|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$54.07 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$72.45
|
| Rate for Payer: Aetna Medicare |
$56.23
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$54.07
|
| Rate for Payer: BCN Medicare Advantage |
$54.07
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$77.86
|
| Rate for Payer: Cofinity Commercial |
$72.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.77
|
| Rate for Payer: Nomi Health Commercial |
$64.88
|
| Rate for Payer: PACE SWMI |
$54.07
|
| Rate for Payer: PHP Medicare Advantage |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$54.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.07
|
| Rate for Payer: UHC Exchange |
$54.07
|
| Rate for Payer: UHC Medicare Advantage |
$54.07
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$232.70 |
| Rate for Payer: Aetna Commercial |
$75.75
|
| Rate for Payer: Aetna Medicare |
$58.79
|
| Rate for Payer: BCBS Complete |
$143.20
|
| Rate for Payer: BCBS MAPPO |
$56.53
|
| Rate for Payer: BCN Medicare Advantage |
$56.53
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.36
|
| Rate for Payer: Nomi Health Commercial |
$67.84
|
| Rate for Payer: PACE SWMI |
$56.53
|
| Rate for Payer: PHP Medicare Advantage |
$56.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: Priority Health Medicare |
$57.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.53
|
| Rate for Payer: UHC Exchange |
$56.53
|
| Rate for Payer: UHC Medicare Advantage |
$56.53
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$228.39
|
| Rate for Payer: Aetna Medicare |
$177.26
|
| Rate for Payer: BCBS Complete |
$544.00
|
| Rate for Payer: BCBS MAPPO |
$170.44
|
| Rate for Payer: BCN Medicare Advantage |
$170.44
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$245.43
|
| Rate for Payer: Cofinity Commercial |
$228.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.96
|
| Rate for Payer: Nomi Health Commercial |
$204.53
|
| Rate for Payer: PACE SWMI |
$170.44
|
| Rate for Payer: PHP Medicare Advantage |
$170.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health Medicare |
$172.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.44
|
| Rate for Payer: UHC Exchange |
$170.44
|
| Rate for Payer: UHC Medicare Advantage |
$170.44
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$319.15 |
| Rate for Payer: Aetna Commercial |
$97.12
|
| Rate for Payer: Aetna Medicare |
$75.38
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: BCBS MAPPO |
$72.48
|
| Rate for Payer: BCN Medicare Advantage |
$72.48
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.10
|
| Rate for Payer: Nomi Health Commercial |
$86.98
|
| Rate for Payer: PACE SWMI |
$72.48
|
| Rate for Payer: PHP Medicare Advantage |
$72.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health Medicare |
$73.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.48
|
| Rate for Payer: UHC Exchange |
$72.48
|
| Rate for Payer: UHC Medicare Advantage |
$72.48
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$91.89 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$123.13
|
| Rate for Payer: Aetna Medicare |
$95.57
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$91.89
|
| Rate for Payer: BCN Medicare Advantage |
$91.89
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$132.32
|
| Rate for Payer: Cofinity Commercial |
$123.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.48
|
| Rate for Payer: Nomi Health Commercial |
$110.27
|
| Rate for Payer: PACE SWMI |
$91.89
|
| Rate for Payer: PHP Medicare Advantage |
$91.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$92.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.89
|
| Rate for Payer: UHC Exchange |
$91.89
|
| Rate for Payer: UHC Medicare Advantage |
$91.89
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$165.10 |
| Rate for Payer: Aetna Commercial |
$57.97
|
| Rate for Payer: Aetna Medicare |
$44.99
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS MAPPO |
$43.26
|
| Rate for Payer: BCN Medicare Advantage |
$43.26
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Cofinity Commercial |
$57.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.42
|
| Rate for Payer: Nomi Health Commercial |
$51.91
|
| Rate for Payer: PACE SWMI |
$43.26
|
| Rate for Payer: PHP Medicare Advantage |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.10
|
| Rate for Payer: Priority Health Medicare |
$43.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.26
|
| Rate for Payer: UHC Exchange |
$43.26
|
| Rate for Payer: UHC Medicare Advantage |
$43.26
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$146.58
|
| Rate for Payer: BCBS Complete |
$220.40
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$140.94
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.99
|
| Rate for Payer: Nomi Health Commercial |
