|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 31238
|
| Min. Negotiated Rate |
$159.42 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna Commercial |
$213.62
|
| Rate for Payer: Aetna Medicare |
$165.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.62
|
| Rate for Payer: BCBS Complete |
$259.20
|
| Rate for Payer: BCBS MAPPO |
$159.42
|
| Rate for Payer: BCN Medicare Advantage |
$159.42
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Cofinity Commercial |
$213.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.42
|
| Rate for Payer: Healthscope Commercial |
$255.07
|
| Rate for Payer: Healthscope Commercial |
$294.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.20
|
| Rate for Payer: Nomi Health Commercial |
$191.30
|
| Rate for Payer: PACE SWMI |
$159.42
|
| Rate for Payer: PHP Medicare Advantage |
$159.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.20
|
| Rate for Payer: Priority Health Medicare |
$159.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.42
|
| Rate for Payer: UHC Medicare Advantage |
$159.42
|
|
|
PR NASAL/SINUS NDSC SURG W/DACRYOCYSTORHINOSTOMY
|
Professional
|
Both
|
$1,332.00
|
|
|
Service Code
|
HCPCS 31239
|
| Min. Negotiated Rate |
$532.80 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Aetna Commercial |
$767.93
|
| Rate for Payer: Aetna Medicare |
$596.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.93
|
| Rate for Payer: BCBS Complete |
$532.80
|
| Rate for Payer: BCBS MAPPO |
$573.08
|
| Rate for Payer: BCN Medicare Advantage |
$573.08
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cofinity Commercial |
$825.24
|
| Rate for Payer: Cofinity Commercial |
$767.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.08
|
| Rate for Payer: Healthscope Commercial |
$916.93
|
| Rate for Payer: Healthscope Commercial |
$1,060.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.80
|
| Rate for Payer: Nomi Health Commercial |
$687.70
|
| Rate for Payer: PACE SWMI |
$573.08
|
| Rate for Payer: PHP Medicare Advantage |
$573.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.80
|
| Rate for Payer: Priority Health Medicare |
$573.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.08
|
| Rate for Payer: UHC Medicare Advantage |
$573.08
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 31296
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$371.15 |
| Rate for Payer: Aetna Commercial |
$230.92
|
| Rate for Payer: Aetna Medicare |
$179.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.92
|
| Rate for Payer: BCBS Complete |
$228.40
|
| Rate for Payer: BCBS MAPPO |
$172.33
|
| Rate for Payer: BCN Medicare Advantage |
$172.33
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cofinity Commercial |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$230.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.33
|
| Rate for Payer: Healthscope Commercial |
$275.73
|
| Rate for Payer: Healthscope Commercial |
$318.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.15
|
| Rate for Payer: Nomi Health Commercial |
$206.80
|
| Rate for Payer: PACE SWMI |
$172.33
|
| Rate for Payer: PHP Medicare Advantage |
$172.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.15
|
| Rate for Payer: Priority Health Medicare |
$172.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.33
|
| Rate for Payer: UHC Medicare Advantage |
$172.33
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS
|
Professional
|
Both
|
$3,993.00
|
|
|
Service Code
|
HCPCS 31295
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$2,595.45 |
| Rate for Payer: Aetna Commercial |
$202.00
|
| Rate for Payer: Aetna Medicare |
$156.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.00
|
| Rate for Payer: BCBS Complete |
$1,597.20
|
| Rate for Payer: BCBS MAPPO |
$150.75
|
| Rate for Payer: BCN Medicare Advantage |
$150.75
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.75
|
| Rate for Payer: Healthscope Commercial |
$278.89
|
| Rate for Payer: Healthscope Commercial |
$241.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,595.45
|
| Rate for Payer: Nomi Health Commercial |
$180.90
|
| Rate for Payer: PACE SWMI |
$150.75
|
| Rate for Payer: PHP Medicare Advantage |
$150.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,595.45
|
| Rate for Payer: Priority Health Medicare |
$150.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.75
|
| Rate for Payer: UHC Medicare Advantage |
$150.75
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS
|
Professional
|
Both
|
$3,272.00
|
|
|
Service Code
|
HCPCS 31297
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$2,126.80 |
| Rate for Payer: Aetna Commercial |
$184.09
|
| Rate for Payer: Aetna Medicare |
$142.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.09
|
| Rate for Payer: BCBS Complete |
$1,308.80
|
| Rate for Payer: BCBS MAPPO |
$137.38
|
| Rate for Payer: BCN Medicare Advantage |
$137.38
|
| Rate for Payer: Cash Price |
$2,617.60
|
| Rate for Payer: Cash Price |
$2,617.60
|
| Rate for Payer: Cofinity Commercial |
$197.83
|
| Rate for Payer: Cofinity Commercial |
$184.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.38
|
| Rate for Payer: Healthscope Commercial |
$219.81
|
| Rate for Payer: Healthscope Commercial |
