narrow Network |
$168.09
|
| Rate for Payer: Railroad Medicare Medicare |
$112.32
|
| Rate for Payer: Railroad Medicare Medicare |
$112.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$112.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$112.32
|
| Rate for Payer: UHC Exchange |
$196.34
|
| Rate for Payer: UHC Exchange |
$196.34
|
| Rate for Payer: UHCCP DNSP |
$112.32
|
| Rate for Payer: UHCCP DNSP |
$112.32
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 93970
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$296.79 |
| Rate for Payer: Aetna Commercial |
$228.67
|
| Rate for Payer: Aetna Commercial |
$228.67
|
| Rate for Payer: Aetna Medicare |
$170.65
|
| Rate for Payer: Aetna Medicare |
$170.65
|
| Rate for Payer: BCBS MAPPO |
$170.65
|
| Rate for Payer: BCBS MAPPO |
$170.65
|
| Rate for Payer: BCN Commercial |
$275.39
|
| Rate for Payer: BCN Commercial |
$275.39
|
| Rate for Payer: BCN Medicare Advantage |
$170.65
|
| Rate for Payer: BCN Medicare Advantage |
$170.65
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cofinity Commercial |
$228.67
|
| Rate for Payer: Cofinity Commercial |
$245.74
|
| Rate for Payer: Cofinity Commercial |
$228.67
|
| Rate for Payer: Cofinity Commercial |
$245.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.65
|
| Rate for Payer: Healthscope Commercial |
$204.78
|
| Rate for Payer: Healthscope Commercial |
$204.78
|
| Rate for Payer: Healthscope Whirlpool |
$204.78
|
| Rate for Payer: Healthscope Whirlpool |
$204.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.72
|
| Rate for Payer: Nomi Health Commercial |
$204.78
|
| Rate for Payer: Nomi Health Commercial |
$204.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.75
|
| Rate for Payer: PACE SWMI |
$170.65
|
| Rate for Payer: PACE SWMI |
$170.65
|
| Rate for Payer: PHP Medicare Advantage |
$170.65
|
| Rate for Payer: PHP Medicare Advantage |
$170.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.97
|
| Rate for Payer: Priority Health Medicare |
$170.65
|
| Rate for Payer: Priority Health Medicare |
$170.65
|
| Rate for Payer: Priority Health Narrow Network |
$253.97
|
| Rate for Payer: Priority Health Narrow Network |
$253.97
|
| Rate for Payer: Railroad Medicare Medicare |
$170.65
|
| Rate for Payer: Railroad Medicare Medicare |
$170.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$170.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$170.65
|
| Rate for Payer: UHC Exchange |
$296.79
|
| Rate for Payer: UHC Exchange |
$296.79
|
| Rate for Payer: UHCCP DNSP |
$170.65
|
| Rate for Payer: UHCCP DNSP |
$170.65
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 93971
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Medicare |
$107.76
|
| Rate for Payer: Aetna Medicare |
$107.76
|
| Rate for Payer: BCBS MAPPO |
$107.76
|
| Rate for Payer: BCBS MAPPO |
$107.76
|
| Rate for Payer: BCN Commercial |
$176.28
|
| Rate for Payer: BCN Commercial |
$176.28
|
| Rate for Payer: BCN Medicare Advantage |
$107.76
|
| Rate for Payer: BCN Medicare Advantage |
$107.76
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$144.40
|
| Rate for Payer: Cofinity Commercial |
$155.17
|
| Rate for Payer: Cofinity Commercial |
$144.40
|
| Rate for Payer: Cofinity Commercial |
$155.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.76
|
| Rate for Payer: Healthscope Commercial |
$129.31
|
| Rate for Payer: Healthscope Commercial |
$129.31
|
| Rate for Payer: Healthscope Whirlpool |
$129.31
|
| Rate for Payer: Healthscope Whirlpool |
$129.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.54
|
| Rate for Payer: Nomi Health Commercial |
$129.31
|
| Rate for Payer: Nomi Health Commercial |
$129.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.25
|
| Rate for Payer: PACE SWMI |
$107.76
|
| Rate for Payer: PACE SWMI |
$107.76
|
| Rate for Payer: PHP Medicare Advantage |
$107.76
|
| Rate for Payer: PHP Medicare Advantage |
$107.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.58
|
| Rate for Payer: Priority Health Medicare |
$107.76
|
| Rate for Payer: Priority Health Medicare |
$107.76
|
| Rate for Payer: Priority Health Narrow Network |
$162.58
|
| Rate for Payer: Priority Health Narrow Network |
$162.58
|
| Rate for Payer: Railroad Medicare Medicare |
$107.76
|
| Rate for Payer: Railroad Medicare Medicare |
$107.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$107.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$107.76
|
| Rate for Payer: UHC Exchange |
$185.31
|
| Rate for Payer: UHC Exchange |
