|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 15736
|
| Min. Negotiated Rate |
$922.40 |
| Max. Negotiated Rate |
$1,671.61 |
| Rate for Payer: Aetna Commercial |
$1,555.53
|
| Rate for Payer: Aetna Medicare |
$1,207.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,671.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,555.53
|
| Rate for Payer: BCBS Complete |
$922.40
|
| Rate for Payer: BCBS MAPPO |
$1,160.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,160.84
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cofinity Commercial |
$1,671.61
|
| Rate for Payer: Cofinity Commercial |
$1,555.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,160.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,218.88
|
| Rate for Payer: Nomi Health Commercial |
$1,393.01
|
| Rate for Payer: PACE SWMI |
$1,160.84
|
| Rate for Payer: PHP Commercial |
$1,625.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,160.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.90
|
| Rate for Payer: Priority Health Medicare |
$1,160.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,160.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,160.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.76
|
|
|
PR MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 15733
|
| Min. Negotiated Rate |
$981.22 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$1,314.83
|
| Rate for Payer: Aetna Medicare |
$1,020.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.83
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: BCBS MAPPO |
$981.22
|
| Rate for Payer: BCN Medicare Advantage |
$981.22
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cofinity Commercial |
$1,412.96
|
| Rate for Payer: Cofinity Commercial |
$1,314.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.28
|
| Rate for Payer: Nomi Health Commercial |
$1,177.46
|
| Rate for Payer: PACE SWMI |
$981.22
|
| Rate for Payer: PHP Commercial |
$1,373.71
|
| Rate for Payer: PHP Medicare Advantage |
$981.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health Medicare |
$981.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.22
|
| Rate for Payer: UHC Medicare Advantage |
$981.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,454.52
|
|
|
PR MYOCARDIAL RESECTION
|
Professional
|
Both
|
$6,268.00
|
|
|
Service Code
|
HCPCS 33542
|
| Min. Negotiated Rate |
$2,507.20 |
| Max. Negotiated Rate |
$4,074.20 |
| Rate for Payer: Aetna Commercial |
$3,378.82
|
| Rate for Payer: Aetna Medicare |
$2,622.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,630.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,378.82
|
| Rate for Payer: BCBS Complete |
$2,507.20
|
| Rate for Payer: BCBS MAPPO |
$2,521.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,521.51
|
| Rate for Payer: Cash Price |
$5,014.40
|
| Rate for Payer: Cash Price |
$5,014.40
|
| Rate for Payer: Cofinity Commercial |
$3,630.97
|
| Rate for Payer: Cofinity Commercial |
$3,378.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,521.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,647.59
|
| Rate for Payer: Nomi Health Commercial |
$3,025.81
|
| Rate for Payer: PACE SWMI |
$2,521.51
|
| Rate for Payer: PHP Commercial |
$3,530.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,521.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,074.20
|
| Rate for Payer: Priority Health Medicare |
$2,521.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,521.51
|
| Rate for Payer: UHC Medicare Advantage |
$2,521.51
|
| Rate for Payer: UMR Bronson Commercial |
$2,883.28
|
|
|
PR MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR
|
Professional
|
Both
|
$1,961.00
|
|
|
Service Code
|
HCPCS 58145
|
| Min. Negotiated Rate |
$537.84 |
| Max. Negotiated Rate |
$1,274.65 |
| Rate for Payer: Aetna Commercial |
$720.71
|
| Rate for Payer: Aetna Medicare |
$559.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.71
|
| Rate for Payer: BCBS Complete |
$784.40
|
| Rate for Payer: BCBS MAPPO |
$537.84
|
| Rate for Payer: BCN Medicare Advantage |
$537.84
|
| Rate for Payer: Cash Price |
$1,568.80
|
| Rate for Payer: Cash Price |
$1,568.80
|
| Rate for Payer: Cofinity Commercial |
$774.49
|
| Rate for Payer: Cofinity Commercial |
$720.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.73
|
| Rate for Payer: Nomi Health Commercial |
$645.41
|
| Rate for Payer: PACE SWMI |
$537.84
|
| Rate for Payer: PHP Commercial |
$752.98
|
| Rate for Payer: PHP Medicare Advantage |
$537.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,274.65
|
| Rate for Payer: Priority Health Medicare |
