|
PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 31296
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$2,519.62 |
| Rate for Payer: Aetna Commercial |
$236.72
|
| Rate for Payer: Aetna Medicare |
$183.73
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$176.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.37
|
| Rate for Payer: BCN Commercial |
$2,519.62
|
| Rate for Payer: BCN Medicare Advantage |
$176.66
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.66
|
| Rate for Payer: Mclaren Medicaid |
$113.96
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.49
|
| Rate for Payer: PACE SWMI |
$176.66
|
| Rate for Payer: PHP Medicare Advantage |
$176.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.27
|
| Rate for Payer: Priority Health Medicare |
$176.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.66
|
| Rate for Payer: UHC Medicare Advantage |
$181.96
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS
|
Professional
|
Both
|
$3,915.00
|
|
|
Service Code
|
HCPCS 31295
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$2,740.50 |
| Rate for Payer: Aetna Commercial |
$207.70
|
| Rate for Payer: Aetna Medicare |
$161.20
|
| Rate for Payer: BCBS Complete |
$105.34
|
| Rate for Payer: BCBS MAPPO |
$155.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,788.82
|
| Rate for Payer: BCN Commercial |
$2,482.00
|
| Rate for Payer: BCN Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$3,132.00
|
| Rate for Payer: Cash Price |
$3,132.00
|
| Rate for Payer: Cofinity Commercial |
$207.70
|
| Rate for Payer: Cofinity Commercial |
$223.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.00
|
| Rate for Payer: Mclaren Medicaid |
$100.32
|
| Rate for Payer: Meridian Medicaid |
$105.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$162.75
|
| Rate for Payer: PACE SWMI |
$155.00
|
| Rate for Payer: PHP Medicare Advantage |
$155.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,740.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.17
|
| Rate for Payer: Priority Health Medicare |
$155.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.00
|
| Rate for Payer: UHC Medicare Advantage |
$159.65
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS
|
Professional
|
Both
|
$3,208.00
|
|
|
Service Code
|
HCPCS 31297
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$2,461.47 |
| Rate for Payer: Aetna Commercial |
$189.53
|
| Rate for Payer: Aetna Medicare |
$147.10
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$141.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.49
|
| Rate for Payer: BCN Commercial |
$2,461.47
|
| Rate for Payer: BCN Medicare Advantage |
$141.44
|
| Rate for Payer: Cash Price |
$2,566.40
|
| Rate for Payer: Cash Price |
$2,566.40
|
| Rate for Payer: Cofinity Commercial |
$189.53
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.44
|
| Rate for Payer: Mclaren Medicaid |
$91.59
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.51
|
| Rate for Payer: PACE SWMI |
$141.44
|
| Rate for Payer: PHP Medicare Advantage |
$141.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Medicare |
$141.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.44
|
| Rate for Payer: UHC Medicare Advantage |
$145.68
|
|
|
PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 31257
|
| Min. Negotiated Rate |
$282.86 |
| Max. Negotiated Rate |
$1,077.73 |
| Rate for Payer: Aetna Commercial |
$588.92
|
| Rate for Payer: Aetna Medicare |
$457.07
|
| Rate for Payer: BCBS Complete |
$297.00
|
| Rate for Payer: BCBS MAPPO |
$439.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.73
|
| Rate for Payer: BCN Commercial |
$647.50
|
| Rate for Payer: BCN Medicare Advantage |
$439.49
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$588.92
|
| Rate for Payer: Cofinity Commercial |
$632.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.49
|
| Rate for Payer: Mclaren Medicaid |
$282.86
|
| Rate for Payer: Meridian Medicaid |
$297.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$461.46
|
| Rate for Payer: PACE SWMI |
$439.49
|
| Rate for Payer: PHP Medicare Advantage |
$439.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.54
|
| Rate for Payer: Priority Health Medicare |
$439.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.49
|
| Rate for Payer: UHC Medicare Advantage |
$452.67
|
|
|
PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
HCPCS 31253
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$661.10
|
| Rate for Payer: Aetna Medicare |
$513.09
|
| Rate for Payer: BCBS Complete |
$332.79
|
| Rate for Payer: BCBS MAPPO |
$493.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$726.66
|
| Rate for Payer: BCN Medicare Advantage |
$493.36
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cofinity Commercial |
$710.44
|
| Rate for Payer: Cofinity Commercial |
$661.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.36
|
| Rate for Payer: Mclaren Medicaid |
$316.94
|
| Rate for Payer: Meridian Medicaid |
$332.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$518.03