$254.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,126.80
|
| Rate for Payer: Nomi Health Commercial |
$164.86
|
| Rate for Payer: PACE SWMI |
$137.38
|
| Rate for Payer: PHP Medicare Advantage |
$137.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.80
|
| Rate for Payer: Priority Health Medicare |
$137.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.38
|
| Rate for Payer: UHC Medicare Advantage |
$137.38
|
|
|
PR NASAL/SINUS NDSC SURG W/LIG SPHENOPALATINE ART
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 31241
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$783.66 |
| Rate for Payer: Aetna Commercial |
$567.62
|
| Rate for Payer: Aetna Medicare |
$440.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.62
|
| Rate for Payer: BCBS Complete |
$369.60
|
| Rate for Payer: BCBS MAPPO |
$423.60
|
| Rate for Payer: BCN Medicare Advantage |
$423.60
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$609.98
|
| Rate for Payer: Cofinity Commercial |
$567.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.60
|
| Rate for Payer: Healthscope Commercial |
$783.66
|
| Rate for Payer: Healthscope Commercial |
$677.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.60
|
| Rate for Payer: Nomi Health Commercial |
$508.32
|
| Rate for Payer: PACE SWMI |
$423.60
|
| Rate for Payer: PHP Medicare Advantage |
$423.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$423.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.60
|
| Rate for Payer: UHC Medicare Advantage |
$423.60
|
|
|
PR NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN
|
Professional
|
Both
|
$2,591.00
|
|
|
Service Code
|
HCPCS 31294
|
| Min. Negotiated Rate |
$1,036.40 |
| Max. Negotiated Rate |
$2,158.64 |
| Rate for Payer: Aetna Commercial |
$1,563.55
|
| Rate for Payer: Aetna Medicare |
$1,213.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,680.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.55
|
| Rate for Payer: BCBS Complete |
$1,036.40
|
| Rate for Payer: BCBS MAPPO |
$1,166.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,166.83
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Cofinity Commercial |
$1,680.24
|
| Rate for Payer: Cofinity Commercial |
$1,563.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,166.83
|
| Rate for Payer: Healthscope Commercial |
$1,866.93
|
| Rate for Payer: Healthscope Commercial |
$2,158.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,225.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,684.15
|
| Rate for Payer: Nomi Health Commercial |
$1,400.20
|
| Rate for Payer: PACE SWMI |
$1,166.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,166.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,684.15
|
| Rate for Payer: Priority Health Medicare |
$1,166.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,166.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,166.83
|
|
|
PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 31257
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$786.23 |
| Rate for Payer: Aetna Commercial |
$569.49
|
| Rate for Payer: Aetna Medicare |
$441.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.49
|
| Rate for Payer: BCBS Complete |
$368.00
|
| Rate for Payer: BCBS MAPPO |
$424.99
|
| Rate for Payer: BCN Medicare Advantage |
$424.99
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$611.99
|
| Rate for Payer: Cofinity Commercial |
$569.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.99
|
| Rate for Payer: Healthscope Commercial |
$786.23
|
| Rate for Payer: Healthscope Commercial |
$679.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.00
|
| Rate for Payer: Nomi Health Commercial |
$509.99
|
| Rate for Payer: PACE SWMI |
$424.99
|
| Rate for Payer: PHP Medicare Advantage |
$424.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.00
|
| Rate for Payer: Priority Health Medicare |
$424.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$424.99
|
| Rate for Payer: UHC Medicare Advantage |
$424.99
|
|
|
PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL
|
Professional
|
Both
|
$1,019.00
|
|
|
Service Code
|
HCPCS 31253
|
| Min. Negotiated Rate |
$407.60 |
| Max. Negotiated Rate |
$881.67 |
| Rate for Payer: Aetna Commercial |
$638.62
|
| Rate for Payer: Aetna Medicare |
$495.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.62
|
| Rate for Payer: BCBS Complete |
$407.60
|
| Rate for Payer: BCBS MAPPO |
$476.58
|
| Rate for Payer: BCN Medicare Advantage |
$476.58
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cofinity Commercial |
$686.28
|
| Rate for Payer: Cofinity Commercial |
$638.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.58
|
| Rate for Payer: Healthscope Commercial |
$762.53
|
| Rate for Payer: Healthscope Commercial |
$881.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$500.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$662.35
|
| Rate for Payer: Nomi Health Commercial |
$571.90
|
| Rate for Payer: PACE SWMI |
$476.58
|
| Rate for Payer: PHP Medicare Advantage |
$476.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.35
|
| Rate for Payer: Priority Health Medicare |
$476.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.58
|
| Rate for Payer: UHC Medicare Advantage |
$476.58
|
|
|
PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 31259
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$832.72 |
| Rate for Payer: Aetna Commercial |
$603.16
|
| Rate for Payer: Aetna Medicare |
$468.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.16
|
| Rate for Payer: BCBS Complete |
$390.00
|
| Rate for Payer: BCBS MAPPO |
$450.12
|
| Rate for Payer: BCN Medicare Advantage |
$450.12
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$648.17
|
| Rate for Payer: Cofinity Commercial |
$603.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.12
|
| Rate for Payer: Healthscope Commercial |
$832.72
|
| Rate for Payer: Healthscope Commercial |
$720.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.75
|
| Rate for Payer: Nomi Health Commercial |
$540.14
|
| Rate for Payer: PACE SWMI |
$450.12
|
| Rate for Payer: PHP Medicare Advantage |
$450.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health Medicare |
$450.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.12
|
| Rate for Payer: UHC Medicare Advantage |
$450.12
|
|
|
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 31254
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$482.95 |
| Rate for Payer: Aetna Commercial |
$310.87
|
| Rate for Payer: Aetna Medicare |
$241.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.87
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$231.99
|
| Rate for Payer: BCN Medicare Advantage |
$231.99
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$334.07
|
| Rate for Payer: Cofinity Commercial |
$310.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.99
|
| Rate for Payer: Healthscope Commercial |
$371.18
|
| Rate for Payer: Healthscope Commercial |
$429.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.95
|
| Rate for Payer: Nomi Health Commercial |
$278.39
|
| Rate for Payer: PACE SWMI |
$231.99
|
| Rate for Payer: PHP Medicare Advantage |
$231.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$231.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.99
|
| Rate for Payer: UHC Medicare Advantage |
$231.99
|
|
|
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 31276
|
| Min. Negotiated Rate |
$360.72 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$483.36
|
| Rate for Payer: Aetna Medicare |
$375.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.36
|
| Rate for Payer: BCBS Complete |
$544.00
|
| Rate for Payer: BCBS MAPPO |
$360.72
|
| Rate for Payer: BCN Medicare Advantage |
$360.72
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$519.44
|
| Rate for Payer: Cofinity Commercial |
$483.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.72
|
| Rate for Payer: Healthscope Commercial |
$667.33
|
| Rate for Payer: Healthscope Commercial |
$577.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$378.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.00
|
| Rate for Payer: Nomi Health Commercial |
$432.86
|
| Rate for Payer: PACE SWMI |
$360.72
|
| Rate for Payer: PHP Medicare Advantage |
$360.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health Medicare |
$360.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$360.72
|
| Rate for Payer: UHC Medicare Advantage |
$360.72
|
|
|
PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 31255
|
| Min. Negotiated Rate |
$308.16 |
| Max. Negotiated Rate |
$614.25 |
| Rate for Payer: Aetna Commercial |
$412.93
|
| Rate for Payer: Aetna Medicare |
$320.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.93
|
| Rate for Payer: BCBS Complete |
$378.00
|
| Rate for Payer: BCBS MAPPO |
$308.16
|
| Rate for Payer: BCN Medicare Advantage |
$308.16
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cofinity Commercial |
$443.75
|
| Rate for Payer: Cofinity Commercial |
$412.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.16
|
| Rate for Payer: Healthscope Commercial |
$493.06
|
| Rate for Payer: Healthscope Commercial |
$570.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.25
|
| Rate for Payer: Nomi Health Commercial |
$369.79
|
| Rate for Payer: PACE SWMI |
$308.16
|
| Rate for Payer: PHP Medicare Advantage |
$308.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$614.25
|
| Rate for Payer: Priority Health Medicare |
$308.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.16
|
| Rate for Payer: UHC Medicare Advantage |
$308.16
|
|
|
PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 43752
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Commercial |
$51.26
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.26
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$70.76
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.35
|
| Rate for Payer: Nomi Health Commercial |
$45.90
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
|
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 92511
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna Commercial |
$47.82
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.82
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS MAPPO |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$35.69
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.69
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Healthscope Commercial |
$66.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.15