$537.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.84
|
| Rate for Payer: UHC Medicare Advantage |
$537.84
|
| Rate for Payer: UMR Bronson Commercial |
$902.06
|
|
|
PR MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR
|
Professional
|
Both
|
$3,033.00
|
|
|
Service Code
|
HCPCS 58140
|
| Min. Negotiated Rate |
$884.46 |
| Max. Negotiated Rate |
$1,971.45 |
| Rate for Payer: Aetna Commercial |
$1,185.18
|
| Rate for Payer: Aetna Medicare |
$919.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.18
|
| Rate for Payer: BCBS Complete |
$1,213.20
|
| Rate for Payer: BCBS MAPPO |
$884.46
|
| Rate for Payer: BCN Medicare Advantage |
$884.46
|
| Rate for Payer: Cash Price |
$2,426.40
|
| Rate for Payer: Cash Price |
$2,426.40
|
| Rate for Payer: Cofinity Commercial |
$1,273.62
|
| Rate for Payer: Cofinity Commercial |
$1,185.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.68
|
| Rate for Payer: Nomi Health Commercial |
$1,061.35
|
| Rate for Payer: PACE SWMI |
$884.46
|
| Rate for Payer: PHP Commercial |
$1,238.24
|
| Rate for Payer: PHP Medicare Advantage |
$884.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,971.45
|
| Rate for Payer: Priority Health Medicare |
$884.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$884.46
|
| Rate for Payer: UHC Medicare Advantage |
$884.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,395.18
|
|
|
PR MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 58146
|
| Min. Negotiated Rate |
$886.00 |
| Max. Negotiated Rate |
$1,598.07 |
| Rate for Payer: Aetna Commercial |
$1,487.09
|
| Rate for Payer: Aetna Medicare |
$1,154.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.09
|
| Rate for Payer: BCBS Complete |
$886.00
|
| Rate for Payer: BCBS MAPPO |
$1,109.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,109.77
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,598.07
|
| Rate for Payer: Cofinity Commercial |
$1,487.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,109.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,165.26
|
| Rate for Payer: Nomi Health Commercial |
$1,331.72
|
| Rate for Payer: PACE SWMI |
$1,109.77
|
| Rate for Payer: PHP Commercial |
$1,553.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.75
|
| Rate for Payer: Priority Health Medicare |
$1,109.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,109.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,109.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,018.90
|
|
|
PR MYRINGOPLASTY
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 69620
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Aetna Commercial |
$625.95
|
| Rate for Payer: Aetna Medicare |
$485.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.95
|
| Rate for Payer: BCBS Complete |
$466.80
|
| Rate for Payer: BCBS MAPPO |
$467.13
|
| Rate for Payer: BCN Medicare Advantage |
$467.13
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cofinity Commercial |
$672.67
|
| Rate for Payer: Cofinity Commercial |
$625.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$467.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$490.49
|
| Rate for Payer: Nomi Health Commercial |
$560.56
|
| Rate for Payer: PACE SWMI |
$467.13
|
| Rate for Payer: PHP Commercial |
$653.98
|
| Rate for Payer: PHP Medicare Advantage |
$467.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.55
|
| Rate for Payer: Priority Health Medicare |
$467.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$467.13
|
| Rate for Payer: UHC Medicare Advantage |
$467.13
|
| Rate for Payer: UMR Bronson Commercial |
$536.82
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 69420
|
| Min. Negotiated Rate |
$113.81 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$152.51
|
| Rate for Payer: Aetna Medicare |
$118.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.51
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$113.81
|
| Rate for Payer: BCN Medicare Advantage |
$113.81
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$163.89
|
| Rate for Payer: Cofinity Commercial |
$152.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.50
|
| Rate for Payer: Nomi Health Commercial |
$136.57
|
| Rate for Payer: PACE SWMI |
$113.81
|
| Rate for Payer: PHP Commercial |
$159.33
|
| Rate for Payer: PHP Medicare Advantage |
$113.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Medicare |
$113.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.81
|
| Rate for Payer: UHC Medicare Advantage |
$113.81
|
| Rate for Payer: UMR Bronson Commercial |
$145.82
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 69421