|
| Rate for Payer: PACE SWMI |
$493.36
|
| Rate for Payer: PHP Medicare Advantage |
$493.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$688.54
|
| Rate for Payer: Priority Health Medicare |
$493.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$688.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.36
|
| Rate for Payer: UHC Medicare Advantage |
$508.16
|
|
|
PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 31259
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,218.26 |
| Rate for Payer: Aetna Commercial |
$623.23
|
| Rate for Payer: Aetna Medicare |
$483.70
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS MAPPO |
$465.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.26
|
| Rate for Payer: BCN Commercial |
$685.13
|
| Rate for Payer: BCN Medicare Advantage |
$465.10
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$669.74
|
| Rate for Payer: Cofinity Commercial |
$623.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.10
|
| Rate for Payer: Mclaren Medicaid |
$298.84
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$488.36
|
| Rate for Payer: PACE SWMI |
$465.10
|
| Rate for Payer: PHP Medicare Advantage |
$465.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.19
|
| Rate for Payer: Priority Health Medicare |
$465.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.10
|
| Rate for Payer: UHC Medicare Advantage |
$479.05
|
|
|
PR NASAL/SINUS NDSC W/LIG SPHENOPALATINE ARTERY
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 31241
|
| Min. Negotiated Rate |
$282.65 |
| Max. Negotiated Rate |
$1,456.52 |
| Rate for Payer: Aetna Commercial |
$587.27
|
| Rate for Payer: Aetna Medicare |
$455.79
|
| Rate for Payer: BCBS Complete |
$296.78
|
| Rate for Payer: BCBS MAPPO |
$438.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,456.52
|
| Rate for Payer: BCN Commercial |
$645.54
|
| Rate for Payer: BCN Medicare Advantage |
$438.26
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$587.27
|
| Rate for Payer: Cofinity Commercial |
$631.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.26
|
| Rate for Payer: Mclaren Medicaid |
$282.65
|
| Rate for Payer: Meridian Medicaid |
$296.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$460.17
|
| Rate for Payer: PACE SWMI |
$438.26
|
| Rate for Payer: PHP Medicare Advantage |
$438.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.68
|
| Rate for Payer: Priority Health Medicare |
$438.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$611.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$438.26
|
| Rate for Payer: UHC Medicare Advantage |
$451.41
|
|
|
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 31254
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$1,345.05 |
| Rate for Payer: Aetna Commercial |
$320.77
|
| Rate for Payer: Aetna Medicare |
$248.96
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS MAPPO |
$239.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,345.05
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$239.38
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cofinity Commercial |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$344.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.38
|
| Rate for Payer: Mclaren Medicaid |
$154.43
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.35
|
| Rate for Payer: PACE SWMI |
$239.38
|
| Rate for Payer: PHP Medicare Advantage |
$239.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.78
|
| Rate for Payer: Priority Health Medicare |
$239.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.38
|
| Rate for Payer: UHC Medicare Advantage |
$246.56
|
|
|
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
HCPCS 31276
|
| Min. Negotiated Rate |
$240.05 |
| Max. Negotiated Rate |
$1,458.11 |
| Rate for Payer: Aetna Commercial |
$499.03
|
| Rate for Payer: Aetna Medicare |
$387.31
|
| Rate for Payer: BCBS Complete |
$252.05
|
| Rate for Payer: BCBS MAPPO |
$372.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.11
|
| Rate for Payer: BCN Commercial |
$548.78
|
| Rate for Payer: BCN Medicare Advantage |
$372.41
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$536.27
|
| Rate for Payer: Cofinity Commercial |
$499.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.41
|
| Rate for Payer: Mclaren Medicaid |
$240.05
|
| Rate for Payer: Meridian Medicaid |
$252.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$391.03
|
| Rate for Payer: PACE SWMI |
$372.41
|
| Rate for Payer: PHP Medicare Advantage |
$372.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$520.00
|
| Rate for Payer: Priority Health Medicare |
$372.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$520.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.41
|
| Rate for Payer: UHC Medicare Advantage |
$383.58
|
|
|
PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS 31255
|
| Min. Negotiated Rate |
$205.12 |
| Max. Negotiated Rate |
$1,500.90 |
| Rate for Payer: Aetna Commercial |
$427.34
|
| Rate for Payer: Aetna Medicare |
$331.67
