|
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 IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$196.30 |
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
93317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$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
|
| Hospital Charge Code |
93317
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$196.30 |
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$300.95 |
| Rate for Payer: Aetna Medicare |
$231.50
|
| Rate for Payer: BCBS Complete |
$185.20
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.95
|
|
|
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 |
$212.86 |
| Max. Negotiated Rate |
$360.75 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$212.86
|
| Rate for Payer: BCBS Complete |
$222.00
|
| Rate for Payer: BCBS MAPPO |
$212.86
|
| Rate for Payer: BCN Medicare Advantage |
$212.86
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Cofinity Commercial |
$285.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.86
|
| Rate for Payer: Healthscope Commercial |
$255.43
|
| Rate for Payer: Healthscope Whirlpool |
$255.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.50
|
| Rate for Payer: Nomi Health Commercial |
$255.43
|
| Rate for Payer: PACE SWMI |
$212.86
|
| Rate for Payer: PHP Medicare Advantage |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health Medicare |
$212.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Medicare Advantage |
$212.86
|
| Rate for Payer: UHCCP DNSP |
$212.86
|
|
|
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
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
93312
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$828.86 |
| Rate for Payer: Aetna Commercial |
$499.50
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$538.35
|
| Rate for Payer: ASR Commercial |
$538.35
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$454.49
|
| Rate for Payer: BCN Commercial |
$430.29
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| 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 |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$555.00
|
| Rate for Payer: Healthscope Whirlpool |
$538.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$499.50
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.75
|
| Rate for Payer: Nomi Health Commercial |
$455.10
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| 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 |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$389.06
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$488.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$212.86 |
| Max. Negotiated Rate |
$360.75 |
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna Medicare |
$212.86
|
| Rate for Payer: BCBS Complete |
$222.00
|
| Rate for Payer: BCBS MAPPO |
$212.86
|
| Rate for Payer: BCN Medicare Advantage |
$212.86
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$306.52
|
| Rate for Payer: Cofinity Commercial |
$285.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.86
|
| Rate for Payer: Healthscope Commercial |
$255.43
|
| Rate for Payer: Healthscope Whirlpool |
$255.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.50
|
| Rate for Payer: Nomi Health Commercial |
$255.43
|
| Rate for Payer: PACE SWMI |
$212.86
|
| Rate for Payer: PHP Medicare Advantage |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health Medicare |
$212.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.86
|
| Rate for Payer: UHC Medicare Advantage |
$212.86
|
| Rate for Payer: UHCCP DNSP |
$212.86
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$122.42 |
| Max. Negotiated Rate |
$220.35 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$122.42
|
| Rate for Payer: Aetna Medicare |
$122.42
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS Complete |
$196.80
|
| Rate for Payer: BCBS MAPPO |
$122.42
|
| Rate for Payer: BCBS MAPPO |
$122.42
|
| Rate for Payer: BCN Medicare Advantage |
$122.42
|
| Rate for Payer: BCN Medicare Advantage |
$122.42
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$176.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.42
|
| Rate for Payer: Healthscope Commercial |
$146.90
|
| Rate for Payer: Healthscope Commercial |
$146.90
|
| Rate for Payer: Healthscope Whirlpool |
$146.90
|
| Rate for Payer: Healthscope Whirlpool |
$146.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.54
|
| Rate for Payer: Nomi Health Commercial |
$146.90
|
| Rate for Payer: Nomi Health Commercial |
$146.90
|
| Rate for Payer: PACE SWMI |
$122.42
|
| Rate for Payer: PACE SWMI |
$122.42
|
| Rate for Payer: PHP Medicare Advantage |
$122.42
|
| Rate for Payer: PHP Medicare Advantage |
$122.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health Medicare |
