|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$162.47 |
| Max. Negotiated Rate |
$345.15 |
| Rate for Payer: Aetna Commercial |
$217.71
|
| Rate for Payer: Aetna Medicare |
$168.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.71
|
| Rate for Payer: BCBS Complete |
$212.40
|
| Rate for Payer: BCBS MAPPO |
$162.47
|
| Rate for Payer: BCN Medicare Advantage |
$162.47
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$233.96
|
| Rate for Payer: Cofinity Commercial |
$217.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.59
|
| Rate for Payer: Nomi Health Commercial |
$194.96
|
| Rate for Payer: PACE SWMI |
$162.47
|
| Rate for Payer: PHP Commercial |
$227.46
|
| Rate for Payer: PHP Medicare Advantage |
$162.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.15
|
| Rate for Payer: Priority Health Medicare |
$162.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.47
|
| Rate for Payer: UHC Medicare Advantage |
$162.47
|
| Rate for Payer: UMR Bronson Commercial |
$244.26
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$184.75 |
| Max. Negotiated Rate |
$312.65 |
| Rate for Payer: Aetna Commercial |
$247.56
|
| Rate for Payer: Aetna Medicare |
$192.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.56
|
| Rate for Payer: BCBS Complete |
$192.40
|
| Rate for Payer: BCBS MAPPO |
$184.75
|
| Rate for Payer: BCN Medicare Advantage |
$184.75
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cofinity Commercial |
$266.04
|
| Rate for Payer: Cofinity Commercial |
$247.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.99
|
| Rate for Payer: Nomi Health Commercial |
$221.70
|
| Rate for Payer: PACE SWMI |
$184.75
|
| Rate for Payer: PHP Commercial |
$258.65
|
| Rate for Payer: PHP Medicare Advantage |
$184.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.65
|
| Rate for Payer: Priority Health Medicare |
$184.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.75
|
| Rate for Payer: UHC Medicare Advantage |
$184.75
|
| Rate for Payer: UMR Bronson Commercial |
$221.26
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$180.61 |
| Max. Negotiated Rate |
$373.10 |
| Rate for Payer: Aetna Commercial |
$242.02
|
| Rate for Payer: Aetna Medicare |
$187.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.02
|
| Rate for Payer: BCBS Complete |
$229.60
|
| Rate for Payer: BCBS MAPPO |
$180.61
|
| Rate for Payer: BCN Medicare Advantage |
$180.61
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$260.08
|
| Rate for Payer: Cofinity Commercial |
$242.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.64
|
| Rate for Payer: Nomi Health Commercial |
$216.73
|
| Rate for Payer: PACE SWMI |
$180.61
|
| Rate for Payer: PHP Commercial |
$252.85
|
| Rate for Payer: PHP Medicare Advantage |
$180.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Medicare |
$180.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.61
|
| Rate for Payer: UHC Medicare Advantage |
$180.61
|
| Rate for Payer: UMR Bronson Commercial |
$264.04
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$525.04 |
| Max. Negotiated Rate |
$859.30 |
| Rate for Payer: Aetna Commercial |
$703.55
|
| Rate for Payer: Aetna Medicare |
$546.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$756.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.55
|
| Rate for Payer: BCBS Complete |
$528.80
|
| Rate for Payer: BCBS MAPPO |
$525.04
|
| Rate for Payer: BCN Medicare Advantage |
$525.04
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$756.06
|
| Rate for Payer: Cofinity Commercial |
$703.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$525.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.29
|
| Rate for Payer: Nomi Health Commercial |
$630.05
|
| Rate for Payer: PACE SWMI |
$525.04
|
| Rate for Payer: PHP Commercial |
$735.06
|
| Rate for Payer: PHP Medicare Advantage |
$525.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health Medicare |
$525.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$525.04
|
| Rate for Payer: UHC Medicare Advantage |
$525.04
|
| Rate for Payer: UMR Bronson Commercial |
$608.12
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$955.60 |
| Max. Negotiated Rate |
$1,552.85 |
| Rate for Payer: Aetna Commercial |
$1,379.42
|
| Rate for Payer: Aetna Medicare |
$1,070.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,482.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,379.42
|
| Rate for Payer: BCBS Complete |
$955.60
|
| Rate for Payer: BCBS MAPPO |
$1,029.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,029.42
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cofinity Commercial |
$1,482.36
|
| Rate for Payer: Cofinity Commercial |
$1,379.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,029.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,080.89
|
| Rate for Payer: Nomi Health Commercial |
$1,235.30
|
| Rate for Payer: PACE SWMI |
$1,029.42
|
| Rate for Payer: PHP Commercial |
$1,441.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,029.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.85
|
| Rate for Payer: Priority Health Medicare |
$1,029.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,029.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,029.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,098.94
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$1,271.45 |
| Max. Negotiated Rate |
$2,299.05 |
| Rate for Payer: Aetna Commercial |
$1,703.74
|
| Rate for Payer: Aetna Medicare |
$1,322.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,830.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.74
|