|
| Rate for Payer: BCBS Complete |
$215.38
|
| Rate for Payer: BCBS MAPPO |
$318.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.90
|
| Rate for Payer: BCN Commercial |
$470.10
|
| Rate for Payer: BCN Medicare Advantage |
$318.91
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cofinity Commercial |
$459.23
|
| Rate for Payer: Cofinity Commercial |
$427.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.91
|
| Rate for Payer: Mclaren Medicaid |
$205.12
|
| Rate for Payer: Meridian Medicaid |
$215.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$334.86
|
| Rate for Payer: PACE SWMI |
$318.91
|
| Rate for Payer: PHP Medicare Advantage |
$318.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.44
|
| Rate for Payer: Priority Health Medicare |
$318.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.91
|
| Rate for Payer: UHC Medicare Advantage |
$328.48
|
|
|
PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 43752
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$1,612.37 |
| Rate for Payer: Aetna Commercial |
$53.25
|
| Rate for Payer: Aetna Medicare |
$41.33
|
| Rate for Payer: BCBS Complete |
$26.39
|
| Rate for Payer: BCBS MAPPO |
$39.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.37
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Medicare Advantage |
$39.74
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$53.25
|
| Rate for Payer: Cofinity Commercial |
$57.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.74
|
| Rate for Payer: Mclaren Medicaid |
$25.13
|
| Rate for Payer: Meridian Medicaid |
$26.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.73
|
| Rate for Payer: PACE SWMI |
$39.74
|
| Rate for Payer: PHP Medicare Advantage |
$39.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.98
|
| Rate for Payer: Priority Health Medicare |
$39.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.74
|
| Rate for Payer: UHC Medicare Advantage |
$40.93
|
|
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 92511
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$49.10
|
| Rate for Payer: Aetna Medicare |
$38.11
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS MAPPO |
$36.64
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$139.00
|
| Rate for Payer: BCN Medicare Advantage |
$36.64
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$52.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.64
|
| Rate for Payer: Mclaren Medicaid |
$24.07
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.47
|
| Rate for Payer: PACE SWMI |
$36.64
|
| Rate for Payer: PHP Medicare Advantage |
$36.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.30
|
| Rate for Payer: Priority Health Medicare |
$36.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.64
|
| Rate for Payer: UHC Medicare Advantage |
$37.74
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 95860
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$1,210.86 |
| Rate for Payer: Aetna Commercial |
$142.83
|
| Rate for Payer: Aetna Medicare |
$110.85
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS MAPPO |
$106.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,210.86
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: BCN Medicare Advantage |
$106.59
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$142.83
|
| Rate for Payer: Cofinity Commercial |
$153.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.92
|
| Rate for Payer: PACE SWMI |
$106.59
|
| Rate for Payer: PHP Medicare Advantage |
$106.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.46
|
| Rate for Payer: Priority Health Medicare |
$106.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.59
|
| Rate for Payer: UHC Medicare Advantage |
$109.79
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 95861
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$204.98
|
| Rate for Payer: Aetna Medicare |
$159.09
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$152.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.84
|
| Rate for Payer: BCN Commercial |
$234.08
|
| Rate for Payer: BCN Medicare Advantage |
$152.97
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$220.28
|
| Rate for Payer: Cofinity Commercial |
$204.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$160.62
|
| Rate for Payer: PACE SWMI |
$152.97
|
| Rate for Payer: PHP Medicare Advantage |
$152.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.14
|
| Rate for Payer: Priority Health Medicare |
$152.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.97
|
| Rate for Payer: UHC Medicare Advantage |
$157.56
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 95863
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$706.87 |
| Rate for Payer: Aetna Commercial |
$265.53
|
| Rate for Payer: Aetna Medicare |
$206.09
|
| Rate for Payer: BCBS Complete |
$141.60
|
| Rate for Payer: BCBS MAPPO |
$198.16
|
| Rate for Payer: BCBS Trust/PPO |
$706.87
|
| Rate for Payer: BCN Commercial |
$303.96
|
| Rate for Payer: BCN Medicare Advantage |
$198.16