$122.42
|
| Rate for Payer: Priority Health Medicare |
$122.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.42
|
| Rate for Payer: UHC Medicare Advantage |
$122.42
|
| Rate for Payer: UHC Medicare Advantage |
$122.42
|
| Rate for Payer: UHCCP DNSP |
$122.42
|
| Rate for Payer: UHCCP DNSP |
$122.42
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$126.59 |
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Medicare |
$87.91
|
| Rate for Payer: Aetna Medicare |
$87.91
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCBS MAPPO |
$87.91
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: BCN Medicare Advantage |
$87.91
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| Rate for Payer: Cofinity Commercial |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.91
|
| Rate for Payer: Healthscope Commercial |
$105.49
|
| Rate for Payer: Healthscope Commercial |
$105.49
|
| Rate for Payer: Healthscope Whirlpool |
$105.49
|
| Rate for Payer: Healthscope Whirlpool |
$105.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.31
|
| Rate for Payer: Nomi Health Commercial |
$105.49
|
| Rate for Payer: Nomi Health Commercial |
$105.49
|
| Rate for Payer: PACE SWMI |
$87.91
|
| Rate for Payer: PACE SWMI |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$87.91
|
| Rate for Payer: Priority Health Medicare |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.91
|
| Rate for Payer: UHCCP DNSP |
$87.91
|
| Rate for Payer: UHCCP DNSP |
$87.91
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna Commercial |
$222.31
|
| Rate for Payer: Aetna Commercial |
$222.31
|
| Rate for Payer: Aetna Medicare |
$165.90
|
| Rate for Payer: Aetna Medicare |
$165.90
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCBS MAPPO |
$165.90
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: BCN Medicare Advantage |
$165.90
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$238.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.90
|
| Rate for Payer: Healthscope Commercial |
$199.08
|
| Rate for Payer: Healthscope Commercial |
$199.08
|
| Rate for Payer: Healthscope Whirlpool |
$199.08
|
| Rate for Payer: Healthscope Whirlpool |
$199.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.19
|
| Rate for Payer: Nomi Health Commercial |
$199.08
|
| Rate for Payer: Nomi Health Commercial |
$199.08
|
| Rate for Payer: PACE SWMI |
$165.90
|
| Rate for Payer: PACE SWMI |
$165.90
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: PHP Medicare Advantage |
$165.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Medicare |
$165.90
|
| Rate for Payer: Priority Health Medicare |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.90
|
| Rate for Payer: UHCCP DNSP |
$165.90
|
| Rate for Payer: UHCCP DNSP |
$165.90
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$235.84
|
| Rate for Payer: Aetna Commercial |
$235.84
|
| Rate for Payer: Aetna Medicare |
$176.00
|
| Rate for Payer: Aetna Medicare |
$176.00
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCBS MAPPO |
$176.00
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: BCN Medicare Advantage |
$176.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| Rate for Payer: Cofinity Commercial |
$235.84
|
| Rate for Payer: Cofinity Commercial |
$253.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$211.20
|
| Rate for Payer: Healthscope Whirlpool |
$211.20
|
| Rate for Payer: Healthscope Whirlpool |
$211.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.80
|
| Rate for Payer: Nomi Health Commercial |
$211.20
|
| Rate for Payer: Nomi Health Commercial |
$211.20
|
| Rate for Payer: PACE SWMI |
$176.00
|
| Rate for Payer: PACE SWMI |
$176.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health Medicare |
$176.00
|
| Rate for Payer: Priority Health Medicare |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
| Rate for Payer: UHC Medicare Advantage |
$176.00
|
| Rate for Payer: UHCCP DNSP |
$176.00
|
| Rate for Payer: UHCCP DNSP |
$176.00
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$222.55 |
| Max. Negotiated Rate |
$514.80 |
| Rate for Payer: Aetna Commercial |
$298.22
|
| Rate for Payer: Aetna Medicare |
$222.55
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCBS MAPPO |
$222.55
|
| Rate for Payer: BCN Medicare Advantage |
$222.55
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$320.47
|
| Rate for Payer: Cofinity Commercial |
$298.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.55
|
| Rate for Payer: Healthscope Commercial |
$267.06
|
| Rate for Payer: Healthscope Whirlpool |
$267.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.68
|
| Rate for Payer: Nomi Health Commercial |
$267.06
|
| Rate for Payer: PACE SWMI |
$222.55
|
| Rate for Payer: PHP Medicare Advantage |
