|
PR SIMPLE IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 00522
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
|
|
PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$9,729.00
|
|
|
Service Code
|
HCPCS 61700
|
| Min. Negotiated Rate |
$3,376.65 |
| Max. Negotiated Rate |
$6,323.85 |
| Rate for Payer: Aetna Commercial |
$4,524.71
|
| Rate for Payer: Aetna Medicare |
$3,511.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,524.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,862.38
|
| Rate for Payer: BCBS Complete |
$3,891.60
|
| Rate for Payer: BCBS MAPPO |
$3,376.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,376.65
|
| Rate for Payer: Cash Price |
$7,783.20
|
| Rate for Payer: Cash Price |
$7,783.20
|
| Rate for Payer: Cofinity Commercial |
$4,862.38
|
| Rate for Payer: Cofinity Commercial |
$4,524.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,376.65
|
| Rate for Payer: Healthscope Commercial |
$6,246.80
|
| Rate for Payer: Healthscope Commercial |
$5,402.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,545.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,323.85
|
| Rate for Payer: Nomi Health Commercial |
$4,051.98
|
| Rate for Payer: PACE SWMI |
$3,376.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,376.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,323.85
|
| Rate for Payer: Priority Health Medicare |
$3,376.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,376.65
|
| Rate for Payer: UHC Medicare Advantage |
$3,376.65
|
|
|
PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$8,669.00
|
|
|
Service Code
|
HCPCS 61702
|
| Min. Negotiated Rate |
$3,467.60 |
| Max. Negotiated Rate |
$7,368.62 |
| Rate for Payer: Aetna Commercial |
$5,337.27
|
| Rate for Payer: Aetna Medicare |
$4,142.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,337.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,735.58
|
| Rate for Payer: BCBS Complete |
$3,467.60
|
| Rate for Payer: BCBS MAPPO |
$3,983.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,983.04
|
| Rate for Payer: Cash Price |
$6,935.20
|
| Rate for Payer: Cash Price |
$6,935.20
|
| Rate for Payer: Cofinity Commercial |
$5,337.27
|
| Rate for Payer: Cofinity Commercial |
$5,735.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,983.04
|
| Rate for Payer: Healthscope Commercial |
$6,372.86
|
| Rate for Payer: Healthscope Commercial |
$7,368.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,182.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,634.85
|
| Rate for Payer: Nomi Health Commercial |
$4,779.65
|
| Rate for Payer: PACE SWMI |
$3,983.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,983.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,634.85
|
| Rate for Payer: Priority Health Medicare |
$3,983.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,983.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,983.04
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 12016
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: Aetna Medicare |
$129.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.03
|
| Rate for Payer: BCBS Complete |
$265.60
|
| Rate for Payer: BCBS MAPPO |
$124.65
|
| Rate for Payer: BCN Medicare Advantage |
$124.65
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$179.50
|
| Rate for Payer: Cofinity Commercial |
$167.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.65
|
| Rate for Payer: Healthscope Commercial |
$230.60
|
| Rate for Payer: Healthscope Commercial |
$199.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.60
|
| Rate for Payer: Nomi Health Commercial |
$149.58
|
| Rate for Payer: PACE SWMI |
$124.65
|
| Rate for Payer: PHP Medicare Advantage |
$124.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.60
|
| Rate for Payer: Priority Health Medicare |
$124.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.65
|
| Rate for Payer: UHC Medicare Advantage |
$124.65
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 12017
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$278.20 |
| Rate for Payer: Aetna Commercial |
$201.51
|
| Rate for Payer: Aetna Medicare |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.51
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$150.38
|
| Rate for Payer: BCN Medicare Advantage |
$150.38
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$216.55
|
| Rate for Payer: Cofinity Commercial |
$201.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.38
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Healthscope Commercial |
$278.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.25
|
| Rate for Payer: Nomi Health Commercial |
$180.46
|
| Rate for Payer: PACE SWMI |
$150.38
|
| Rate for Payer: PHP Medicare Advantage |
$150.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$150.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.38
|
| Rate for Payer: UHC Medicare Advantage |
$150.38
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$54.07 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$72.45
|
| Rate for Payer: Aetna Medicare |
$56.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.45
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$54.07
|
| Rate for Payer: BCN Medicare Advantage |
$54.07
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$77.86
|
| Rate for Payer: Cofinity Commercial |
$72.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.07
|
| Rate for Payer: Healthscope Commercial |
$86.51
|
| Rate for Payer: Healthscope Commercial |
$100.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Nomi Health Commercial |
$64.88
|
| Rate for Payer: PACE SWMI |
$54.07
|
| Rate for Payer: PHP Medicare Advantage |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$54.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.07