|
| Rate for Payer: Nomi Health Commercial |
$42.83
|
| Rate for Payer: PACE SWMI |
$35.69
|
| Rate for Payer: PHP Medicare Advantage |
$35.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Medicare |
$35.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.69
|
| Rate for Payer: UHC Medicare Advantage |
$35.69
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 95860
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$186.35 |
| Rate for Payer: Aetna Commercial |
$134.98
|
| Rate for Payer: Aetna Medicare |
$104.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.98
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$100.73
|
| Rate for Payer: BCN Medicare Advantage |
$100.73
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$145.05
|
| Rate for Payer: Cofinity Commercial |
$134.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.73
|
| Rate for Payer: Healthscope Commercial |
$186.35
|
| Rate for Payer: Healthscope Commercial |
$161.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.75
|
| Rate for Payer: Nomi Health Commercial |
$120.88
|
| Rate for Payer: PACE SWMI |
$100.73
|
| Rate for Payer: PHP Medicare Advantage |
$100.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$100.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.73
|
| Rate for Payer: UHC Medicare Advantage |
$100.73
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 95861
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$261.16 |
| Rate for Payer: Aetna Commercial |
$189.17
|
| Rate for Payer: Aetna Medicare |
$146.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.17
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: BCBS MAPPO |
$141.17
|
| Rate for Payer: BCN Medicare Advantage |
$141.17
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$203.28
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.17
|
| Rate for Payer: Healthscope Commercial |
$225.87
|
| Rate for Payer: Healthscope Commercial |
$261.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.40
|
| Rate for Payer: Nomi Health Commercial |
$169.40
|
| Rate for Payer: PACE SWMI |
$141.17
|
| Rate for Payer: PHP Medicare Advantage |
$141.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health Medicare |
$141.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.17
|
| Rate for Payer: UHC Medicare Advantage |
$141.17
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 95863
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$353.57 |
| Rate for Payer: Aetna Commercial |
$256.10
|
| Rate for Payer: Aetna Medicare |
$198.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.10
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$191.12
|
| Rate for Payer: BCN Medicare Advantage |
$191.12
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$275.21
|
| Rate for Payer: Cofinity Commercial |
$256.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.12
|
| Rate for Payer: Healthscope Commercial |
$353.57
|
| Rate for Payer: Healthscope Commercial |
$305.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.65
|
| Rate for Payer: Nomi Health Commercial |
$229.34
|
| Rate for Payer: PACE SWMI |
$191.12
|
| Rate for Payer: PHP Medicare Advantage |
$191.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health Medicare |
$191.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.12
|
| Rate for Payer: UHC Medicare Advantage |
$191.12
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 95864
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Aetna Commercial |
$270.89
|
| Rate for Payer: Aetna Medicare |
$210.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.89
|
| Rate for Payer: BCBS Complete |
$165.20
|
| Rate for Payer: BCBS MAPPO |
$202.16
|
| Rate for Payer: BCN Medicare Advantage |
$202.16
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cofinity Commercial |
$291.11
|
| Rate for Payer: Cofinity Commercial |
$270.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.16
|
| Rate for Payer: Healthscope Commercial |
$323.46
|
| Rate for Payer: Healthscope Commercial |
$374.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.45
|
| Rate for Payer: Nomi Health Commercial |
$242.59
|
| Rate for Payer: PACE SWMI |
$202.16
|
| Rate for Payer: PHP Medicare Advantage |
$202.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.45
|
| Rate for Payer: Priority Health Medicare |
$202.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.16
|
| Rate for Payer: UHC Medicare Advantage |
$202.16
|
|
|
PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 92265
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$146.91 |
| Rate for Payer: Aetna Commercial |
$106.41
|
| Rate for Payer: Aetna Medicare |
$82.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.41
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$79.41
|
| Rate for Payer: BCN Medicare Advantage |
$79.41
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$114.35
|
| Rate for Payer: Cofinity Commercial |
$106.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.41
|
| Rate for Payer: Healthscope Commercial |
$146.91
|
| Rate for Payer: Healthscope Commercial |
$127.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.10
|
| Rate for Payer: Nomi Health Commercial |
$95.29
|