$169.13
|
| Rate for Payer: PACE SWMI |
$140.94
|
| Rate for Payer: PHP Medicare Advantage |
$140.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.15
|
| Rate for Payer: Priority Health Medicare |
$142.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Exchange |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Aetna Commercial |
$95.21
|
| Rate for Payer: Aetna Medicare |
$73.89
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: BCBS MAPPO |
$71.05
|
| Rate for Payer: BCN Medicare Advantage |
$71.05
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$95.21
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.60
|
| Rate for Payer: Nomi Health Commercial |
$85.26
|
| Rate for Payer: PACE SWMI |
$71.05
|
| Rate for Payer: PHP Medicare Advantage |
$71.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health Medicare |
$71.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.05
|
| Rate for Payer: UHC Exchange |
$71.05
|
| Rate for Payer: UHC Medicare Advantage |
$71.05
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$17.07
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$12.74
|
| Rate for Payer: BCN Medicare Advantage |
$12.74
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$17.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.38
|
| Rate for Payer: Nomi Health Commercial |
$15.29
|
| Rate for Payer: PACE SWMI |
$12.74
|
| Rate for Payer: PHP Medicare Advantage |
$12.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.74
|
| Rate for Payer: UHC Exchange |
$12.74
|
| Rate for Payer: UHC Medicare Advantage |
$12.74
|
|
|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 31087
|
| Min. Negotiated Rate |
$857.20 |
| Max. Negotiated Rate |
$1,515.43 |
| Rate for Payer: Aetna Commercial |
$1,410.19
|
| Rate for Payer: Aetna Medicare |
$1,094.48
|
| Rate for Payer: BCBS Complete |
$857.20
|
| Rate for Payer: BCBS MAPPO |
$1,052.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,052.38
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cofinity Commercial |
$1,515.43
|
| Rate for Payer: Cofinity Commercial |
$1,410.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,052.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,105.00
|
| Rate for Payer: Nomi Health Commercial |
$1,262.86
|
| Rate for Payer: PACE SWMI |
$1,052.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,052.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.95
|
| Rate for Payer: Priority Health Medicare |
$1,062.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,052.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,052.38
|
| Rate for Payer: UHC Exchange |
$1,052.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,052.38
|
|
|
PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 31081
|
| Min. Negotiated Rate |
$834.00 |
| Max. Negotiated Rate |
$1,569.99 |
| Rate for Payer: Aetna Commercial |
$1,460.96
|
| Rate for Payer: Aetna Medicare |
$1,133.88
|
| Rate for Payer: BCBS Complete |
$834.00
|
| Rate for Payer: BCBS MAPPO |
$1,090.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,090.27
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,569.99
|
| Rate for Payer: Cofinity Commercial |
$1,460.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,090.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,144.78
|
| Rate for Payer: Nomi Health Commercial |
$1,308.32
|
| Rate for Payer: PACE SWMI |
$1,090.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,090.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.25
|
| Rate for Payer: Priority Health Medicare |
$1,101.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,090.27
|
| Rate for Payer: UHC Exchange |
$1,090.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,090.27
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,667.00
|
|
|
Service Code
|
HCPCS 31085
|
| Min. Negotiated Rate |
$1,066.80 |
| Max. Negotiated Rate |
$1,733.55 |
| Rate for Payer: Aetna Commercial |
$1,560.71
|
| Rate for Payer: Aetna Medicare |
$1,211.30
|
| Rate for Payer: BCBS Complete |
$1,066.80
|
| Rate for Payer: BCBS MAPPO |
$1,164.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,164.71
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cofinity Commercial |
$1,677.18
|
| Rate for Payer: Cofinity Commercial |
$1,560.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,164.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,222.95
|
| Rate for Payer: Nomi Health Commercial |
$1,397.65
|
| Rate for Payer: PACE SWMI |
$1,164.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,164.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.55
|
| Rate for Payer: Priority Health Medicare |
$1,176.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,164.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,164.71
|
| Rate for Payer: UHC Exchange |