|
| Rate for Payer: UHC Medicare Advantage |
$54.07
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$232.70 |
| Rate for Payer: Aetna Commercial |
$75.75
|
| Rate for Payer: Aetna Medicare |
$58.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.75
|
| Rate for Payer: BCBS Complete |
$143.20
|
| Rate for Payer: BCBS MAPPO |
$56.53
|
| Rate for Payer: BCN Medicare Advantage |
$56.53
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.53
|
| Rate for Payer: Healthscope Commercial |
$104.58
|
| Rate for Payer: Healthscope Commercial |
$90.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.70
|
| Rate for Payer: Nomi Health Commercial |
$67.84
|
| Rate for Payer: PACE SWMI |
$56.53
|
| Rate for Payer: PHP Medicare Advantage |
$56.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: Priority Health Medicare |
$56.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.53
|
| Rate for Payer: UHC Medicare Advantage |
$56.53
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$228.39
|
| Rate for Payer: Aetna Medicare |
$177.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.39
|
| Rate for Payer: BCBS Complete |
$544.00
|
| Rate for Payer: BCBS MAPPO |
$170.44
|
| Rate for Payer: BCN Medicare Advantage |
$170.44
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$245.43
|
| Rate for Payer: Cofinity Commercial |
$228.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.44
|
| Rate for Payer: Healthscope Commercial |
$315.31
|
| Rate for Payer: Healthscope Commercial |
$272.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.00
|
| Rate for Payer: Nomi Health Commercial |
$204.53
|
| Rate for Payer: PACE SWMI |
$170.44
|
| Rate for Payer: PHP Medicare Advantage |
$170.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health Medicare |
$170.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.44
|
| Rate for Payer: UHC Medicare Advantage |
$170.44
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$319.15 |
| Rate for Payer: Aetna Commercial |
$97.12
|
| Rate for Payer: Aetna Medicare |
$75.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.37
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: BCBS MAPPO |
$72.48
|
| Rate for Payer: BCN Medicare Advantage |
$72.48
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.48
|
| Rate for Payer: Healthscope Commercial |
$115.97
|
| Rate for Payer: Healthscope Commercial |
$134.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.15
|
| Rate for Payer: Nomi Health Commercial |
$86.98
|
| Rate for Payer: PACE SWMI |
$72.48
|
| Rate for Payer: PHP Medicare Advantage |
$72.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health Medicare |
$72.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.48
|
| Rate for Payer: UHC Medicare Advantage |
$72.48
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$91.89 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$123.13
|
| Rate for Payer: Aetna Medicare |
$95.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.13
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$91.89
|
| Rate for Payer: BCN Medicare Advantage |
$91.89
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$132.32
|
| Rate for Payer: Cofinity Commercial |
$123.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.89
|
| Rate for Payer: Healthscope Commercial |
$170.00
|
| Rate for Payer: Healthscope Commercial |
$147.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.10
|
| Rate for Payer: Nomi Health Commercial |
$110.27
|
| Rate for Payer: PACE SWMI |
$91.89
|
| Rate for Payer: PHP Medicare Advantage |
$91.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$91.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.89
|
| Rate for Payer: UHC Medicare Advantage |
$91.89
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$165.10 |
| Rate for Payer: Aetna Commercial |
$57.97
|
| Rate for Payer: Aetna Medicare |
$44.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.97
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS MAPPO |
$43.26
|
| Rate for Payer: BCN Medicare Advantage |
$43.26
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Cofinity Commercial |
$57.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Healthscope Commercial |
$80.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.10
|
| Rate for Payer: Nomi Health Commercial |
$51.91
|
| Rate for Payer: PACE SWMI |
$43.26
|
| Rate for Payer: PHP Medicare Advantage |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.10
|
| Rate for Payer: Priority Health Medicare |
$43.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.26
|
| Rate for Payer: UHC Medicare Advantage |
$43.26
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$146.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.86
|
| Rate for Payer: BCBS Complete |
$220.40
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$140.94
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$260.74
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: Nomi Health Commercial |
$169.13
|
| Rate for Payer: PACE SWMI |
$140.94
|
| Rate for Payer: PHP Medicare Advantage |
$140.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.15
|
| Rate for Payer: Priority Health Medicare |
$140.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Aetna Commercial |
$95.21
|
| Rate for Payer: Aetna Medicare |
$73.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.31
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: BCBS MAPPO |
$71.05
|
| Rate for Payer: BCN Medicare Advantage |
$71.05
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$95.21
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.05
|
| Rate for Payer: Healthscope Commercial |
$113.68
|
| Rate for Payer: Healthscope Commercial |
$131.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.35