| Rate for Payer: BCBS Complete |
$1,414.80
|
| Rate for Payer: BCBS MAPPO |
$1,271.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,271.45
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.89
|
| Rate for Payer: Cofinity Commercial |
$1,703.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,271.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,335.02
|
| Rate for Payer: Nomi Health Commercial |
$1,525.74
|
| Rate for Payer: PACE SWMI |
$1,271.45
|
| Rate for Payer: PHP Commercial |
$1,780.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,271.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health Medicare |
$1,271.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,271.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,271.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,627.02
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$1,256.47 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Aetna Commercial |
$1,683.67
|
| Rate for Payer: Aetna Medicare |
$1,306.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,809.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,683.67
|
| Rate for Payer: BCBS Complete |
$1,310.40
|
| Rate for Payer: BCBS MAPPO |
$1,256.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,256.47
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cofinity Commercial |
$1,809.32
|
| Rate for Payer: Cofinity Commercial |
$1,683.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,256.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.29
|
| Rate for Payer: Nomi Health Commercial |
$1,507.76
|
| Rate for Payer: PACE SWMI |
$1,256.47
|
| Rate for Payer: PHP Commercial |
$1,759.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,256.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health Medicare |
$1,256.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,256.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,256.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,506.96
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$158.75 |
| Rate for Payer: Aetna Commercial |
$147.72
|
| Rate for Payer: Aetna Medicare |
$114.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.72
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$110.24
|
| Rate for Payer: BCN Medicare Advantage |
$110.24
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$147.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.75
|
| Rate for Payer: Nomi Health Commercial |
$132.29
|
| Rate for Payer: PACE SWMI |
$110.24
|
| Rate for Payer: PHP Commercial |
$154.34
|
| Rate for Payer: PHP Medicare Advantage |
$110.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$110.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.24
|
| Rate for Payer: UHC Medicare Advantage |
$110.24
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Medicare |
$359.02
|
| Rate for Payer: Aetna Medicare |
$359.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.10
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PHP Commercial |
$483.29
|
| Rate for Payer: PHP Commercial |
$483.29
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health Medicare |
$345.21
|
| Rate for Payer: Priority Health Medicare |
$345.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UMR Bronson Commercial |
$376.74
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Aetna Medicare |
$131.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.22
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$181.84
|
| Rate for Payer: Cofinity Commercial |
$169.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.59
|
| Rate for Payer: Nomi Health Commercial |
$151.54
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Commercial |
$176.79
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$126.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.28
|
| Rate for Payer: UHC Medicare Advantage |
$126.28
|
| Rate for Payer: UMR Bronson Commercial |
$538.20
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$132.28 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$177.26
|
| Rate for Payer: Aetna Medicare |
$137.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.26
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$132.28
|
| Rate for Payer: BCN Medicare Advantage |
$132.28
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$190.48
|
| Rate for Payer: Cofinity Commercial |
$177.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.89
|
| Rate for Payer: Nomi Health Commercial |
$158.74
|
| Rate for Payer: PACE SWMI |
$132.28
|
| Rate for Payer: PHP Commercial |
$185.19
|
| Rate for Payer: PHP Medicare Advantage |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$132.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.28
|
| Rate for Payer: UHC Medicare Advantage |
$132.28
|
| Rate for Payer: UMR Bronson Commercial |
$507.84
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,658.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$2,663.20 |
| Max. Negotiated Rate |
$4,327.70 |
| Rate for Payer: Aetna Commercial |
$3,779.36
|
| Rate for Payer: Aetna Medicare |
$2,933.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,061.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.36
|
| Rate for Payer: BCBS Complete |
$2,663.20
|
| Rate for Payer: BCBS MAPPO |
$2,820.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,820.42
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cofinity Commercial |
$4,061.40
|
| Rate for Payer: Cofinity Commercial |
$3,779.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,820.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,961.44
|
