|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial |
$75.33
|
| Rate for Payer: Aetna Medicare |
$56.22
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: BCBS MAPPO |
$56.22
|
| Rate for Payer: BCN Medicare Advantage |
$56.22
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$80.96
|
| Rate for Payer: Cofinity Commercial |
$75.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.22
|
| Rate for Payer: Healthscope Commercial |
$67.46
|
| Rate for Payer: Healthscope Whirlpool |
$67.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.03
|
| Rate for Payer: Nomi Health Commercial |
$67.46
|
| Rate for Payer: PACE SWMI |
$56.22
|
| Rate for Payer: PHP Medicare Advantage |
$56.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health Medicare |
$56.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.22
|
| Rate for Payer: UHC Medicare Advantage |
$56.22
|
| Rate for Payer: UHCCP DNSP |
$56.22
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$182.13 |
| Max. Negotiated Rate |
$404.30 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$182.13
|
| Rate for Payer: BCBS Complete |
$248.80
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Healthscope Commercial |
$218.56
|
| Rate for Payer: Healthscope Whirlpool |
$218.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health Medicare |
$182.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
| Rate for Payer: UHCCP DNSP |
$182.13
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,951.97 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| Rate for Payer: Aetna Medicare |
$1,904.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: ASR ASR |
$603.34
|
| Rate for Payer: ASR Commercial |
$603.34
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCBS Trust/PPO |
$509.36
|
| Rate for Payer: BCN Commercial |
$482.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$584.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$622.00
|
| Rate for Payer: Healthscope Whirlpool |
$603.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,904.50
|
| Rate for Payer: Mclaren Commercial |
$559.80
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$510.04
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,094.95
|
| Rate for Payer: PHP Medicaid |
$1,020.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.00
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health Narrow Network |
$436.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$2,951.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP DNSP |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$182.13 |
| Max. Negotiated Rate |
$404.30 |
| Rate for Payer: Aetna Commercial |
$244.05
|
| Rate for Payer: Aetna Medicare |
$182.13
|
| Rate for Payer: BCBS Complete |
$248.80
|
| Rate for Payer: BCBS MAPPO |
$182.13
|
| Rate for Payer: BCN Medicare Advantage |
$182.13
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$262.27
|
| Rate for Payer: Cofinity Commercial |
$244.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.13
|
| Rate for Payer: Healthscope Commercial |
$218.56
|
| Rate for Payer: Healthscope Whirlpool |
$218.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.24
|
| Rate for Payer: Nomi Health Commercial |
$218.56
|
| Rate for Payer: PACE SWMI |
$182.13
|
| Rate for Payer: PHP Medicare Advantage |
$182.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: Priority Health Medicare |
$182.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.13
|
| Rate for Payer: UHC Medicare Advantage |
$182.13
|
| Rate for Payer: UHCCP DNSP |
$182.13
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
64633
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$622.00 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| Rate for Payer: ASR ASR |
$603.34
|
| Rate for Payer: ASR Commercial |
$603.34
|
| Rate for Payer: BCBS Trust/PPO |
$506.87
|
| Rate for Payer: BCN Commercial |
$482.24
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$584.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Healthscope Commercial |
$622.00
|
| Rate for Payer: Healthscope Whirlpool |
$603.34
|
| Rate for Payer: Mclaren Commercial |
$559.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.70
|
| Rate for Payer: Nomi Health Commercial |
$510.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.36
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$182.04
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Healthscope Commercial |
$218.45
|
| Rate for Payer: Healthscope Whirlpool |
$218.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
| Rate for Payer: UHCCP DNSP |
$182.04
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$182.04
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Healthscope Commercial |
$218.45
|
| Rate for Payer: Healthscope Whirlpool |
