|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$29,923.00 |
| Rate for Payer: Aetna Commercial |
$217.71
|
| Rate for Payer: Aetna Medicare |
$168.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.96
|
| Rate for Payer: BCBS Complete |
$114.51
|
| Rate for Payer: BCBS MAPPO |
$162.47
|
| Rate for Payer: BCBS Trust/PPO |
$46.49
|
| Rate for Payer: BCN Commercial |
$246.29
|
| Rate for Payer: BCN Medicare Advantage |
$162.47
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$233.96
|
| Rate for Payer: Cofinity Commercial |
$217.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.47
|
| Rate for Payer: Healthscope Commercial |
$259.95
|
| Rate for Payer: Healthscope Commercial |
$300.57
|
| Rate for Payer: Mclaren Medicaid |
$109.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.59
|
| Rate for Payer: Meridian Medicaid |
$114.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,923.00
|
| Rate for Payer: Nomi Health Commercial |
$194.96
|
| Rate for Payer: PACE SWMI |
$162.47
|
| Rate for Payer: PHP Medicare Advantage |
$162.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.48
|
| Rate for Payer: Priority Health Medicare |
$162.47
|
| Rate for Payer: Priority Health Narrow Network |
$302.48
|
| Rate for Payer: Priority Health SBD |
$302.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.47
|
| Rate for Payer: UHC Medicare Advantage |
$162.47
|
| Rate for Payer: UHCCP Medicaid |
$109.06
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$34,274.00 |
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Medicare |
$192.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.04
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS MAPPO |
$184.75
|
| Rate for Payer: BCBS Trust/PPO |
$54.94
|
| Rate for Payer: BCN Commercial |
$279.53
|
| Rate for Payer: BCN Medicare Advantage |
$184.75
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cofinity Commercial |
$266.04
|
| Rate for Payer: Cofinity Commercial |
$247.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.75
|
| Rate for Payer: Healthscope Commercial |
$295.60
|
| Rate for Payer: Healthscope Commercial |
$341.79
|
| Rate for Payer: Mclaren Medicaid |
$123.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.99
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,274.00
|
| Rate for Payer: Nomi Health Commercial |
$221.70
|
| Rate for Payer: PACE SWMI |
$184.75
|
| Rate for Payer: PHP Medicare Advantage |
$184.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.86
|
| Rate for Payer: Priority Health Medicare |
$184.75
|
| Rate for Payer: Priority Health Narrow Network |
$338.86
|
| Rate for Payer: Priority Health SBD |
$338.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.75
|
| Rate for Payer: UHC Medicare Advantage |
$184.75
|
| Rate for Payer: UHCCP Medicaid |
$123.11
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$33,437.00 |
| Rate for Payer: Aetna Commercial |
$242.02
|
| Rate for Payer: Aetna Medicare |
$187.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.08
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCBS MAPPO |
$180.61
|
| Rate for Payer: BCBS Trust/PPO |
$156.91
|
| Rate for Payer: BCN Commercial |
$272.68
|
| Rate for Payer: BCN Medicare Advantage |
$180.61
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$260.08
|
| Rate for Payer: Cofinity Commercial |
$242.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.61
|
| Rate for Payer: Healthscope Commercial |
$288.98
|
| Rate for Payer: Healthscope Commercial |
$334.13
|
| Rate for Payer: Mclaren Medicaid |
$119.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.64
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,437.00
|
| Rate for Payer: Nomi Health Commercial |
$216.73
|
| Rate for Payer: PACE SWMI |
$180.61
|
| Rate for Payer: PHP Medicare Advantage |
$180.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.89
|
| Rate for Payer: Priority Health Medicare |
$180.61
|
| Rate for Payer: Priority Health Narrow Network |
$332.89
|
| Rate for Payer: Priority Health SBD |
$332.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.61
|
| Rate for Payer: UHC Medicare Advantage |
$180.61
|
| Rate for Payer: UHCCP Medicaid |
$119.92
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$97,196.00 |
| Rate for Payer: Aetna Commercial |
$703.55
|
| Rate for Payer: Aetna Medicare |
$546.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$756.06
|
| Rate for Payer: BCBS Complete |
$370.15
|
| Rate for Payer: BCBS MAPPO |
$525.04
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$799.97
|
| Rate for Payer: BCN Medicare Advantage |
$525.04
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$756.06
|
| Rate for Payer: Cofinity Commercial |
$703.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$525.04
|
| Rate for Payer: Healthscope Commercial |
$840.06
|
| Rate for Payer: Healthscope Commercial |
$971.32
|
| Rate for Payer: Mclaren Medicaid |