$185.31
|
| Rate for Payer: UHCCP DNSP |
$107.76
|
| Rate for Payer: UHCCP DNSP |
$107.76
|
|
|
PR DURAL GRAFT SPINAL
|
Professional
|
Both
|
$5,245.00
|
|
|
Service Code
|
HCPCS 63710
|
| Min. Negotiated Rate |
$666.90 |
| Max. Negotiated Rate |
$3,933.75 |
| Rate for Payer: Aetna Commercial |
$1,382.97
|
| Rate for Payer: Aetna Medicare |
$1,032.07
|
| Rate for Payer: BCBS Complete |
$700.25
|
| Rate for Payer: BCBS MAPPO |
$1,032.07
|
| Rate for Payer: BCN Commercial |
$1,815.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,032.07
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Cofinity Commercial |
$1,486.18
|
| Rate for Payer: Cofinity Commercial |
$1,382.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,032.07
|
| Rate for Payer: Healthscope Commercial |
$1,238.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,238.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,083.67
|
| Rate for Payer: Meridian Medicaid |
$700.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,135.28
|
| Rate for Payer: Nomi Health Commercial |
$1,238.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,933.75
|
| Rate for Payer: PACE SWMI |
$1,032.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,032.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,919.69
|
| Rate for Payer: Priority Health Medicare |
$1,032.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,919.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,032.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,909.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,032.07
|
| Rate for Payer: UHC Exchange |
$1,909.23
|
| Rate for Payer: UHC Medicaid |
$666.90
|
| Rate for Payer: UHCCP DNSP |
$1,032.07
|
| Rate for Payer: UHCCP Medicaid |
$666.90
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR 1ST 60
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92622
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$52.80
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$52.80
|
| Rate for Payer: BCN Commercial |
$98.60
|
| Rate for Payer: BCN Medicare Advantage |
$52.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$76.03
|
| Rate for Payer: Cofinity Commercial |
$70.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$63.36
|
| Rate for Payer: Healthscope Whirlpool |
$63.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.44
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.08
|
| Rate for Payer: Nomi Health Commercial |
$63.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.25
|
| Rate for Payer: PACE SWMI |
$52.80
|
| Rate for Payer: PHP Medicare Advantage |
$52.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$90.94
|
| Rate for Payer: Priority Health Medicare |
$52.80
|
| Rate for Payer: Priority Health Narrow Network |
$90.94
|
| Rate for Payer: Railroad Medicare Medicare |
$52.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.80
|
| Rate for Payer: UHC Exchange |
$110.53
|
| Rate for Payer: UHC Medicaid |
$34.29
|
| Rate for Payer: UHCCP DNSP |
$52.80
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR EA ADL
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 92623
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Healthscope Whirlpool |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.15
|
| Rate for Payer: Nomi Health Commercial |
$16.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.88
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: Priority Health Narrow Network |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$13.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.77
|
| Rate for Payer: UHC Exchange |
$29.32
|
| Rate for Payer: UHC Medicaid |
$8.95
|
| Rate for Payer: UHCCP DNSP |
$13.77
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
|
|
PR DYSPORT
|
Professional
|
Both
|
$12.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
|
|
PR EAR MOLD/INSERT
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS V5264
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$57.45
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
|
|
PR EAR PIERCING
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 69090
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.27
|
| Rate for Payer: Priority Health Narrow Network |
$45.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.28
|
| Rate for Payer: UHC Exchange |
$53.28
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$20,178.18
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$11,714.37 |
| Max. Negotiated Rate |
$20,178.18 |