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Medicare |
$148.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.95
|
| Rate for Payer: BCBS Complete |
$188.80
|
| Rate for Payer: BCBS MAPPO |
$142.50
|
| Rate for Payer: BCN Medicare Advantage |
$142.50
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Commercial |
$190.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.62
|
| Rate for Payer: Nomi Health Commercial |
$171.00
|
| Rate for Payer: PACE SWMI |
$142.50
|
| Rate for Payer: PHP Commercial |
$199.50
|
| Rate for Payer: PHP Medicare Advantage |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.80
|
| Rate for Payer: Priority Health Medicare |
$142.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.50
|
| Rate for Payer: UHC Medicare Advantage |
$142.50
|
| Rate for Payer: UMR Bronson Commercial |
$217.12
|
|
|
PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 31231
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$204.10 |
| Rate for Payer: Aetna Commercial |
$82.28
|
| Rate for Payer: Aetna Medicare |
$63.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.28
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS MAPPO |
$61.40
|
| Rate for Payer: BCN Medicare Advantage |
$61.40
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$82.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.47
|
| Rate for Payer: Nomi Health Commercial |
$73.68
|
| Rate for Payer: PACE SWMI |
$61.40
|
| Rate for Payer: PHP Commercial |
$85.96
|
| Rate for Payer: PHP Medicare Advantage |
$61.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.10
|
| Rate for Payer: Priority Health Medicare |
$61.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.40
|
| Rate for Payer: UHC Medicare Advantage |
$61.40
|
| Rate for Payer: UMR Bronson Commercial |
$144.44
|
|
|
PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 31233
|
| Min. Negotiated Rate |
$128.46 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$172.14
|
| Rate for Payer: Aetna Medicare |
$133.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.14
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$128.46
|
| Rate for Payer: BCN Medicare Advantage |
$128.46
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$184.98
|
| Rate for Payer: Cofinity Commercial |
$172.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.88
|
| Rate for Payer: Nomi Health Commercial |
$154.15
|
| Rate for Payer: PACE SWMI |
$128.46
|
| Rate for Payer: PHP Commercial |
$179.84
|
| Rate for Payer: PHP Medicare Advantage |
$128.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$128.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.46
|
| Rate for Payer: UHC Medicare Advantage |
$128.46
|
| Rate for Payer: UMR Bronson Commercial |
$237.82
|
|
|
PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 31235
|
| Min. Negotiated Rate |
$153.23 |
| Max. Negotiated Rate |
$329.55 |
| Rate for Payer: Aetna Commercial |
$205.33
|
| Rate for Payer: Aetna Medicare |
$159.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.33
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: BCBS MAPPO |
$153.23
|
| Rate for Payer: BCN Medicare Advantage |
$153.23
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$220.65
|
| Rate for Payer: Cofinity Commercial |
$205.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.89
|
| Rate for Payer: Nomi Health Commercial |
$183.88
|
| Rate for Payer: PACE SWMI |
$153.23
|
| Rate for Payer: PHP Commercial |
$214.52
|
| Rate for Payer: PHP Medicare Advantage |
$153.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
| Rate for Payer: Priority Health Medicare |
$153.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.23
|
| Rate for Payer: UHC Medicare Advantage |
$153.23
|
| Rate for Payer: UMR Bronson Commercial |
$233.22
|
|
|
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 31256
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$231.86
|
| Rate for Payer: Aetna Medicare |
$179.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.86
|
| Rate for Payer: BCBS Complete |
$216.40
|
| Rate for Payer: BCBS MAPPO |
$173.03
|
| Rate for Payer: BCN Medicare Advantage |
$173.03
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Cofinity Commercial |
$231.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.68
|
| Rate for Payer: Nomi Health Commercial |
$207.64
|
| Rate for Payer: PACE SWMI |
$173.03
|
| Rate for Payer: PHP Commercial |
$242.24
|
| Rate for Payer: PHP Medicare Advantage |
$173.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.65
|
| Rate for Payer: Priority Health Medicare |