$352.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.29
|
| Rate for Payer: Meridian Medicaid |
$370.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97,196.00
|
| Rate for Payer: Nomi Health Commercial |
$630.05
|
| Rate for Payer: PACE SWMI |
$525.04
|
| Rate for Payer: PHP Medicare Advantage |
$525.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$981.40
|
| Rate for Payer: Priority Health Medicare |
$525.04
|
| Rate for Payer: Priority Health Narrow Network |
$981.40
|
| Rate for Payer: Priority Health SBD |
$981.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$525.04
|
| Rate for Payer: UHC Medicare Advantage |
$525.04
|
| Rate for Payer: UHCCP Medicaid |
$352.52
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$680.32 |
| Max. Negotiated Rate |
$189,536.00 |
| Rate for Payer: Aetna Commercial |
$1,379.42
|
| Rate for Payer: Aetna Medicare |
$1,070.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,379.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,482.36
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS MAPPO |
$1,029.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.75
|
| Rate for Payer: BCN Commercial |
$1,543.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,029.42
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cofinity Commercial |
$1,482.36
|
| Rate for Payer: Cofinity Commercial |
$1,379.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,029.42
|
| Rate for Payer: Healthscope Commercial |
$1,904.43
|
| Rate for Payer: Healthscope Commercial |
$1,647.07
|
| Rate for Payer: Mclaren Medicaid |
$680.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,080.89
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189,536.00
|
| Rate for Payer: Nomi Health Commercial |
$1,235.30
|
| Rate for Payer: PACE SWMI |
$1,029.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,029.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,895.98
|
| Rate for Payer: Priority Health Medicare |
$1,029.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,895.98
|
| Rate for Payer: Priority Health SBD |
$1,895.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,085.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,029.42
|
| Rate for Payer: UHC Exchange |
$1,085.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,029.42
|
| Rate for Payer: UHCCP Medicaid |
$680.32
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$840.07 |
| Max. Negotiated Rate |
$233,955.00 |
| Rate for Payer: Aetna Commercial |
$1,703.74
|
| Rate for Payer: Aetna Medicare |
$1,322.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,830.89
|
| Rate for Payer: BCBS Complete |
$882.07
|
| Rate for Payer: BCBS MAPPO |
$1,271.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.94
|
| Rate for Payer: BCN Commercial |
$1,905.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,271.45
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.89
|
| Rate for Payer: Cofinity Commercial |
$1,703.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,271.45
|
| Rate for Payer: Healthscope Commercial |
$2,352.18
|
| Rate for Payer: Healthscope Commercial |
$2,034.32
|
| Rate for Payer: Mclaren Medicaid |
$840.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,335.02
|
| Rate for Payer: Meridian Medicaid |
$882.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233,955.00
|
| Rate for Payer: Nomi Health Commercial |
$1,525.74
|
| Rate for Payer: PACE SWMI |
$1,271.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,271.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,342.82
|
| Rate for Payer: Priority Health Medicare |
$1,271.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,342.82
|
| Rate for Payer: Priority Health SBD |
$2,342.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,261.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,271.45
|
| Rate for Payer: UHC Exchange |
$1,261.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,271.45
|
| Rate for Payer: UHCCP Medicaid |
$840.07
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$272.07 |
| Max. Negotiated Rate |
$231,397.00 |
| Rate for Payer: Aetna Commercial |
$1,683.67
|
| Rate for Payer: Aetna Medicare |
$1,306.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,683.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,809.32
|
| Rate for Payer: BCBS Complete |
$871.34
|
| Rate for Payer: BCBS MAPPO |
$1,256.47
|
| Rate for Payer: BCBS Trust/PPO |
$272.07
|
| Rate for Payer: BCN Commercial |
$1,883.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,256.47
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cofinity Commercial |
$1,809.32
|
| Rate for Payer: Cofinity Commercial |
$1,683.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,256.47
|
| Rate for Payer: Healthscope Commercial |
$2,324.47
|
| Rate for Payer: Healthscope Commercial |
$2,010.35
|
| Rate for Payer: Mclaren Medicaid |
$829.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.29