|
| Rate for Payer: Nomi Health Commercial |
$85.26
|
| Rate for Payer: PACE SWMI |
$71.05
|
| Rate for Payer: PHP Medicare Advantage |
$71.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health Medicare |
$71.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.05
|
| Rate for Payer: UHC Medicare Advantage |
$71.05
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$17.07
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$12.74
|
| Rate for Payer: BCN Medicare Advantage |
$12.74
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$17.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.50
|
| Rate for Payer: Nomi Health Commercial |
$15.29
|
| Rate for Payer: PACE SWMI |
$12.74
|
| Rate for Payer: PHP Medicare Advantage |
$12.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$12.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.74
|
| Rate for Payer: UHC Medicare Advantage |
$12.74
|
|
|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 31087
|
| Min. Negotiated Rate |
$857.20 |
| Max. Negotiated Rate |
$1,946.90 |
| Rate for Payer: Aetna Commercial |
$1,410.19
|
| Rate for Payer: Aetna Medicare |
$1,094.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,515.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,410.19
|
| Rate for Payer: BCBS Complete |
$857.20
|
| Rate for Payer: BCBS MAPPO |
$1,052.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,052.38
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cofinity Commercial |
$1,515.43
|
| Rate for Payer: Cofinity Commercial |
$1,410.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,052.38
|
| Rate for Payer: Healthscope Commercial |
$1,683.81
|
| Rate for Payer: Healthscope Commercial |
$1,946.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,392.95
|
| Rate for Payer: Nomi Health Commercial |
$1,262.86
|
| Rate for Payer: PACE SWMI |
$1,052.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,052.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.95
|
| Rate for Payer: Priority Health Medicare |
$1,052.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,052.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,052.38
|
|
|
PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 31081
|
| Min. Negotiated Rate |
$834.00 |
| Max. Negotiated Rate |
$2,017.00 |
| Rate for Payer: Aetna Commercial |
$1,460.96
|
| Rate for Payer: Aetna Medicare |
$1,133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,569.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,460.96
|
| Rate for Payer: BCBS Complete |
$834.00
|
| Rate for Payer: BCBS MAPPO |
$1,090.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,090.27
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,569.99
|
| Rate for Payer: Cofinity Commercial |
$1,460.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,090.27
|
| Rate for Payer: Healthscope Commercial |
$2,017.00
|
| Rate for Payer: Healthscope Commercial |
$1,744.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,144.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,355.25
|
| Rate for Payer: Nomi Health Commercial |
$1,308.32
|
| Rate for Payer: PACE SWMI |
$1,090.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,090.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.25
|
| Rate for Payer: Priority Health Medicare |
$1,090.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,090.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,090.27
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,667.00
|
|
|
Service Code
|
HCPCS 31085
|
| Min. Negotiated Rate |
$1,066.80 |
| Max. Negotiated Rate |
$2,154.71 |
| Rate for Payer: Aetna Commercial |
$1,560.71
|
| Rate for Payer: Aetna Medicare |
$1,211.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,560.71
|
| Rate for Payer: BCBS Complete |
$1,066.80
|
| Rate for Payer: BCBS MAPPO |
$1,164.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,164.71
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cofinity Commercial |
$1,677.18
|
| Rate for Payer: Cofinity Commercial |
$1,560.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,164.71
|
| Rate for Payer: Healthscope Commercial |
$1,863.54
|
| Rate for Payer: Healthscope Commercial |
$2,154.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,222.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,733.55
|
| Rate for Payer: Nomi Health Commercial |
$1,397.65
|
| Rate for Payer: PACE SWMI |
$1,164.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,164.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.55
|
| Rate for Payer: Priority Health Medicare |
$1,164.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,164.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,164.71
|
|
|
PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 31032
|
| Min. Negotiated Rate |
$449.60 |
| Max. Negotiated Rate |
$1,028.14 |
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna Medicare |
$577.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.71
|
| Rate for Payer: BCBS Complete |
$449.60
|
| Rate for Payer: BCBS MAPPO |
$555.75
|
| Rate for Payer: BCN Medicare Advantage |
$555.75
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cofinity Commercial |
$800.28
|
| Rate for Payer: Cofinity Commercial |
$744.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.75
|
| Rate for Payer: Healthscope Commercial |
$889.20
|
| Rate for Payer: Healthscope Commercial |
$1,028.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$730.60
|
| Rate for Payer: Nomi Health Commercial |
$666.90
|
| Rate for Payer: PACE SWMI |
$555.75
|
| Rate for Payer: PHP Medicare Advantage |
$555.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.60
|
| Rate for Payer: Priority Health Medicare |
$555.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.75