$173.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.03
|
| Rate for Payer: UHC Medicare Advantage |
$173.03
|
| Rate for Payer: UMR Bronson Commercial |
$248.86
|
|
|
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 31287
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$577.85 |
| Rate for Payer: Aetna Commercial |
$257.28
|
| Rate for Payer: Aetna Medicare |
$199.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.28
|
| Rate for Payer: BCBS Complete |
$355.60
|
| Rate for Payer: BCBS MAPPO |
$192.00
|
| Rate for Payer: BCN Medicare Advantage |
$192.00
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cofinity Commercial |
$276.48
|
| Rate for Payer: Cofinity Commercial |
$257.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.60
|
| Rate for Payer: Nomi Health Commercial |
$230.40
|
| Rate for Payer: PACE SWMI |
$192.00
|
| Rate for Payer: PHP Commercial |
$268.80
|
| Rate for Payer: PHP Medicare Advantage |
$192.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health Medicare |
$192.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.00
|
| Rate for Payer: UHC Medicare Advantage |
$192.00
|
| Rate for Payer: UMR Bronson Commercial |
$408.94
|
|
|
PR NASAL/SINUS NDSC DSTRJ CRYOABLATION PST NSL NRV
|
Professional
|
Both
|
$4,457.00
|
|
|
Service Code
|
HCPCS 31243
|
| Min. Negotiated Rate |
$150.46 |
| Max. Negotiated Rate |
$2,897.05 |
| Rate for Payer: Aetna Commercial |
$201.62
|
| Rate for Payer: Aetna Medicare |
$156.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.62
|
| Rate for Payer: BCBS Complete |
$1,782.80
|
| Rate for Payer: BCBS MAPPO |
$150.46
|
| Rate for Payer: BCN Medicare Advantage |
$150.46
|
| Rate for Payer: Cash Price |
$3,565.60
|
| Rate for Payer: Cash Price |
$3,565.60
|
| Rate for Payer: Cofinity Commercial |
$216.66
|
| Rate for Payer: Cofinity Commercial |
$201.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.98
|
| Rate for Payer: Nomi Health Commercial |
$180.55
|
| Rate for Payer: PACE SWMI |
$150.46
|
| Rate for Payer: PHP Commercial |
$210.64
|
| Rate for Payer: PHP Medicare Advantage |
$150.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,897.05
|
| Rate for Payer: Priority Health Medicare |
$150.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.46
|
| Rate for Payer: UHC Medicare Advantage |
$150.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,050.22
|
|
|
PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 31290
|
| Min. Negotiated Rate |
$844.00 |
| Max. Negotiated Rate |
$1,575.59 |
| Rate for Payer: Aetna Commercial |
$1,466.17
|
| Rate for Payer: Aetna Medicare |
$1,137.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,575.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,466.17
|
| Rate for Payer: BCBS Complete |
$844.00
|
| Rate for Payer: BCBS MAPPO |
$1,094.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,094.16
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,575.59
|
| Rate for Payer: Cofinity Commercial |
$1,466.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,094.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,148.87
|
| Rate for Payer: Nomi Health Commercial |
$1,312.99
|
| Rate for Payer: PACE SWMI |
$1,094.16
|
| Rate for Payer: PHP Commercial |
$1,531.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,094.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health Medicare |
$1,094.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,094.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.16
|
| Rate for Payer: UMR Bronson Commercial |
$970.60
|
|
|
PR NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID
|
Professional
|
Both
|
$2,318.00
|
|
|
Service Code
|
HCPCS 31291
|
| Min. Negotiated Rate |
$927.20 |
| Max. Negotiated Rate |
$1,691.31 |
| Rate for Payer: Aetna Commercial |
$1,573.86
|
| Rate for Payer: Aetna Medicare |
$1,221.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,573.86
|
| Rate for Payer: BCBS Complete |
$927.20
|
| Rate for Payer: BCBS MAPPO |
$1,174.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,174.52
|
| Rate for Payer: Cash Price |
$1,854.40
|
| Rate for Payer: Cash Price |
$1,854.40
|
| Rate for Payer: Cofinity Commercial |
$1,691.31
|
| Rate for Payer: Cofinity Commercial |
$1,573.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,174.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,233.25
|
| Rate for Payer: Nomi Health Commercial |
$1,409.42
|
| Rate for Payer: PACE SWMI |
$1,174.52
|
| Rate for Payer: PHP Commercial |
$1,644.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,174.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.70
|