| Rate for Payer: PACE SWMI |
$79.41
|
| Rate for Payer: PHP Medicare Advantage |
$79.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$79.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.41
|
| Rate for Payer: UHC Medicare Advantage |
$79.41
|
|
|
PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 44385
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$567.45 |
| Rate for Payer: Aetna Commercial |
$92.14
|
| Rate for Payer: Aetna Medicare |
$71.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.14
|
| Rate for Payer: BCBS Complete |
$349.20
|
| Rate for Payer: BCBS MAPPO |
$68.76
|
| Rate for Payer: BCN Medicare Advantage |
$68.76
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$99.01
|
| Rate for Payer: Cofinity Commercial |
$92.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.76
|
| Rate for Payer: Healthscope Commercial |
$110.02
|
| Rate for Payer: Healthscope Commercial |
$127.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.45
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: PACE SWMI |
$68.76
|
| Rate for Payer: PHP Medicare Advantage |
$68.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health Medicare |
$68.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.76
|
| Rate for Payer: UHC Medicare Advantage |
$68.76
|
|
|
PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 44386
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$674.70 |
| Rate for Payer: Aetna Commercial |
$112.47
|
| Rate for Payer: Aetna Medicare |
$87.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.47
|
| Rate for Payer: BCBS Complete |
$415.20
|
| Rate for Payer: BCBS MAPPO |
$83.93
|
| Rate for Payer: BCN Medicare Advantage |
$83.93
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.93
|
| Rate for Payer: Healthscope Commercial |
$155.27
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.70
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: PACE SWMI |
$83.93
|
| Rate for Payer: PHP Medicare Advantage |
$83.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.70
|
| Rate for Payer: Priority Health Medicare |
$83.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.93
|
| Rate for Payer: UHC Medicare Advantage |
$83.93
|
|
|
PR NDSC NJX IMPLT MATRL URT&/BLDR NCK
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 51715
|
| Min. Negotiated Rate |
$190.39 |
| Max. Negotiated Rate |
$1,136.85 |
| Rate for Payer: Aetna Commercial |
$255.12
|
| Rate for Payer: Aetna Medicare |
$198.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.12
|
| Rate for Payer: BCBS Complete |
$699.60
|
| Rate for Payer: BCBS MAPPO |
$190.39
|
| Rate for Payer: BCN Medicare Advantage |
$190.39
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$274.16
|
| Rate for Payer: Cofinity Commercial |
$255.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.39
|
| Rate for Payer: Healthscope Commercial |
$304.62
|
| Rate for Payer: Healthscope Commercial |
$352.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.85
|
| Rate for Payer: Nomi Health Commercial |
$228.47
|
| Rate for Payer: PACE SWMI |
$190.39
|
| Rate for Payer: PHP Medicare Advantage |
$190.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.85
|
| Rate for Payer: Priority Health Medicare |
$190.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.39
|
| Rate for Payer: UHC Medicare Advantage |
$190.39
|
|
|
PR NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 33508
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$20.56
|
| Rate for Payer: Aetna Medicare |
$15.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.56
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: BCBS MAPPO |
$15.34
|
| Rate for Payer: BCN Medicare Advantage |
$15.34
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$22.09
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$28.38
|
| Rate for Payer: Healthscope Commercial |
$24.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.30
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: PACE SWMI |
$15.34
|
| Rate for Payer: PHP Medicare Advantage |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health Medicare |
$15.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.34
|
| Rate for Payer: UHC Medicare Advantage |
$15.34
|
|
|
PR NDSC URETEROTOMY RMVL FB/CALCULUS
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 50980
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$623.88 |
| Rate for Payer: Aetna Commercial |
$451.89
|
| Rate for Payer: Aetna Medicare |
$350.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.89
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$337.23
|
| Rate for Payer: BCN Medicare Advantage |
$337.23
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$485.61
|
| Rate for Payer: Cofinity Commercial |
$451.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$539.57
|
| Rate for Payer: Healthscope Commercial |
$623.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.15
|
| Rate for Payer: Nomi Health Commercial |
$404.68
|
| Rate for Payer: PACE SWMI |
$337.23
|
| Rate for Payer: PHP Medicare Advantage |
$337.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$337.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.23
|
| Rate for Payer: UHC Medicare Advantage |
$337.23
|
|