|
| Rate for Payer: Meridian Medicaid |
$871.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231,397.00
|
| Rate for Payer: Nomi Health Commercial |
$1,507.76
|
| Rate for Payer: PACE SWMI |
$1,256.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,256.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$829.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,314.79
|
| Rate for Payer: Priority Health Medicare |
$1,256.47
|
| Rate for Payer: Priority Health Narrow Network |
$2,314.79
|
| Rate for Payer: Priority Health SBD |
$2,314.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,555.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,256.47
|
| Rate for Payer: UHC Exchange |
$1,555.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,256.47
|
| Rate for Payer: UHCCP Medicaid |
$829.85
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$20,470.00 |
| Rate for Payer: Aetna Commercial |
$147.72
|
| Rate for Payer: Aetna Medicare |
$114.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.75
|
| Rate for Payer: BCBS Complete |
$75.37
|
| Rate for Payer: BCBS MAPPO |
$110.24
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: BCN Medicare Advantage |
$110.24
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$147.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.24
|
| Rate for Payer: Healthscope Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$176.38
|
| Rate for Payer: Mclaren Medicaid |
$71.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.75
|
| Rate for Payer: Meridian Medicaid |
$75.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,470.00
|
| Rate for Payer: Nomi Health Commercial |
$132.29
|
| Rate for Payer: PACE SWMI |
$110.24
|
| Rate for Payer: PHP Medicare Advantage |
$110.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.46
|
| Rate for Payer: Priority Health Medicare |
$110.24
|
| Rate for Payer: Priority Health Narrow Network |
$200.46
|
| Rate for Payer: Priority Health SBD |
$200.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.24
|
| Rate for Payer: UHC Medicare Advantage |
$110.24
|
| Rate for Payer: UHCCP Medicaid |
$71.78
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$57,320.00 |
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Medicare |
$359.02
|
| Rate for Payer: Aetna Medicare |
$359.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.58
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Healthscope Commercial |
$552.34
|
| Rate for Payer: Healthscope Commercial |
$638.64
|
| Rate for Payer: Healthscope Commercial |
$552.34
|
| Rate for Payer: Healthscope Commercial |
$638.64
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57,320.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57,320.00
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.39
|
| Rate for Payer: Priority Health Medicare |
$345.21
|
| Rate for Payer: Priority Health Medicare |
$345.21
|
| Rate for Payer: Priority Health Narrow Network |
$546.39
|
| Rate for Payer: Priority Health Narrow Network |
$546.39
|
| Rate for Payer: Priority Health SBD |
$73.73
|
| Rate for Payer: Priority Health SBD |
$73.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Exchange |
$134.36
|
| Rate for Payer: UHC Exchange |
$134.36
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$23,247.00 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Aetna Medicare |
$131.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.84
|
| Rate for Payer: BCBS Complete |
$89.01
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: BCN Commercial |
$603.52
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$181.84
|
| Rate for Payer: Cofinity Commercial |
$169.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Healthscope Commercial |
$233.62
|
| Rate for Payer: Healthscope Commercial |
$202.05
|
| Rate for Payer: Mclaren Medicaid |
$84.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.59
|
| Rate for Payer: Meridian Medicaid |
$89.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,247.00
|
| Rate for Payer: Nomi Health Commercial |
$151.54
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.66
|
| Rate for Payer: Priority Health Medicare |
$126.28
|
| Rate for Payer: Priority Health Narrow Network |
$235.66
|
| Rate for Payer: Priority Health SBD |
$235.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.28
|
| Rate for Payer: UHC Exchange |
$178.62
|
| Rate for Payer: UHC Medicare Advantage |
$126.28
|
| Rate for Payer: UHCCP Medicaid |
$84.77
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$24,547.00 |
| Rate for Payer: Aetna Commercial |
$177.26
|
| Rate for Payer: Aetna Medicare |
$137.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.48
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS MAPPO |
$132.28
|
| Rate for Payer: BCBS Trust/PPO |
$278.94
|
| Rate for Payer: BCN Commercial |
$201.83
|
| Rate for Payer: BCN Medicare Advantage |
$132.28