$1,164.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,164.71
|
|
|
PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 31032
|
| Min. Negotiated Rate |
$449.60 |
| Max. Negotiated Rate |
$800.28 |
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna Medicare |
$577.98
|
| Rate for Payer: BCBS Complete |
$449.60
|
| Rate for Payer: BCBS MAPPO |
$555.75
|
| Rate for Payer: BCN Medicare Advantage |
$555.75
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cofinity Commercial |
$800.28
|
| Rate for Payer: Cofinity Commercial |
$744.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.54
|
| Rate for Payer: Nomi Health Commercial |
$666.90
|
| Rate for Payer: PACE SWMI |
$555.75
|
| Rate for Payer: PHP Medicare Advantage |
$555.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.60
|
| Rate for Payer: Priority Health Medicare |
$561.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.75
|
| Rate for Payer: UHC Exchange |
$555.75
|
| Rate for Payer: UHC Medicare Advantage |
$555.75
|
|
|
PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 31080
|
| Min. Negotiated Rate |
$905.60 |
| Max. Negotiated Rate |
$1,471.60 |
| Rate for Payer: Aetna Commercial |
$1,360.07
|
| Rate for Payer: Aetna Medicare |
$1,055.58
|
| Rate for Payer: BCBS Complete |
$905.60
|
| Rate for Payer: BCBS MAPPO |
$1,014.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.98
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,461.57
|
| Rate for Payer: Cofinity Commercial |
$1,360.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,065.73
|
| Rate for Payer: Nomi Health Commercial |
$1,217.98
|
| Rate for Payer: PACE SWMI |
$1,014.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,471.60
|
| Rate for Payer: Priority Health Medicare |
$1,025.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,014.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,014.98
|
| Rate for Payer: UHC Exchange |
$1,014.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.98
|
|
|
PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 31070
|
| Min. Negotiated Rate |
$354.40 |
| Max. Negotiated Rate |
$632.72 |
| Rate for Payer: Aetna Commercial |
$588.78
|
| Rate for Payer: Aetna Medicare |
$456.97
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$439.39
|
| Rate for Payer: BCN Medicare Advantage |
$439.39
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$632.72
|
| Rate for Payer: Cofinity Commercial |
$588.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.36
|
| Rate for Payer: Nomi Health Commercial |
$527.27
|
| Rate for Payer: PACE SWMI |
$439.39
|
| Rate for Payer: PHP Medicare Advantage |
$439.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$443.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.39
|
| Rate for Payer: UHC Exchange |
$439.39
|
| Rate for Payer: UHC Medicare Advantage |
$439.39
|
|
|
PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 31020
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$425.57
|
| Rate for Payer: Aetna Medicare |
$330.29
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$317.59
|
| Rate for Payer: BCN Medicare Advantage |
$317.59
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$457.33
|
| Rate for Payer: Cofinity Commercial |
$425.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.47
|
| Rate for Payer: Nomi Health Commercial |
$381.11
|
| Rate for Payer: PACE SWMI |
$317.59
|
| Rate for Payer: PHP Medicare Advantage |
$317.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$320.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.59
|
| Rate for Payer: UHC Exchange |
$317.59
|
| Rate for Payer: UHC Medicare Advantage |
$317.59
|
|
|
PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 31030
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$751.40 |
| Rate for Payer: Aetna Commercial |
$645.67
|
| Rate for Payer: Aetna Medicare |
$501.11
|
| Rate for Payer: BCBS Complete |
$462.40
|
| Rate for Payer: BCBS MAPPO |
$481.84
|
| Rate for Payer: BCN Medicare Advantage |
$481.84
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$693.85
|
| Rate for Payer: Cofinity Commercial |
$645.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.93
|
| Rate for Payer: Nomi Health Commercial |
$578.21
|
| Rate for Payer: PACE SWMI |
$481.84
|
| Rate for Payer: PHP Medicare Advantage |
$481.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health Medicare |
$486.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.84
|
| Rate for Payer: UHC Exchange |
$481.84
|
| Rate for Payer: UHC Medicare Advantage |
$481.84
|
|
|
PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 31051
|
| Min. Negotiated Rate |
$642.02 |
| Max. Negotiated Rate |
$1,213.55 |
| Rate for Payer: Aetna Commercial |
$860.31
|
| Rate for Payer: Aetna Medicare |
$667.70
|
| Rate for Payer: BCBS Complete |
$746.80