$222.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health Medicare |
$222.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.55
|
| Rate for Payer: UHC Medicare Advantage |
$222.55
|
| Rate for Payer: UHCCP DNSP |
$222.55
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$328.70 |
| Max. Negotiated Rate |
$683.15 |
| Rate for Payer: Aetna Commercial |
$440.46
|
| Rate for Payer: Aetna Medicare |
$328.70
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: BCBS MAPPO |
$328.70
|
| Rate for Payer: BCN Medicare Advantage |
$328.70
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cofinity Commercial |
$473.33
|
| Rate for Payer: Cofinity Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.70
|
| Rate for Payer: Healthscope Commercial |
$394.44
|
| Rate for Payer: Healthscope Whirlpool |
$394.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.13
|
| Rate for Payer: Nomi Health Commercial |
$394.44
|
| Rate for Payer: PACE SWMI |
$328.70
|
| Rate for Payer: PHP Medicare Advantage |
$328.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.15
|
| Rate for Payer: Priority Health Medicare |
$328.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.70
|
| Rate for Payer: UHC Medicare Advantage |
$328.70
|
| Rate for Payer: UHCCP DNSP |
$328.70
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$426.51 |
| Rate for Payer: Aetna Commercial |
$396.89
|
| Rate for Payer: Aetna Medicare |
$296.19
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$296.19
|
| Rate for Payer: BCN Medicare Advantage |
$296.19
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$426.51
|
| Rate for Payer: Cofinity Commercial |
$396.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.19
|
| Rate for Payer: Healthscope Commercial |
$355.43
|
| Rate for Payer: Healthscope Whirlpool |
$355.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.00
|
| Rate for Payer: Nomi Health Commercial |
$355.43
|
| Rate for Payer: PACE SWMI |
$296.19
|
| Rate for Payer: PHP Medicare Advantage |
$296.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health Medicare |
$296.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.19
|
| Rate for Payer: UHC Medicare Advantage |
$296.19
|
| Rate for Payer: UHCCP DNSP |
$296.19
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,607.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$798.71 |
| Max. Negotiated Rate |
$1,694.55 |
| Rate for Payer: Aetna Commercial |
$1,070.27
|
| Rate for Payer: Aetna Medicare |
$798.71
|
| Rate for Payer: BCBS Complete |
$1,042.80
|
| Rate for Payer: BCBS MAPPO |
$798.71
|
| Rate for Payer: BCN Medicare Advantage |
$798.71
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.14
|
| Rate for Payer: Cofinity Commercial |
$1,070.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.71
|
| Rate for Payer: Healthscope Commercial |
$958.45
|
| Rate for Payer: Healthscope Whirlpool |
$958.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.65
|
| Rate for Payer: Nomi Health Commercial |
$958.45
|
| Rate for Payer: PACE SWMI |
$798.71
|
| Rate for Payer: PHP Medicare Advantage |
$798.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.55
|
| Rate for Payer: Priority Health Medicare |
$798.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.71
|
| Rate for Payer: UHC Medicare Advantage |
$798.71
|
| Rate for Payer: UHCCP DNSP |
$798.71
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$656.99 |
| Rate for Payer: Aetna Commercial |
$611.36
|
| Rate for Payer: Aetna Medicare |
$456.24
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: BCBS MAPPO |
$456.24
|
| Rate for Payer: BCN Medicare Advantage |
$456.24
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$656.99
|
| Rate for Payer: Cofinity Commercial |
$611.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$456.24
|
| Rate for Payer: Healthscope Commercial |
$547.49
|
| Rate for Payer: Healthscope Whirlpool |
$547.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.05
|
| Rate for Payer: Nomi Health Commercial |
$547.49
|
| Rate for Payer: PACE SWMI |
$456.24
|
| Rate for Payer: PHP Medicare Advantage |
$456.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health Medicare |
$456.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.24
|
| Rate for Payer: UHC Medicare Advantage |
$456.24
|
| Rate for Payer: UHCCP DNSP |
$456.24
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$586.60 |
| Rate for Payer: Aetna Commercial |
$545.86
|
| Rate for Payer: Aetna Medicare |
$407.36
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$407.36
|
| Rate for Payer: BCN Medicare Advantage |
$407.36
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$586.60
|
| Rate for Payer: Cofinity Commercial |
$545.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.36
|
| Rate for Payer: Healthscope Commercial |