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$190.48
|
| Rate for Payer: Cofinity Commercial |
$177.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.28
|
| Rate for Payer: Healthscope Commercial |
$244.72
|
| Rate for Payer: Healthscope Commercial |
$211.65
|
| Rate for Payer: Mclaren Medicaid |
$88.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.89
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,547.00
|
| Rate for Payer: Nomi Health Commercial |
$158.74
|
| Rate for Payer: PACE SWMI |
$132.28
|
| Rate for Payer: PHP Medicare Advantage |
$132.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$132.28
|
| Rate for Payer: Priority Health Narrow Network |
$248.78
|
| Rate for Payer: Priority Health SBD |
$248.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.28
|
| Rate for Payer: UHC Exchange |
$258.49
|
| Rate for Payer: UHC Medicare Advantage |
$132.28
|
| Rate for Payer: UHCCP Medicaid |
$88.82
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,658.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$1,290.11 |
| Max. Negotiated Rate |
$518,706.00 |
| Rate for Payer: Aetna Commercial |
$3,779.36
|
| Rate for Payer: Aetna Medicare |
$2,933.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,061.40
|
| Rate for Payer: BCBS Complete |
$1,955.37
|
| Rate for Payer: BCBS MAPPO |
$2,820.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.11
|
| Rate for Payer: BCN Commercial |
$4,222.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,820.42
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cofinity Commercial |
$4,061.40
|
| Rate for Payer: Cofinity Commercial |
$3,779.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,820.42
|
| Rate for Payer: Healthscope Commercial |
$5,217.78
|
| Rate for Payer: Healthscope Commercial |
$4,512.67
|
| Rate for Payer: Mclaren Medicaid |
$1,862.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,961.44
|
| Rate for Payer: Meridian Medicaid |
$1,955.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518,706.00
|
| Rate for Payer: Nomi Health Commercial |
$3,384.50
|
| Rate for Payer: PACE SWMI |
$2,820.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,820.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,862.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,327.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,185.60
|
| Rate for Payer: Priority Health Medicare |
$2,820.42
|
| Rate for Payer: Priority Health Narrow Network |
$5,185.60
|
| Rate for Payer: Priority Health SBD |
$5,185.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,093.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,820.42
|
| Rate for Payer: UHC Exchange |
$3,093.88
|
| Rate for Payer: UHC Medicare Advantage |
$2,820.42
|
| Rate for Payer: UHCCP Medicaid |
$1,862.26
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,567.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$557,053.00 |
| Rate for Payer: Aetna Commercial |
$4,050.31
|
| Rate for Payer: Aetna Medicare |
$3,143.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,050.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,352.57
|
| Rate for Payer: BCBS Complete |
$2,089.78
|
| Rate for Payer: BCBS MAPPO |
$3,022.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,288.00
|
| Rate for Payer: BCN Commercial |
$4,525.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,022.62
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cofinity Commercial |
$4,352.57
|
| Rate for Payer: Cofinity Commercial |
$4,050.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,022.62
|
| Rate for Payer: Healthscope Commercial |
$5,591.85
|
| Rate for Payer: Healthscope Commercial |
$4,836.19
|
| Rate for Payer: Mclaren Medicaid |
$1,990.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,173.75
|
| Rate for Payer: Meridian Medicaid |
$2,089.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557,053.00
|
| Rate for Payer: Nomi Health Commercial |
$3,627.14
|
| Rate for Payer: PACE SWMI |
$3,022.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,022.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,990.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,918.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,547.72
|
| Rate for Payer: Priority Health Medicare |
$3,022.62
|
| Rate for Payer: Priority Health Narrow Network |
$5,547.72
|
| Rate for Payer: Priority Health SBD |
$5,547.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,387.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,022.62
|
| Rate for Payer: UHC Exchange |
$3,387.96
|
| Rate for Payer: UHC Medicare Advantage |
$3,022.62
|
| Rate for Payer: UHCCP Medicaid |
$1,990.27
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$110,974.00 |
| Rate for Payer: Aetna Commercial |
$802.47
|
| Rate for Payer: Aetna Medicare |
$622.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.36
|
| Rate for Payer: BCBS Complete |
$425.39
|
| Rate for Payer: BCBS MAPPO |