$218.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
| Rate for Payer: UHCCP DNSP |
$182.04
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: ASR ASR |
$596.55
|
| Rate for Payer: ASR Commercial |
$596.55
|
| Rate for Payer: BCBS Trust/PPO |
$501.16
|
| Rate for Payer: BCN Commercial |
$476.81
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$578.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Healthscope Commercial |
$615.00
|
| Rate for Payer: Healthscope Whirlpool |
$596.55
|
| Rate for Payer: Mclaren Commercial |
$553.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.20
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
64635
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,951.97 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Medicare |
$1,904.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: ASR ASR |
$596.55
|
| Rate for Payer: ASR Commercial |
$596.55
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCBS Trust/PPO |
$503.62
|
| Rate for Payer: BCN Commercial |
$476.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$578.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$615.00
|
| Rate for Payer: Healthscope Whirlpool |
$596.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,904.50
|
| Rate for Payer: Mclaren Commercial |
$553.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.75
|
| Rate for Payer: Nomi Health Commercial |
$504.30
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,094.95
|
| Rate for Payer: PHP Medicaid |
$1,020.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.86
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health Narrow Network |
$431.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$2,951.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP DNSP |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$71.50 |
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
|
|
PR DTP/HIB VACCINE,IM
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 90720
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90702
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$63.50
|
| Rate for Payer: Aetna Medicare |
$47.39
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$47.39
|
| Rate for Payer: BCN Medicare Advantage |
$47.39
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$63.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.39
|
| Rate for Payer: Healthscope Commercial |
$56.87
|
| Rate for Payer: Healthscope Whirlpool |
$56.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.76
|
| Rate for Payer: Nomi Health Commercial |
$56.87
|
| Rate for Payer: PACE SWMI |
$47.39
|
| Rate for Payer: PHP Medicare Advantage |
$47.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health Medicare |
$47.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.39
|
| Rate for Payer: UHC Medicare Advantage |
$47.39
|
| Rate for Payer: UHCCP DNSP |
$47.39
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$810.42 |
| Max. Negotiated Rate |
$1,908.40 |
| Rate for Payer: Aetna Commercial |
$1,085.96
|
| Rate for Payer: Aetna Medicare |
$810.42
|
| Rate for Payer: BCBS Complete |
$1,174.40
|
| Rate for Payer: BCBS MAPPO |
$810.42
|
| Rate for Payer: BCN Medicare Advantage |
$810.42
|
| Rate for Payer: Cash Price |
$2,348.80
|
| Rate for Payer: Cash Price |
$2,348.80
|
| Rate for Payer: Cofinity Commercial |
$1,167.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.42
|
| Rate for Payer: Healthscope Commercial |
$972.50
|
| Rate for Payer: Healthscope Whirlpool |
$972.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$850.94
|
| Rate for Payer: Nomi Health Commercial |
$972.50
|
| Rate for Payer: PACE SWMI |
$810.42
|
| Rate for Payer: PHP Medicare Advantage |
$810.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.40
|
| Rate for Payer: Priority Health Medicare |
$810.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.42
|
| Rate for Payer: UHC Medicare Advantage |
$810.42
|
| Rate for Payer: UHCCP DNSP |
$810.42
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$6,281.00
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$1,742.24 |
| Max. Negotiated Rate |
$4,082.65 |
| Rate for Payer: Aetna Commercial |
$2,334.60
|
| Rate for Payer: Aetna Medicare |
$1,742.24
|
| Rate for Payer: BCBS Complete |
$2,512.40
|
| Rate for Payer: BCBS MAPPO |
$1,742.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,742.24
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cofinity Commercial |
$2,508.83
|
| Rate for Payer: Cofinity Commercial |
$2,334.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,742.24
|
| Rate for Payer: Healthscope Commercial |
$2,090.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,090.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,829.35
|
| Rate for Payer: Nomi Health Commercial |