| Rate for Payer: Nomi Health Commercial |
$3,384.50
|
| Rate for Payer: PACE SWMI |
$2,820.42
|
| Rate for Payer: PHP Commercial |
$3,948.59
|
| Rate for Payer: PHP Medicare Advantage |
$2,820.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,327.70
|
| Rate for Payer: Priority Health Medicare |
$2,820.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,820.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,820.42
|
| Rate for Payer: UMR Bronson Commercial |
$3,062.68
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,567.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$3,022.62 |
| Max. Negotiated Rate |
$4,918.55 |
| Rate for Payer: Aetna Commercial |
$4,050.31
|
| Rate for Payer: Aetna Medicare |
$3,143.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,352.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,050.31
|
| Rate for Payer: BCBS Complete |
$3,026.80
|
| Rate for Payer: BCBS MAPPO |
$3,022.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,022.62
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cofinity Commercial |
$4,352.57
|
| Rate for Payer: Cofinity Commercial |
$4,050.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,022.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,173.75
|
| Rate for Payer: Nomi Health Commercial |
$3,627.14
|
| Rate for Payer: PACE SWMI |
$3,022.62
|
| Rate for Payer: PHP Commercial |
$4,231.67
|
| Rate for Payer: PHP Medicare Advantage |
$3,022.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,918.55
|
| Rate for Payer: Priority Health Medicare |
$3,022.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,022.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,022.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,480.82
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$598.86 |
| Max. Negotiated Rate |
$1,346.80 |
| Rate for Payer: Aetna Commercial |
$802.47
|
| Rate for Payer: Aetna Medicare |
$622.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.47
|
| Rate for Payer: BCBS Complete |
$828.80
|
| Rate for Payer: BCBS MAPPO |
$598.86
|
| Rate for Payer: BCN Medicare Advantage |
$598.86
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cofinity Commercial |
$862.36
|
| Rate for Payer: Cofinity Commercial |
$802.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$628.80
|
| Rate for Payer: Nomi Health Commercial |
$718.63
|
| Rate for Payer: PACE SWMI |
$598.86
|
| Rate for Payer: PHP Commercial |
$838.40
|
| Rate for Payer: PHP Medicare Advantage |
$598.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.80
|
| Rate for Payer: Priority Health Medicare |
$598.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.86
|
| Rate for Payer: UHC Medicare Advantage |
$598.86
|
| Rate for Payer: UMR Bronson Commercial |
$953.12
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$925.20 |
| Max. Negotiated Rate |
$1,509.00 |
| Rate for Payer: Aetna Commercial |
$1,404.21
|
| Rate for Payer: Aetna Medicare |
$1,089.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.21
|
| Rate for Payer: BCBS Complete |
$925.20
|
| Rate for Payer: BCBS MAPPO |
$1,047.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.92
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,509.00
|
| Rate for Payer: Cofinity Commercial |
$1,404.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.32
|
| Rate for Payer: Nomi Health Commercial |
$1,257.50
|
| Rate for Payer: PACE SWMI |
$1,047.92
|
| Rate for Payer: PHP Commercial |
$1,467.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health Medicare |
$1,047.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,063.98
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,977.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$1,427.55 |
| Max. Negotiated Rate |
$3,235.05 |
| Rate for Payer: Aetna Commercial |
$1,912.92
|
| Rate for Payer: Aetna Medicare |
$1,484.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,055.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,912.92
|
| Rate for Payer: BCBS Complete |
$1,990.80
|
| Rate for Payer: BCBS MAPPO |
$1,427.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.55
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cofinity Commercial |
$2,055.67
|
| Rate for Payer: Cofinity Commercial |
$1,912.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,427.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.93
|
| Rate for Payer: Nomi Health Commercial |
$1,713.06
|
| Rate for Payer: PACE SWMI |
$1,427.55
|
| Rate for Payer: PHP Commercial |
$1,998.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,235.05
|
| Rate for Payer: Priority Health Medicare |
$1,427.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,427.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.55
|
| Rate for Payer: UMR Bronson Commercial |
$2,289.42
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$1,341.60 |
| Max. Negotiated Rate |
$2,200.77 |
| Rate for Payer: Aetna Commercial |
$2,047.94
|
| Rate for Payer: Aetna Medicare |
$1,589.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,200.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.94
|
| Rate for Payer: BCBS Complete |
$1,341.60
|
| Rate for Payer: BCBS MAPPO |
$1,528.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,528.31
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cofinity Commercial |
$2,200.77
|
| Rate for Payer: Cofinity Commercial |
$2,047.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,528.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,604.73
|
| Rate for Payer: Nomi Health Commercial |
$1,833.97
|
| Rate for Payer: PACE SWMI |
$1,528.31
|
