|
PR DURAL GRAFT SPINAL
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63710
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$3,309.80 |
| Rate for Payer: Aetna Commercial |
$1,398.53
|
| Rate for Payer: Aetna Medicare |
$2,546.00
|
| Rate for Payer: BCBS Complete |
$742.30
|
| Rate for Payer: BCBS Trust/PPO |
$172.75
|
| Rate for Payer: BCN Commercial |
$1,749.81
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Meridian Medicaid |
$742.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$706.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,871.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,871.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,271.76
|
| Rate for Payer: UHC Exchange |
$1,271.76
|
| Rate for Payer: UHCCP Medicaid |
$706.95
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR 1ST 60
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 92622
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$107.90 |
| Rate for Payer: Aetna Commercial |
$69.85
|
| Rate for Payer: Aetna Medicare |
$83.00
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.65
|
| Rate for Payer: Priority Health Narrow Network |
$88.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.98
|
| Rate for Payer: UHC Exchange |
$74.98
|
|
|
PR DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR EA ADL
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 92623
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.52
|
| Rate for Payer: Priority Health Narrow Network |
$23.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.90
|
| Rate for Payer: UHC Exchange |
$19.90
|
|
|
PR DYSPORT
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 00385
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
|
|
PR EAR MOLD/INSERT
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS V5264
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$57.45
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR EAR PIERCING
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 69090
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$248.83 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Trust/PPO |
$248.83
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.24
|
| Rate for Payer: Priority Health Narrow Network |
$45.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.65
|
| Rate for Payer: UHC Exchange |
$33.65
|
|
|
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: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.82
|
| Rate for Payer: BCN Commercial |
$9.43
|
| 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 |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.30
|
| Rate for Payer: Priority Health Narrow Network |
$11.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.61
|
| Rate for Payer: UHC Exchange |
$9.61
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 93005
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$1,832.67 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,832.67
|
| Rate for Payer: BCN Commercial |
$7.46
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Narrow Network |
$8.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.22
|
| Rate for Payer: UHC Exchange |
$11.22
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$1,966.86 |
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,966.86
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.24
|
| Rate for Payer: Priority Health Narrow Network |
$20.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
| Rate for Payer: UHC Exchange |
$20.83
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS G6001
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$263.39 |
| Rate for Payer: Aetna Commercial |
$173.52
|
| Rate for Payer: Aetna Medicare |
$191.50
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCN Commercial |
$263.39
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.25
|
| Rate for Payer: Priority Health Narrow Network |
$48.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.30
|
| Rate for Payer: UHC Exchange |
$91.30
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$761.00
|
|
|
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: Aetna Medicare |
$380.50
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.26
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.53
|
| Rate for Payer: Priority Health Narrow Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.94
|
| Rate for Payer: UHC Exchange |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$140.58 |
| Max. Negotiated Rate |
$1,372.52 |
| Rate for Payer: Aetna Commercial |
$304.22
|
| Rate for Payer: Aetna Medicare |
$230.50
|
| Rate for Payer: BCBS Complete |
$147.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.52
|
| Rate for Payer: BCN Commercial |
$321.06
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Meridian Medicaid |
$147.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.81
|
| Rate for Payer: Priority Health Narrow Network |
$309.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.05
|
| Rate for Payer: UHC Exchange |
$295.05
|
| Rate for Payer: UHCCP Medicaid |
$140.58
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: BCN Commercial |
$646.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.74
|
| Rate for Payer: Priority Health Narrow Network |
$173.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.49
|
| Rate for Payer: UHC Exchange |
$379.49
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$832.68 |
| Rate for Payer: Aetna Commercial |
$532.80
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$574.24
|
| Rate for Payer: ASR Commercial |
$574.24
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$484.79
|
| Rate for Payer: BCN Commercial |
$458.98
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cofinity Commercial |
$556.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$592.00
|
| Rate for Payer: Healthscope Whirlpool |
$574.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren Commercial |
$532.80
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.20
|
| Rate for Payer: Nomi Health Commercial |
$485.44
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.71
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$414.99
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
93315
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna Commercial |
$532.80
|
| Rate for Payer: ASR ASR |
$574.24
|