$2,090.69
|
| Rate for Payer: PACE SWMI |
$1,742.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,742.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,082.65
|
| Rate for Payer: Priority Health Medicare |
$1,742.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,742.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.24
|
| Rate for Payer: UHCCP DNSP |
$1,742.24
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 93985
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$318.56 |
| Rate for Payer: Aetna Commercial |
$296.43
|
| Rate for Payer: Aetna Medicare |
$221.22
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$221.22
|
| Rate for Payer: BCN Medicare Advantage |
$221.22
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$318.56
|
| Rate for Payer: Cofinity Commercial |
$296.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.22
|
| Rate for Payer: Healthscope Commercial |
$265.46
|
| Rate for Payer: Healthscope Whirlpool |
$265.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.28
|
| Rate for Payer: Nomi Health Commercial |
$265.46
|
| Rate for Payer: PACE SWMI |
$221.22
|
| Rate for Payer: PHP Medicare Advantage |
$221.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$221.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.22
|
| Rate for Payer: UHC Medicare Advantage |
$221.22
|
| Rate for Payer: UHCCP DNSP |
$221.22
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 93986
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$186.91 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: Aetna Medicare |
$129.80
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$129.80
|
| Rate for Payer: BCN Medicare Advantage |
$129.80
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$186.91
|
| Rate for Payer: Cofinity Commercial |
$173.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.80
|
| Rate for Payer: Healthscope Commercial |
$155.76
|
| Rate for Payer: Healthscope Whirlpool |
$155.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.29
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: PACE SWMI |
$129.80
|
| Rate for Payer: PHP Medicare Advantage |
$129.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$129.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.80
|
| Rate for Payer: UHC Medicare Advantage |
$129.80
|
| Rate for Payer: UHCCP DNSP |
$129.80
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 93880
|
| Min. Negotiated Rate |
$168.67 |
| Max. Negotiated Rate |
$288.60 |
| Rate for Payer: Aetna Commercial |
$226.02
|
| Rate for Payer: Aetna Medicare |
$168.67
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: BCBS MAPPO |
$168.67
|
| Rate for Payer: BCN Medicare Advantage |
$168.67
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$242.88
|
| Rate for Payer: Cofinity Commercial |
$226.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.67
|
| Rate for Payer: Healthscope Commercial |
$202.40
|
| Rate for Payer: Healthscope Whirlpool |
$202.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.10
|
| Rate for Payer: Nomi Health Commercial |
$202.40
|
| Rate for Payer: PACE SWMI |
$168.67
|
| Rate for Payer: PHP Medicare Advantage |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health Medicare |
$168.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.67
|
| Rate for Payer: UHC Medicare Advantage |
$168.67
|
| Rate for Payer: UHCCP DNSP |
$168.67
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 93882
|
| Min. Negotiated Rate |
$110.47 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Aetna Commercial |
$148.03
|
| Rate for Payer: Aetna Medicare |
$110.47
|
| Rate for Payer: BCBS Complete |
$127.20
|
| Rate for Payer: BCBS MAPPO |
$110.47
|
| Rate for Payer: BCN Medicare Advantage |
$110.47
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cofinity Commercial |
$159.08
|
| Rate for Payer: Cofinity Commercial |
$148.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.47
|
| Rate for Payer: Healthscope Commercial |
$132.56
|
| Rate for Payer: Healthscope Whirlpool |
$132.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.99
|
| Rate for Payer: Nomi Health Commercial |
$132.56
|
| Rate for Payer: PACE SWMI |
$110.47
|
| Rate for Payer: PHP Medicare Advantage |
$110.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.70
|
| Rate for Payer: Priority Health Medicare |
$110.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.47
|
| Rate for Payer: UHC Medicare Advantage |
$110.47
|
| Rate for Payer: UHCCP DNSP |
$110.47
|
|
|
PR DUPLEX SCAN HEMODIALYSIS ACCESS
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 93990
|
| Min. Negotiated Rate |
$130.18 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Aetna Commercial |
$174.44
|
| Rate for Payer: Aetna Commercial |
$174.44
|