$598.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,573.28
|
| Rate for Payer: BCN Commercial |
$919.69
|
| Rate for Payer: BCN Medicare Advantage |
$598.86
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cofinity Commercial |
$862.36
|
| Rate for Payer: Cofinity Commercial |
$802.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.86
|
| Rate for Payer: Healthscope Commercial |
$958.18
|
| Rate for Payer: Healthscope Commercial |
$1,107.89
|
| Rate for Payer: Mclaren Medicaid |
$405.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$628.80
|
| Rate for Payer: Meridian Medicaid |
$425.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,974.00
|
| Rate for Payer: Nomi Health Commercial |
$718.63
|
| Rate for Payer: PACE SWMI |
$598.86
|
| Rate for Payer: PHP Medicare Advantage |
$598.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.55
|
| Rate for Payer: Priority Health Medicare |
$598.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,130.55
|
| Rate for Payer: Priority Health SBD |
$1,130.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.86
|
| Rate for Payer: UHC Exchange |
$856.56
|
| Rate for Payer: UHC Medicare Advantage |
$598.86
|
| Rate for Payer: UHCCP Medicaid |
$405.13
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$703.75 |
| Max. Negotiated Rate |
$194,722.00 |
| Rate for Payer: Aetna Commercial |
$1,404.21
|
| Rate for Payer: Aetna Medicare |
$1,089.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.00
|
| Rate for Payer: BCBS Complete |
$738.94
|
| Rate for Payer: BCBS MAPPO |
$1,047.92
|
| Rate for Payer: BCN Commercial |
$1,603.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.92
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,509.00
|
| Rate for Payer: Cofinity Commercial |
$1,404.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.92
|
| Rate for Payer: Healthscope Commercial |
$1,938.65
|
| Rate for Payer: Healthscope Commercial |
$1,676.67
|
| Rate for Payer: Mclaren Medicaid |
$703.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.32
|
| Rate for Payer: Meridian Medicaid |
$738.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194,722.00
|
| Rate for Payer: Nomi Health Commercial |
$1,257.50
|
| Rate for Payer: PACE SWMI |
$1,047.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,965.18
|
| Rate for Payer: Priority Health Medicare |
$1,047.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,965.18
|
| Rate for Payer: Priority Health SBD |
$1,965.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,513.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.92
|
| Rate for Payer: UHC Exchange |
$1,513.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.92
|
| Rate for Payer: UHCCP Medicaid |
$703.75
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,977.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$937.84 |
| Max. Negotiated Rate |
$263,461.00 |
| Rate for Payer: Aetna Commercial |
$1,912.92
|
| Rate for Payer: Aetna Medicare |
$1,484.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,912.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,055.67
|
| Rate for Payer: BCBS Complete |
$984.73
|
| Rate for Payer: BCBS MAPPO |
$1,427.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.37
|
| Rate for Payer: BCN Commercial |
$2,135.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.55
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cofinity Commercial |
$2,055.67
|
| Rate for Payer: Cofinity Commercial |
$1,912.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,427.55
|
| Rate for Payer: Healthscope Commercial |
$2,640.97
|
| Rate for Payer: Healthscope Commercial |
$2,284.08
|
| Rate for Payer: Mclaren Medicaid |
$937.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.93
|
| Rate for Payer: Meridian Medicaid |
$984.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263,461.00
|
| Rate for Payer: Nomi Health Commercial |
$1,713.06
|
| Rate for Payer: PACE SWMI |
$1,427.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$937.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,235.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,618.45
|
| Rate for Payer: Priority Health Medicare |
$1,427.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,618.45
|
| Rate for Payer: Priority Health SBD |
$2,618.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,107.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,427.55
|
| Rate for Payer: UHC Exchange |
$2,107.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.55
|
| Rate for Payer: UHCCP Medicaid |
$937.84
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$1,000.04 |
| Max. Negotiated Rate |
$282,357.00 |
| Rate for Payer: Aetna Commercial |
$2,047.94
|
| Rate for Payer: Aetna Medicare |
$1,589.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,200.77
|
| Rate for Payer: BCBS Complete |
$1,050.04
|
| Rate for Payer: BCBS MAPPO |