|
| Rate for Payer: BCBS MAPPO |
$642.02
|
| Rate for Payer: BCN Medicare Advantage |
$642.02
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cofinity Commercial |
$860.31
|
| Rate for Payer: Cofinity Commercial |
$924.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.12
|
| Rate for Payer: Nomi Health Commercial |
$770.42
|
| Rate for Payer: PACE SWMI |
$642.02
|
| Rate for Payer: PHP Medicare Advantage |
$642.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.55
|
| Rate for Payer: Priority Health Medicare |
$648.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.02
|
| Rate for Payer: UHC Exchange |
$642.02
|
| Rate for Payer: UHC Medicare Advantage |
$642.02
|
|
|
PR SKIN LESION SHAVE/EXCISION (15 MIN)
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00367
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR SKIN LESION SHAVE/EXCISION (30 MIN)
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00368
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
|
|
PR SKYLA, 13.5 MG
|
Professional
|
Both
|
$1,462.00
|
|
|
Service Code
|
HCPCS J7301
|
| Min. Negotiated Rate |
$584.80 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Aetna Medicare |
$731.00
|
| Rate for Payer: BCBS Complete |
$584.80
|
| Rate for Payer: Cash Price |
$1,169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.30
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 36251
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$324.47
|
| Rate for Payer: Aetna Medicare |
$251.83
|
| Rate for Payer: BCBS Complete |
$205.60
|
| Rate for Payer: BCBS MAPPO |
$242.14
|
| Rate for Payer: BCN Medicare Advantage |
$242.14
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$348.68
|
| Rate for Payer: Cofinity Commercial |
$324.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.25
|
| Rate for Payer: Nomi Health Commercial |
$290.57
|
| Rate for Payer: PACE SWMI |
$242.14
|
| Rate for Payer: PHP Medicare Advantage |
$242.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.10
|
| Rate for Payer: Priority Health Medicare |
$244.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.14
|
| Rate for Payer: UHC Exchange |
$242.14
|
| Rate for Payer: UHC Medicare Advantage |
$242.14
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 36252
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$489.31 |
| Rate for Payer: Aetna Commercial |
$455.33
|
| Rate for Payer: Aetna Medicare |
$353.39
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$339.80
|
| Rate for Payer: BCN Medicare Advantage |
$339.80
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$489.31
|
| Rate for Payer: Cofinity Commercial |
$455.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.79
|
| Rate for Payer: Nomi Health Commercial |
$407.76
|
| Rate for Payer: PACE SWMI |
$339.80
|
| Rate for Payer: PHP Medicare Advantage |
$339.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$343.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.80
|
| Rate for Payer: UHC Exchange |
$339.80
|
| Rate for Payer: UHC Medicare Advantage |
$339.80
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
HCPCS 36223
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,170.65 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Aetna Medicare |
$333.01
|
| Rate for Payer: BCBS Complete |
$720.40
|
| Rate for Payer: BCBS MAPPO |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$320.20
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cofinity Commercial |
$461.09
|
| Rate for Payer: Cofinity Commercial |
$429.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.21
|
| Rate for Payer: Nomi Health Commercial |
$384.24
|
| Rate for Payer: PACE SWMI |
$320.20
|
| Rate for Payer: PHP Medicare Advantage |
$320.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.65
|
| Rate for Payer: Priority Health Medicare |
$323.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.20
|
| Rate for Payer: UHC Exchange |
$320.20
|
| Rate for Payer: UHC Medicare Advantage |
$320.20
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 36222
|
| Min. Negotiated Rate |
$275.22 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$368.79
|
| Rate for Payer: Aetna Medicare |
$286.23
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$275.22
|
| Rate for Payer: BCN Medicare Advantage |
$275.22
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$396.32
|
| Rate for Payer: Cofinity Commercial |
$368.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.98
|
| Rate for Payer: Nomi Health Commercial |
$330.26
|
| Rate for Payer: PACE SWMI |
$275.22
|
| Rate for Payer: PHP Medicare Advantage |
$275.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$277.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.22
|
| Rate for Payer: UHC Exchange |
$275.22
|
| Rate for Payer: UHC Medicare Advantage |
$275.22
|
|