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cofinity Commercial |
$265.53
|
| Rate for Payer: Cofinity Commercial |
$285.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$208.07
|
| Rate for Payer: PACE SWMI |
$198.16
|
| Rate for Payer: PHP Medicare Advantage |
$198.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.37
|
| Rate for Payer: Priority Health Medicare |
$198.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.16
|
| Rate for Payer: UHC Medicare Advantage |
$204.10
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 95864
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$953.58 |
| Rate for Payer: Aetna Commercial |
$297.20
|
| Rate for Payer: Aetna Medicare |
$230.66
|
| Rate for Payer: BCBS Complete |
$162.00
|
| Rate for Payer: BCBS MAPPO |
$221.79
|
| Rate for Payer: BCBS Trust/PPO |
$953.58
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: BCN Medicare Advantage |
$221.79
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$319.38
|
| Rate for Payer: Cofinity Commercial |
$297.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.88
|
| Rate for Payer: PACE SWMI |
$221.79
|
| Rate for Payer: PHP Medicare Advantage |
$221.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.05
|
| Rate for Payer: Priority Health Medicare |
$221.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.79
|
| Rate for Payer: UHC Medicare Advantage |
$228.44
|
|
|
PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$856.00
|
|
|
Service Code
|
HCPCS 44385
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$1,990.63 |
| Rate for Payer: Aetna Commercial |
$95.56
|
| Rate for Payer: Aetna Medicare |
$74.16
|
| Rate for Payer: BCBS Complete |
$48.53
|
| Rate for Payer: BCBS MAPPO |
$71.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,990.63
|
| Rate for Payer: BCN Commercial |
$317.65
|
| Rate for Payer: BCN Medicare Advantage |
$71.31
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.31
|
| Rate for Payer: Mclaren Medicaid |
$46.22
|
| Rate for Payer: Meridian Medicaid |
$48.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$74.88
|
| Rate for Payer: PACE SWMI |
$71.31
|
| Rate for Payer: PHP Medicare Advantage |
$71.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.01
|
| Rate for Payer: Priority Health Medicare |
$71.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.31
|
| Rate for Payer: UHC Medicare Advantage |
$73.45
|
|
|
PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 44386
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$3,257.50 |
| Rate for Payer: Aetna Commercial |
$116.29
|
| Rate for Payer: Aetna Medicare |
$90.25
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS MAPPO |
$86.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,257.50
|
| Rate for Payer: BCN Commercial |
$458.38
|
| Rate for Payer: BCN Medicare Advantage |
$86.78
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cofinity Commercial |
$116.29
|
| Rate for Payer: Cofinity Commercial |
$124.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.78
|
| Rate for Payer: Mclaren Medicaid |
$56.45
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.12
|
| Rate for Payer: PACE SWMI |
$86.78
|
| Rate for Payer: PHP Medicare Advantage |
$86.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.63
|
| Rate for Payer: Priority Health Medicare |
$86.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.78
|
| Rate for Payer: UHC Medicare Advantage |
$89.38
|
|
|
PR NDSC NJX IMPLT MATRL URT&/BLDR NCK
|
Professional
|
Both
|
$1,715.00
|
|
|
Service Code
|
HCPCS 51715
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$2,071.46 |
| Rate for Payer: Aetna Commercial |
$262.13
|
| Rate for Payer: Aetna Medicare |
$203.44
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS MAPPO |
$195.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.46
|
| Rate for Payer: BCN Commercial |
$544.39
|
| Rate for Payer: BCN Medicare Advantage |
$195.62
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cofinity Commercial |
$281.69
|
| Rate for Payer: Cofinity Commercial |
$262.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.62
|
| Rate for Payer: Mclaren Medicaid |
$126.10
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$205.40
|
| Rate for Payer: PACE SWMI |
$195.62
|
| Rate for Payer: PHP Medicare Advantage |
$195.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.74
|
| Rate for Payer: Priority Health Medicare |
$195.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.62
|
| Rate for Payer: UHC Medicare Advantage |
$201.49
|
|
|
PR NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 33508
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$878.56 |
| Rate for Payer: Aetna Commercial |
$21.23
|
| Rate for Payer: Aetna Medicare |
$16.47
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS MAPPO |
$15.84
|
| Rate for Payer: BCBS Trust/PPO |
$878.56
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Medicare Advantage |
$15.84
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$22.81
|