| Rate for Payer: Aetna Medicare |
$130.18
|
| Rate for Payer: Aetna Medicare |
$130.18
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$138.80
|
| Rate for Payer: BCBS MAPPO |
$130.18
|
| Rate for Payer: BCBS MAPPO |
$130.18
|
| Rate for Payer: BCN Medicare Advantage |
$130.18
|
| Rate for Payer: BCN Medicare Advantage |
$130.18
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$174.44
|
| Rate for Payer: Cofinity Commercial |
$187.46
|
| Rate for Payer: Cofinity Commercial |
$174.44
|
| Rate for Payer: Cofinity Commercial |
$187.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.18
|
| Rate for Payer: Healthscope Commercial |
$156.22
|
| Rate for Payer: Healthscope Commercial |
$156.22
|
| Rate for Payer: Healthscope Whirlpool |
$156.22
|
| Rate for Payer: Healthscope Whirlpool |
$156.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.69
|
| Rate for Payer: Nomi Health Commercial |
$156.22
|
| Rate for Payer: Nomi Health Commercial |
$156.22
|
| Rate for Payer: PACE SWMI |
$130.18
|
| Rate for Payer: PACE SWMI |
$130.18
|
| Rate for Payer: PHP Medicare Advantage |
$130.18
|
| Rate for Payer: PHP Medicare Advantage |
$130.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.55
|
| Rate for Payer: Priority Health Medicare |
$130.18
|
| Rate for Payer: Priority Health Medicare |
$130.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.18
|
| Rate for Payer: UHC Medicare Advantage |
$130.18
|
| Rate for Payer: UHC Medicare Advantage |
$130.18
|
| Rate for Payer: UHCCP DNSP |
$130.18
|
| Rate for Payer: UHCCP DNSP |
$130.18
|
|
|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 93978
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Aetna Commercial |
$217.23
|
| Rate for Payer: Aetna Commercial |
$217.23
|
| Rate for Payer: Aetna Medicare |
$162.11
|
| Rate for Payer: Aetna Medicare |
$162.11
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS MAPPO |
$162.11
|
| Rate for Payer: BCBS MAPPO |
$162.11
|
| Rate for Payer: BCN Medicare Advantage |
$162.11
|
| Rate for Payer: BCN Medicare Advantage |
$162.11
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$217.23
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Cofinity Commercial |
$217.23
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.11
|
| Rate for Payer: Healthscope Commercial |
$194.53
|
| Rate for Payer: Healthscope Commercial |
$194.53
|
| Rate for Payer: Healthscope Whirlpool |
$194.53
|
| Rate for Payer: Healthscope Whirlpool |
$194.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.22
|
| Rate for Payer: Nomi Health Commercial |
$194.53
|
| Rate for Payer: Nomi Health Commercial |
$194.53
|
| Rate for Payer: PACE SWMI |
$162.11
|
| Rate for Payer: PACE SWMI |
$162.11
|
| Rate for Payer: PHP Medicare Advantage |
$162.11
|
| Rate for Payer: PHP Medicare Advantage |
$162.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health Medicare |
$162.11
|
| Rate for Payer: Priority Health Medicare |
$162.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.11
|
| Rate for Payer: UHC Medicare Advantage |
$162.11
|
| Rate for Payer: UHC Medicare Advantage |
$162.11
|
| Rate for Payer: UHCCP DNSP |
$162.11
|
| Rate for Payer: UHCCP DNSP |
$162.11
|
|
|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 93979
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$178.75 |
| Rate for Payer: Aetna Commercial |
$140.53
|
| Rate for Payer: Aetna Commercial |
$140.53
|
| Rate for Payer: Aetna Medicare |
$104.87
|
| Rate for Payer: Aetna Medicare |
$104.87
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$104.87
|
| Rate for Payer: BCBS MAPPO |
$104.87
|
| Rate for Payer: BCN Medicare Advantage |
$104.87
|
| Rate for Payer: BCN Medicare Advantage |
$104.87
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$140.53
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Cofinity Commercial |
$140.53
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$125.84
|
| Rate for Payer: Healthscope Commercial |
$125.84
|
| Rate for Payer: Healthscope Whirlpool |
$125.84
|
| Rate for Payer: Healthscope Whirlpool |
$125.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.11
|
| Rate for Payer: Nomi Health Commercial |
$125.84
|
| Rate for Payer: Nomi Health Commercial |
$125.84
|
| Rate for Payer: PACE SWMI |
$104.87
|
| Rate for Payer: PACE SWMI |
$104.87
|
| Rate for Payer: PHP Medicare Advantage |
$104.87
|
| Rate for Payer: PHP Medicare Advantage |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Medicare |
$104.87
|
| Rate for Payer: Priority Health Medicare |
$104.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.87
|
| Rate for Payer: UHC Medicare Advantage |
$104.87
|
| Rate for Payer: UHC Medicare Advantage |
$104.87
|
| Rate for Payer: UHCCP DNSP |
$104.87
|
| Rate for Payer: UHCCP DNSP |
$104.87
|
|