|
| Rate for Payer: UHC Medicare Advantage |
$555.75
|
|
|
PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 31080
|
| Min. Negotiated Rate |
$905.60 |
| Max. Negotiated Rate |
$1,877.71 |
| Rate for Payer: Aetna Commercial |
$1,360.07
|
| Rate for Payer: Aetna Medicare |
$1,055.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,360.07
|
| Rate for Payer: BCBS Complete |
$905.60
|
| Rate for Payer: BCBS MAPPO |
$1,014.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.98
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,461.57
|
| Rate for Payer: Cofinity Commercial |
$1,360.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.98
|
| Rate for Payer: Healthscope Commercial |
$1,623.97
|
| Rate for Payer: Healthscope Commercial |
$1,877.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,065.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,471.60
|
| Rate for Payer: Nomi Health Commercial |
$1,217.98
|
| Rate for Payer: PACE SWMI |
$1,014.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,471.60
|
| Rate for Payer: Priority Health Medicare |
$1,014.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,014.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.98
|
|
|
PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 31070
|
| Min. Negotiated Rate |
$354.40 |
| Max. Negotiated Rate |
$812.87 |
| Rate for Payer: Aetna Commercial |
$588.78
|
| Rate for Payer: Aetna Medicare |
$456.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.78
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$439.39
|
| Rate for Payer: BCN Medicare Advantage |
$439.39
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$632.72
|
| Rate for Payer: Cofinity Commercial |
$588.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.39
|
| Rate for Payer: Healthscope Commercial |
$812.87
|
| Rate for Payer: Healthscope Commercial |
$703.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.90
|
| Rate for Payer: Nomi Health Commercial |
$527.27
|
| Rate for Payer: PACE SWMI |
$439.39
|
| Rate for Payer: PHP Medicare Advantage |
$439.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$439.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.39
|
| Rate for Payer: UHC Medicare Advantage |
$439.39
|
|
|
PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 31020
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$587.54 |
| Rate for Payer: Aetna Commercial |
$425.57
|
| Rate for Payer: Aetna Medicare |
$330.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.57
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$317.59
|
| Rate for Payer: BCN Medicare Advantage |
$317.59
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$457.33
|
| Rate for Payer: Cofinity Commercial |
$425.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.59
|
| Rate for Payer: Healthscope Commercial |
$508.14
|
| Rate for Payer: Healthscope Commercial |
$587.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.10
|
| Rate for Payer: Nomi Health Commercial |
$381.11
|
| Rate for Payer: PACE SWMI |
$317.59
|
| Rate for Payer: PHP Medicare Advantage |
$317.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$317.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.59
|
| Rate for Payer: UHC Medicare Advantage |
$317.59
|
|
|
PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 31030
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$891.40 |
| Rate for Payer: Aetna Commercial |
$645.67
|
| Rate for Payer: Aetna Medicare |
$501.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.67
|
| Rate for Payer: BCBS Complete |
$462.40
|
| Rate for Payer: BCBS MAPPO |
$481.84
|
| Rate for Payer: BCN Medicare Advantage |
$481.84
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$693.85
|
| Rate for Payer: Cofinity Commercial |
$645.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.84
|
| Rate for Payer: Healthscope Commercial |
$891.40
|
| Rate for Payer: Healthscope Commercial |
$770.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.40
|
| Rate for Payer: Nomi Health Commercial |
$578.21
|
| Rate for Payer: PACE SWMI |
$481.84
|
| Rate for Payer: PHP Medicare Advantage |
$481.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health Medicare |
$481.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.84
|
| Rate for Payer: UHC Medicare Advantage |
$481.84
|
|
|
PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 31051
|
| Min. Negotiated Rate |
$642.02 |
| Max. Negotiated Rate |
$1,213.55 |
| Rate for Payer: Aetna Commercial |
$860.31
|
| Rate for Payer: Aetna Medicare |
$667.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.31
|
| Rate for Payer: BCBS Complete |
$746.80
|
| Rate for Payer: BCBS MAPPO |
$642.02
|
| Rate for Payer: BCN Medicare Advantage |
$642.02
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cofinity Commercial |
$924.51
|
| Rate for Payer: Cofinity Commercial |
$860.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.02
|
| Rate for Payer: Healthscope Commercial |
$1,027.23
|
| Rate for Payer: Healthscope Commercial |
$1,187.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,213.55
|
| Rate for Payer: Nomi Health Commercial |
$770.42
|
| Rate for Payer: PACE SWMI |
$642.02
|
| Rate for Payer: PHP Medicare Advantage |
$642.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.55
|
| Rate for Payer: Priority Health Medicare |
$642.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.02
|
| Rate for Payer: UHC Medicare Advantage |
$642.02
|
|
|
PR SKIN LESION SHAVE/EXCISION (15 MIN)
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00367
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR SKIN LESION SHAVE/EXCISION (30 MIN)
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00368
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
|