| Rate for Payer: PHP Commercial |
$2,139.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,528.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,180.10
|
| Rate for Payer: Priority Health Medicare |
$1,528.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,528.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,528.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,542.84
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.26
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$9.15
|
| Rate for Payer: BCN Medicare Advantage |
$9.15
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.61
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: PACE SWMI |
$9.15
|
| Rate for Payer: PHP Commercial |
$12.81
|
| Rate for Payer: PHP Medicare Advantage |
$9.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$9.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.15
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$275.36 |
| Rate for Payer: Aetna Commercial |
$256.23
|
| Rate for Payer: Aetna Medicare |
$198.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.23
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$191.22
|
| Rate for Payer: BCN Medicare Advantage |
$191.22
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$275.36
|
| Rate for Payer: Cofinity Commercial |
$256.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.78
|
| Rate for Payer: Nomi Health Commercial |
$229.46
|
| Rate for Payer: PACE SWMI |
$191.22
|
| Rate for Payer: PHP Commercial |
$267.71
|
| Rate for Payer: PHP Medicare Advantage |
$191.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$191.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.22
|
| Rate for Payer: UHC Medicare Advantage |
$191.22
|
| Rate for Payer: UMR Bronson Commercial |
$147.20
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$400.45 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.64
|
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Commercial |
$389.33
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UMR Bronson Commercial |
$190.44
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$482.99 |
| Rate for Payer: Aetna Commercial |
$449.45
|
| Rate for Payer: Aetna Medicare |
$348.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.45
|
| Rate for Payer: BCBS Complete |
$196.80
|
| Rate for Payer: BCBS MAPPO |
$335.41
|
| Rate for Payer: BCN Medicare Advantage |
$335.41
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$482.99
|
| Rate for Payer: Cofinity Commercial |
$449.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.18
|
| Rate for Payer: Nomi Health Commercial |
$402.49
|
| Rate for Payer: PACE SWMI |
$335.41
|
| Rate for Payer: PHP Commercial |
$469.57
|
| Rate for Payer: PHP Medicare Advantage |
$335.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health Medicare |
$335.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.41
|
| Rate for Payer: UHC Medicare Advantage |
$335.41
|
| Rate for Payer: UMR Bronson Commercial |
$226.32
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$400.45 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.64
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Commercial |
$389.33
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health Medicare |
$278.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UMR Bronson Commercial |
$195.50
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,655.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$1,725.75 |
| Rate for Payer: Aetna Medicare |
$1,327.50
|
| Rate for Payer: BCBS Complete |
$1,062.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,221.30
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$570.42 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Aetna Commercial |
$764.36
|
| Rate for Payer: Aetna Medicare |
$593.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.40
|
| Rate for Payer: BCBS Complete |
$1,020.00
|
| Rate for Payer: BCBS MAPPO |
$570.42
|
| Rate for Payer: BCN Medicare Advantage |
$570.42
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$764.36
|
| Rate for Payer: Cofinity Commercial |
$821.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.94
|
| Rate for Payer: Nomi Health Commercial |
$684.50
|
| Rate for Payer: PACE SWMI |
$570.42
|
| Rate for Payer: PHP Commercial |
$798.59
|
| Rate for Payer: PHP Medicare Advantage |
$570.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health Medicare |
$570.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.42
|
| Rate for Payer: UHC Medicare Advantage |
$570.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.00
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$1,043.42 |
| Rate for Payer: Aetna Commercial |
$970.96
|
| Rate for Payer: Aetna Medicare |
$753.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,043.42
|
| Rate for Payer: BCBS Complete |
$613.60
|
| Rate for Payer: BCBS MAPPO |
$724.60
|
| Rate for Payer: BCN Medicare Advantage |
$724.60
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cofinity Commercial |
$970.96
|
| Rate for Payer: Cofinity Commercial |
$1,043.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$760.83
|
| Rate for Payer: Nomi Health Commercial |
$869.52
|
| Rate for Payer: PACE SWMI |
$724.60
|
| Rate for Payer: PHP Commercial |
$1,014.44
|
| Rate for Payer: PHP Medicare Advantage |
$724.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.10
|
| Rate for Payer: Priority Health Medicare |
$724.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.60
|
| Rate for Payer: UHC Medicare Advantage |
$724.60
|
| Rate for Payer: UMR Bronson Commercial |
$705.64
|
|