| Rate for Payer: ASR Commercial |
$574.24
|
| Rate for Payer: BCBS Trust/PPO |
$482.42
|
| Rate for Payer: BCN Commercial |
$458.98
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cofinity Commercial |
$556.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.60
|
| Rate for Payer: Healthscope Commercial |
$592.00
|
| Rate for Payer: Healthscope Whirlpool |
$574.24
|
| Rate for Payer: Mclaren Commercial |
$532.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.20
|
| Rate for Payer: Nomi Health Commercial |
$485.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.96
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$1,889.20 |
| Rate for Payer: Aetna Commercial |
$637.15
|
| Rate for Payer: Aetna Medicare |
$296.00
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.20
|
| Rate for Payer: BCN Commercial |
$646.21
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.74
|
| Rate for Payer: Priority Health Narrow Network |
$173.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.49
|
| Rate for Payer: UHC Exchange |
$379.49
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$1,443.32 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.32
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.79
|
| Rate for Payer: Priority Health Narrow Network |
$35.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.36
|
| Rate for Payer: UHC Exchange |
$57.36
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$322.53 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCN Commercial |
$315.68
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.01
|
| Rate for Payer: Priority Health Narrow Network |
$121.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.53
|
| Rate for Payer: UHC Exchange |
$322.53
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: ASR ASR |
$292.94
|
| Rate for Payer: ASR Commercial |
$292.94
|
| Rate for Payer: BCBS Trust/PPO |
$246.10
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$283.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Healthscope Whirlpool |
$292.94
|
| Rate for Payer: Mclaren Commercial |
$271.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.70
|
| Rate for Payer: Nomi Health Commercial |
$247.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.76
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$322.53 |
| Rate for Payer: Aetna Commercial |
$233.32
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCN Commercial |
$315.68
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.01
|
| Rate for Payer: Priority Health Narrow Network |
$121.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.53
|
| Rate for Payer: UHC Exchange |
$322.53
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: ASR ASR |
$292.94
|
| Rate for Payer: ASR Commercial |
$292.94
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS Trust/PPO |
$247.31
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$283.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Healthscope Whirlpool |
$292.94
|
| Rate for Payer: Mclaren Commercial |
$271.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.70
|
| Rate for Payer: Nomi Health Commercial |
$247.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.61
|
| Rate for Payer: Priority Health Narrow Network |
$211.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.76
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$2,220.97 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: Aetna Medicare |
$231.50
|
| Rate for Payer: BCBS Complete |
$67.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,220.97
|
| Rate for Payer: BCN Commercial |
$611.51
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Meridian Medicaid |
$67.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.83
|
| Rate for Payer: Priority Health Narrow Network |
$139.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$563.10
|
| Rate for Payer: UHC Exchange |
$563.10
|
| Rate for Payer: UHCCP Medicaid |
$63.90
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$832.68 |
| Rate for Payer: Aetna Commercial |
$499.50
|
| Rate for Payer: Aetna Medicare |
$537.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: ASR ASR |
$538.35
|
| Rate for Payer: ASR Commercial |
$538.35
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$454.49
|
| Rate for Payer: BCN Commercial |
$430.29
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$521.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$555.00
|
| Rate for Payer: Healthscope Whirlpool |
$538.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.21
|
| Rate for Payer: Mclaren Commercial |
$499.50
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: Nomi Health Commercial |
$455.10
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$590.93
|
| Rate for Payer: PHP Medicaid |
$287.94
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.29
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$389.06
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$488.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$832.68
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP DNSP |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$360.75 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna Commercial |
$499.50
|
| Rate for Payer: ASR ASR |
$538.35
|
| Rate for Payer: ASR Commercial |
$538.35
|
| Rate for Payer: BCBS Trust/PPO |
$452.27
|
| Rate for Payer: BCN Commercial |
$430.29
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$521.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.00
|
| Rate for Payer: Healthscope Commercial |
$555.00
|
| Rate for Payer: Healthscope Whirlpool |
$538.35
|
| Rate for Payer: Mclaren Commercial |
$499.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: Nomi Health Commercial |
$455.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$488.40
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$1,669.96 |
| Rate for Payer: Aetna Commercial |
$320.26
|
| Rate for Payer: Aetna Medicare |
$277.50
|
| Rate for Payer: BCBS Complete |
$69.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.96
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Meridian Medicaid |
$69.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.42
|
| Rate for Payer: Priority Health Narrow Network |
$146.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.13
|
| Rate for Payer: UHC Exchange |
$385.13
|
| Rate for Payer: UHCCP Medicaid |
$66.46
|
|