| Rate for Payer: Cofinity Commercial |
$21.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.84
|
| Rate for Payer: Mclaren Medicaid |
$10.01
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.63
|
| Rate for Payer: PACE SWMI |
$15.84
|
| Rate for Payer: PHP Medicare Advantage |
$15.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.01
|
| Rate for Payer: Priority Health Medicare |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.84
|
| Rate for Payer: UHC Medicare Advantage |
$16.32
|
|
|
PR NDSC URETEROTOMY RMVL FB/CALCULUS
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 50980
|
| Min. Negotiated Rate |
$223.22 |
| Max. Negotiated Rate |
$2,962.71 |
| Rate for Payer: Aetna Commercial |
$463.60
|
| Rate for Payer: Aetna Medicare |
$359.81
|
| Rate for Payer: BCBS Complete |
$234.38
|
| Rate for Payer: BCBS MAPPO |
$345.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,962.71
|
| Rate for Payer: BCN Commercial |
$507.73
|
| Rate for Payer: BCN Medicare Advantage |
$345.97
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$498.20
|
| Rate for Payer: Cofinity Commercial |
$463.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.97
|
| Rate for Payer: Mclaren Medicaid |
$223.22
|
| Rate for Payer: Meridian Medicaid |
$234.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$363.27
|
| Rate for Payer: PACE SWMI |
$345.97
|
| Rate for Payer: PHP Medicare Advantage |
$345.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.44
|
| Rate for Payer: Priority Health Medicare |
$345.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.97
|
| Rate for Payer: UHC Medicare Advantage |
$356.35
|
|
|
PR NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 50972
|
| Min. Negotiated Rate |
$224.29 |
| Max. Negotiated Rate |
$2,720.22 |
| Rate for Payer: Aetna Commercial |
$466.24
|
| Rate for Payer: Aetna Medicare |
$361.86
|
| Rate for Payer: BCBS Complete |
$235.50
|
| Rate for Payer: BCBS MAPPO |
$347.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,720.22
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$347.94
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$501.03
|
| Rate for Payer: Cofinity Commercial |
$466.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.94
|
| Rate for Payer: Mclaren Medicaid |
$224.29
|
| Rate for Payer: Meridian Medicaid |
$235.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$365.34
|
| Rate for Payer: PACE SWMI |
$347.94
|
| Rate for Payer: PHP Medicare Advantage |
$347.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$224.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$564.67
|
| Rate for Payer: Priority Health Medicare |
$347.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.94
|
| Rate for Payer: UHC Medicare Advantage |
$358.38
|
|
|
PR NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$1,840.00
|
|
|
Service Code
|
HCPCS 29848
|
| Min. Negotiated Rate |
$333.98 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$675.11
|
| Rate for Payer: Aetna Medicare |
$523.96
|
| Rate for Payer: BCBS Complete |
$350.68
|
| Rate for Payer: BCBS MAPPO |
$503.81
|
| Rate for Payer: BCBS Trust/PPO |
$571.09
|
| Rate for Payer: BCN Commercial |
$756.47
|
| Rate for Payer: BCN Medicare Advantage |
$503.81
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cofinity Commercial |
$725.49
|
| Rate for Payer: Cofinity Commercial |
$675.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$503.81
|
| Rate for Payer: Mclaren Medicaid |
$333.98
|
| Rate for Payer: Meridian Medicaid |
$350.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$529.00
|
| Rate for Payer: PACE SWMI |
$503.81
|
| Rate for Payer: PHP Medicare Advantage |
$503.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$790.48
|
| Rate for Payer: Priority Health Medicare |
$503.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$790.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$503.81
|
| Rate for Payer: UHC Medicare Advantage |
$518.92
|
|
|
PR NECK LIFT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 00541
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: BCBS Complete |
$800.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 95868
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$284.75 |
| Rate for Payer: Aetna Commercial |
$177.23
|
| Rate for Payer: Aetna Medicare |
$137.55
|
| Rate for Payer: BCBS Complete |
$105.60
|
| Rate for Payer: BCBS MAPPO |
$132.26
|
| Rate for Payer: BCBS Trust/PPO |
$284.75
|
| Rate for Payer: BCN Commercial |
$203.29
|
| Rate for Payer: BCN Medicare Advantage |
$132.26
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$177.23
|
| Rate for Payer: Cofinity Commercial |
$190.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.87
|
| Rate for Payer: PACE SWMI |
$132.26
|
| Rate for Payer: PHP Medicare Advantage |
$132.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.84
|
| Rate for Payer: Priority Health Medicare |
$132.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.26
|
| Rate for Payer: UHC Medicare Advantage |
$136.23
|
|