| Rate for Payer: Aetna Medicare |
$12,330.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,413.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,413.65
|
| Rate for Payer: BCBS MAPPO |
$12,330.92
|
| Rate for Payer: BCN Medicare Advantage |
$12,330.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,330.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,330.92
|
| Rate for Payer: Mclaren Medicare |
$12,330.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,947.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,180.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,564.01
|
| Rate for Payer: PACE Medicare |
$11,714.37
|
| Rate for Payer: PACE SWMI |
$12,330.92
|
| Rate for Payer: PHP Commercial |
$13,564.01
|
| Rate for Payer: PHP Medicare Advantage |
$12,330.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,178.18
|
| Rate for Payer: Priority Health Medicare |
$12,330.92
|
| Rate for Payer: Priority Health Narrow Network |
$16,142.54
|
| Rate for Payer: Railroad Medicare Medicare |
$12,330.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,330.92
|
| Rate for Payer: UHC Exchange |
$19,112.93
|
| Rate for Payer: UHCCP DNSP |
$12,330.92
|
| Rate for Payer: VA VA |
$12,330.92
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$12,367.78
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$7,580.25 |
| Max. Negotiated Rate |
$12,367.78 |
| Rate for Payer: Aetna Medicare |
$7,979.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,974.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,974.01
|
| Rate for Payer: BCBS MAPPO |
$7,979.21
|
| Rate for Payer: BCN Medicare Advantage |
$7,979.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,979.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,979.21
|
| Rate for Payer: Mclaren Medicare |
$7,979.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,378.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,176.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,777.13
|
| Rate for Payer: PACE Medicare |
$7,580.25
|
| Rate for Payer: PACE SWMI |
$7,979.21
|
| Rate for Payer: PHP Commercial |
$8,777.13
|
| Rate for Payer: PHP Medicare Advantage |
$7,979.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,875.82
|
| Rate for Payer: Priority Health Medicare |
$7,979.21
|
| Rate for Payer: Priority Health Narrow Network |
$9,500.65
|
| Rate for Payer: Railroad Medicare Medicare |
$7,979.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,979.21
|
| Rate for Payer: UHC Exchange |
$12,367.78
|
| Rate for Payer: UHCCP DNSP |
$7,979.21
|
| Rate for Payer: VA VA |
$7,979.21
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 93010
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$9.83
|
| Rate for Payer: Healthscope Whirlpool |
$9.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.01
|
| Rate for Payer: Nomi Health Commercial |
$9.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$11.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.19
|
| Rate for Payer: UHC Exchange |
$13.65
|
| Rate for Payer: UHC Medicaid |
$5.33
|
| Rate for Payer: UHCCP DNSP |
$8.19
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 93005
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$8.68
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCN Commercial |
$7.46
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$8.68
|
| Rate for Payer: Cofinity Commercial |
$9.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$7.78
|
| Rate for Payer: Healthscope Whirlpool |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.13
|
| Rate for Payer: Nomi Health Commercial |
$7.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.00
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow Network |
$9.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.48
|
| Rate for Payer: UHC Exchange |
$12.82
|
| Rate for Payer: UHCCP DNSP |
$6.48
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Medicare |
$14.67
|
| Rate for Payer: BCBS MAPPO |
$14.67
|
| Rate for Payer: BCN Commercial |
$16.89
|
| Rate for Payer: BCN Medicare Advantage |
$14.67
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Healthscope Whirlpool |
$17.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.14
|
| Rate for Payer: Nomi Health Commercial |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PACE SWMI |
$14.67
|
| Rate for Payer: PHP Medicare Advantage |
$14.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.35
|
| Rate for Payer: Priority Health Medicare |
$14.67
|