$1,528.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.03
|
| Rate for Payer: BCN Commercial |
$2,281.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,528.31
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cofinity Commercial |
$2,200.77
|
| Rate for Payer: Cofinity Commercial |
$2,047.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,528.31
|
| Rate for Payer: Healthscope Commercial |
$2,827.37
|
| Rate for Payer: Healthscope Commercial |
$2,445.30
|
| Rate for Payer: Mclaren Medicaid |
$1,000.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,604.73
|
| Rate for Payer: Meridian Medicaid |
$1,050.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282,357.00
|
| Rate for Payer: Nomi Health Commercial |
$1,833.97
|
| Rate for Payer: PACE SWMI |
$1,528.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,528.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,180.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,795.64
|
| Rate for Payer: Priority Health Medicare |
$1,528.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,795.64
|
| Rate for Payer: Priority Health SBD |
$2,795.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,238.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,528.31
|
| Rate for Payer: UHC Exchange |
$2,238.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,528.31
|
| Rate for Payer: UHCCP Medicaid |
$1,000.04
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$1,386.00 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$9.15
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$13.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.15
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$14.64
|
| Rate for Payer: Healthscope Commercial |
$16.93
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.61
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,386.00
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: PACE SWMI |
$9.15
|
| Rate for Payer: PHP Medicare Advantage |
$9.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.66
|
| Rate for Payer: Priority Health Medicare |
$9.15
|
| Rate for Payer: Priority Health Narrow Network |
$12.66
|
| Rate for Payer: Priority Health SBD |
$12.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.15
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$29,399.00 |
| Rate for Payer: Aetna Commercial |
$256.23
|
| Rate for Payer: Aetna Medicare |
$198.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.36
|
| Rate for Payer: BCBS Complete |
$135.98
|
| Rate for Payer: BCBS MAPPO |
$191.22
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: BCN Medicare Advantage |
$191.22
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$275.36
|
| Rate for Payer: Cofinity Commercial |
$256.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.22
|
| Rate for Payer: Healthscope Commercial |
$305.95
|
| Rate for Payer: Healthscope Commercial |
$353.76
|
| Rate for Payer: Mclaren Medicaid |
$129.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.78
|
| Rate for Payer: Meridian Medicaid |
$135.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,399.00
|
| Rate for Payer: Nomi Health Commercial |
$229.46
|
| Rate for Payer: PACE SWMI |
$191.22
|
| Rate for Payer: PHP Medicare Advantage |
$191.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.29
|
| Rate for Payer: Priority Health Medicare |
$191.22
|
| Rate for Payer: Priority Health Narrow Network |
$272.29
|
| Rate for Payer: Priority Health SBD |
$272.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.22
|
| Rate for Payer: UHC Medicare Advantage |
$191.22
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$42,884.00 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.45
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$423.20
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Healthscope Commercial |
$444.94
|
| Rate for Payer: Healthscope Commercial |
$514.47
|
| Rate for Payer: Mclaren Medicaid |
$187.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,884.00
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.42
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: Priority Health Narrow Network |
$394.42
|
| Rate for Payer: Priority Health SBD |
$394.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$51,603.00 |
| Rate for Payer: Aetna Commercial |
$449.45
|
| Rate for Payer: Aetna Medicare |
$348.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.99
|
| Rate for Payer: BCBS Complete |
$237.07
|
| Rate for Payer: BCBS MAPPO |
$335.41
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$335.41
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$482.99
|
| Rate for Payer: Cofinity Commercial |
$449.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.41
|
| Rate for Payer: Healthscope Commercial |
$536.66
|
| Rate for Payer: Healthscope Commercial |
$620.51
|
| Rate for Payer: Mclaren Medicaid |
$225.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.18
|