$488.83
|
| Rate for Payer: Healthscope Whirlpool |
$488.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.73
|
| Rate for Payer: Nomi Health Commercial |
$488.83
|
| Rate for Payer: PACE SWMI |
$407.36
|
| Rate for Payer: PHP Medicare Advantage |
$407.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health Medicare |
$407.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.36
|
| Rate for Payer: UHC Medicare Advantage |
$407.36
|
| Rate for Payer: UHCCP DNSP |
$407.36
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$649.83 |
| Rate for Payer: Aetna Commercial |
$604.70
|
| Rate for Payer: Aetna Medicare |
$451.27
|
| Rate for Payer: BCBS Complete |
$289.60
|
| Rate for Payer: BCBS MAPPO |
$451.27
|
| Rate for Payer: BCN Medicare Advantage |
$451.27
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$649.83
|
| Rate for Payer: Cofinity Commercial |
$604.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.27
|
| Rate for Payer: Healthscope Commercial |
$541.52
|
| Rate for Payer: Healthscope Whirlpool |
$541.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$473.83
|
| Rate for Payer: Nomi Health Commercial |
$541.52
|
| Rate for Payer: PACE SWMI |
$451.27
|
| Rate for Payer: PHP Medicare Advantage |
$451.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health Medicare |
$451.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.27
|
| Rate for Payer: UHC Medicare Advantage |
$451.27
|
| Rate for Payer: UHCCP DNSP |
$451.27
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$724.16 |
| Rate for Payer: Aetna Commercial |
$673.87
|
| Rate for Payer: Aetna Medicare |
$502.89
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: BCBS MAPPO |
$502.89
|
| Rate for Payer: BCN Medicare Advantage |
$502.89
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$724.16
|
| Rate for Payer: Cofinity Commercial |
$673.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.89
|
| Rate for Payer: Healthscope Commercial |
$603.47
|
| Rate for Payer: Healthscope Whirlpool |
$603.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.03
|
| Rate for Payer: Nomi Health Commercial |
$603.47
|
| Rate for Payer: PACE SWMI |
$502.89
|
| Rate for Payer: PHP Medicare Advantage |
$502.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health Medicare |
$502.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.89
|
| Rate for Payer: UHC Medicare Advantage |
$502.89
|
| Rate for Payer: UHCCP DNSP |
$502.89
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$133.84
|
| Rate for Payer: Aetna Medicare |
$99.88
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$99.88
|
| Rate for Payer: BCN Medicare Advantage |
$99.88
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$143.83
|
| Rate for Payer: Cofinity Commercial |
$133.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$119.86
|
| Rate for Payer: Healthscope Whirlpool |
$119.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.87
|
| Rate for Payer: Nomi Health Commercial |
$119.86
|
| Rate for Payer: PACE SWMI |
$99.88
|
| Rate for Payer: PHP Medicare Advantage |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$99.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.88
|
| Rate for Payer: UHC Medicare Advantage |
$99.88
|
| Rate for Payer: UHCCP DNSP |
$99.88
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$212.84 |
| Max. Negotiated Rate |
$648.70 |
| Rate for Payer: Aetna Commercial |
$285.21
|
| Rate for Payer: Aetna Medicare |
$212.84
|
| Rate for Payer: BCBS Complete |
$399.20
|
| Rate for Payer: BCBS MAPPO |
$212.84
|
| Rate for Payer: BCN Medicare Advantage |
$212.84
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cofinity Commercial |
$306.49
|
| Rate for Payer: Cofinity Commercial |
$285.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.84
|
| Rate for Payer: Healthscope Commercial |
$255.41
|
| Rate for Payer: Healthscope Whirlpool |
$255.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.48
|
| Rate for Payer: Nomi Health Commercial |
$255.41
|
| Rate for Payer: PACE SWMI |
$212.84
|
| Rate for Payer: PHP Medicare Advantage |
$212.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.70
|
| Rate for Payer: Priority Health Medicare |
$212.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.84
|
| Rate for Payer: UHC Medicare Advantage |
$212.84
|
| Rate for Payer: UHCCP DNSP |
$212.84
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: ASR Commercial |
$5.81
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.91
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.25
|
| Rate for Payer: Priority Health Narrow Network |
$4.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: ASR Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$4.88
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
|