| Rate for Payer: Priority Health Narrow Network |
$20.35
|
| Rate for Payer: Railroad Medicare Medicare |
$14.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.67
|
| Rate for Payer: UHC Exchange |
$26.45
|
| Rate for Payer: UHCCP DNSP |
$14.67
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS G6001
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$295.50 |
| Rate for Payer: Aetna Commercial |
$173.52
|
| Rate for Payer: BCBS Complete |
$157.60
|
| Rate for Payer: BCN Commercial |
$264.43
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.50
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCN Commercial |
$16.44
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Whirlpool |
$12.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.35
|
| Rate for Payer: Nomi Health Commercial |
$12.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.00
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.61
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health Narrow Network |
$15.61
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.32
|
| Rate for Payer: UHC Exchange |
$18.93
|
| Rate for Payer: UHC Medicaid |
$6.60
|
| Rate for Payer: UHCCP DNSP |
$10.32
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$374.41 |
| Rate for Payer: Aetna Commercial |
$255.93
|
| Rate for Payer: Aetna Medicare |
$190.99
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$190.99
|
| Rate for Payer: BCN Commercial |
$328.67
|
| Rate for Payer: BCN Medicare Advantage |
$190.99
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$275.03
|
| Rate for Payer: Cofinity Commercial |
$255.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.99
|
| Rate for Payer: Healthscope Commercial |
$229.19
|
| Rate for Payer: Healthscope Whirlpool |
$229.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.54
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$210.09
|
| Rate for Payer: Nomi Health Commercial |
$229.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.25
|
| Rate for Payer: PACE SWMI |
$190.99
|
| Rate for Payer: PHP Medicare Advantage |
$190.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$312.39
|
| Rate for Payer: Priority Health Medicare |
$190.99
|
| Rate for Payer: Priority Health Narrow Network |
$312.39
|
| Rate for Payer: Railroad Medicare Medicare |
$190.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$190.99
|
| Rate for Payer: UHC Exchange |
$374.41
|
| Rate for Payer: UHC Medicaid |
$122.48
|
| Rate for Payer: UHCCP DNSP |
$190.99
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$183.27 |
| Max. Negotiated Rate |
$918.12 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: BCN Commercial |
$183.27
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$348.35
|
| Rate for Payer: Priority Health Narrow Network |
$348.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$918.12
|
| Rate for Payer: UHC Exchange |
$918.12
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$32.62
|
| Rate for Payer: Aetna Medicare |
$24.34
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$24.34
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$24.34
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$32.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$29.21
|
| Rate for Payer: Healthscope Whirlpool |
$29.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.56
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$29.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: PACE SWMI |
$24.34
|
| Rate for Payer: PHP Medicare Advantage |
$24.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$24.34
|
| Rate for Payer: Priority Health Narrow Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.34
|
| Rate for Payer: UHC Exchange |
$44.68
|
| Rate for Payer: UHC Medicaid |
$15.55
|
| Rate for Payer: UHCCP DNSP |
$24.34
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$233.25 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna Commercial |
$279.90
|
| Rate for Payer: ASR ASR |
$301.67
|
| Rate for Payer: BCBS Trust/PPO |
$255.39
|
| Rate for Payer: BCN Commercial |
$255.39
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$292.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.80
|
| Rate for Payer: Healthscope Commercial |
$301.67
|
| Rate for Payer: Healthscope Whirlpool |
$311.00
|
| Rate for Payer: Mclaren Commercial |
$279.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.35
|
| Rate for Payer: Nomi Health Commercial |
$255.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.68
|
|