| Rate for Payer: Meridian Medicaid |
$237.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51,603.00
|
| Rate for Payer: Nomi Health Commercial |
$402.49
|
| Rate for Payer: PACE SWMI |
$335.41
|
| Rate for Payer: PHP Medicare Advantage |
$335.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.93
|
| Rate for Payer: Priority Health Medicare |
$335.41
|
| Rate for Payer: Priority Health Narrow Network |
$474.93
|
| Rate for Payer: Priority Health SBD |
$474.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.41
|
| Rate for Payer: UHC Medicare Advantage |
$335.41
|
| Rate for Payer: UHCCP Medicaid |
$225.78
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$42,839.00 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.45
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCBS Trust/PPO |
$211.32
|
| Rate for Payer: BCN Commercial |
$422.71
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Healthscope Commercial |
$444.94
|
| Rate for Payer: Healthscope Commercial |
$514.47
|
| Rate for Payer: Mclaren Medicaid |
$187.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,839.00
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.42
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: Priority Health Narrow Network |
$394.42
|
| Rate for Payer: Priority Health SBD |
$394.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,655.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$132.14 |
| Max. Negotiated Rate |
$62,381.00 |
| Rate for Payer: Aetna Commercial |
$391.44
|
| Rate for Payer: Aetna Medicare |
$1,327.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.44
|
| Rate for Payer: BCBS Complete |
$1,062.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62,381.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.75
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$398.74 |
| Max. Negotiated Rate |
$107,869.00 |
| Rate for Payer: Aetna Commercial |
$764.36
|
| Rate for Payer: Aetna Medicare |
$593.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.40
|
| Rate for Payer: BCBS Complete |
$418.68
|
| Rate for Payer: BCBS MAPPO |
$570.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.94
|
| Rate for Payer: BCN Commercial |
$920.18
|
| Rate for Payer: BCN Medicare Advantage |
$570.42
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$764.36
|
| Rate for Payer: Cofinity Commercial |
$821.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.42
|
| Rate for Payer: Healthscope Commercial |
$1,055.28
|
| Rate for Payer: Healthscope Commercial |
$912.67
|
| Rate for Payer: Mclaren Medicaid |
$398.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.94
|
| Rate for Payer: Meridian Medicaid |
$418.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107,869.00
|
| Rate for Payer: Nomi Health Commercial |
$684.50
|
| Rate for Payer: PACE SWMI |
$570.42
|
| Rate for Payer: PHP Medicare Advantage |
$570.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.95
|
| Rate for Payer: Priority Health Medicare |
$570.42
|
| Rate for Payer: Priority Health Narrow Network |
$875.95
|
| Rate for Payer: Priority Health SBD |
$875.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.42
|
| Rate for Payer: UHC Exchange |
$452.41
|
| Rate for Payer: UHC Medicare Advantage |
$570.42
|
| Rate for Payer: UHCCP Medicaid |
$398.74
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$498.21 |
| Max. Negotiated Rate |
$139,997.00 |
| Rate for Payer: Aetna Commercial |
$970.96
|
| Rate for Payer: Aetna Medicare |
$753.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,043.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.96
|
| Rate for Payer: BCBS Complete |
$523.12
|
| Rate for Payer: BCBS MAPPO |
$724.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.51
|
| Rate for Payer: BCN Commercial |
$1,178.69
|
| Rate for Payer: BCN Medicare Advantage |
$724.60
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cofinity Commercial |
$970.96
|
| Rate for Payer: Cofinity Commercial |
$1,043.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.60
|
| Rate for Payer: Healthscope Commercial |
$1,340.51
|
| Rate for Payer: Healthscope Commercial |
$1,159.36
|
| Rate for Payer: Mclaren Medicaid |
$498.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$760.83
|
| Rate for Payer: Meridian Medicaid |
$523.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139,997.00
|
| Rate for Payer: Nomi Health Commercial |
$869.52
|
| Rate for Payer: PACE SWMI |
$724.60
|
| Rate for Payer: PHP Medicare Advantage |
$724.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,091.46
|
| Rate for Payer: Priority Health Medicare |
$724.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,091.46
|
| Rate for Payer: Priority Health SBD |
$1,091.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.60
|
| Rate for Payer: UHC Exchange |
$699.49
|
| Rate for Payer: UHC Medicare Advantage |
$724.60
|
| Rate for Payer: UHCCP Medicaid |
$498.21
|
|