| Rate for Payer: Priority Health Medicare |
$1,174.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,174.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,174.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,066.28
|
|
|
PR NASAL/SINUS NDSC SURG MEDIAL/INF ORB WALL DCMPRN
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 31292
|
| Min. Negotiated Rate |
$822.00 |
| Max. Negotiated Rate |
$1,356.38 |
| Rate for Payer: Aetna Commercial |
$1,262.19
|
| Rate for Payer: Aetna Medicare |
$979.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,356.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.19
|
| Rate for Payer: BCBS Complete |
$822.00
|
| Rate for Payer: BCBS MAPPO |
$941.93
|
| Rate for Payer: BCN Medicare Advantage |
$941.93
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cofinity Commercial |
$1,356.38
|
| Rate for Payer: Cofinity Commercial |
$1,262.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$941.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$989.03
|
| Rate for Payer: Nomi Health Commercial |
$1,130.32
|
| Rate for Payer: PACE SWMI |
$941.93
|
| Rate for Payer: PHP Commercial |
$1,318.70
|
| Rate for Payer: PHP Medicare Advantage |
$941.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.75
|
| Rate for Payer: Priority Health Medicare |
$941.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$941.93
|
| Rate for Payer: UHC Medicare Advantage |
$941.93
|
| Rate for Payer: UMR Bronson Commercial |
$945.30
|
|
|
PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 31237
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$384.15 |
| Rate for Payer: Aetna Commercial |
$205.18
|
| Rate for Payer: Aetna Medicare |
$159.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.18
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS MAPPO |
$153.12
|
| Rate for Payer: BCN Medicare Advantage |
$153.12
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cofinity Commercial |
$220.49
|
| Rate for Payer: Cofinity Commercial |
$205.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.78
|
| Rate for Payer: Nomi Health Commercial |
$183.74
|
| Rate for Payer: PACE SWMI |
$153.12
|
| Rate for Payer: PHP Commercial |
$214.37
|
| Rate for Payer: PHP Medicare Advantage |
$153.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.15
|
| Rate for Payer: Priority Health Medicare |
$153.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.12
|
| Rate for Payer: UHC Medicare Advantage |
$153.12
|
| Rate for Payer: UMR Bronson Commercial |
$271.86
|
|
|
PR NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 31240
|
| Min. Negotiated Rate |
$151.97 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$203.64
|
| Rate for Payer: Aetna Medicare |
$158.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.64
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$151.97
|
| Rate for Payer: BCN Medicare Advantage |
$151.97
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$218.84
|
| Rate for Payer: Cofinity Commercial |
$203.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.57
|
| Rate for Payer: Nomi Health Commercial |
$182.36
|
| Rate for Payer: PACE SWMI |
$151.97
|
| Rate for Payer: PHP Commercial |
$212.76
|
| Rate for Payer: PHP Medicare Advantage |
$151.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health Medicare |
$151.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.97
|
| Rate for Payer: UHC Medicare Advantage |
$151.97
|
| Rate for Payer: UMR Bronson Commercial |
$237.82
|
|
|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 31238
|
| Min. Negotiated Rate |
$159.42 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna Commercial |
$213.62
|
| Rate for Payer: Aetna Medicare |
$165.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.62
|
| Rate for Payer: BCBS Complete |
$259.20
|
| Rate for Payer: BCBS MAPPO |
$159.42
|
| Rate for Payer: BCN Medicare Advantage |
$159.42
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Cofinity Commercial |
$213.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.39
|
| Rate for Payer: Nomi Health Commercial |
$191.30
|
| Rate for Payer: PACE SWMI |
$159.42
|
| Rate for Payer: PHP Commercial |
$223.19
|
| Rate for Payer: PHP Medicare Advantage |
$159.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.20
|
| Rate for Payer: Priority Health Medicare |
$159.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.42
|
| Rate for Payer: UHC Medicare Advantage |
$159.42
|
| Rate for Payer: UMR Bronson Commercial |
$298.08
|
|
|
PR NASAL/SINUS NDSC SURG W/DACRYOCYSTORHINOSTOMY
|
Professional
|
Both
|
$1,332.00
|
|
|
Service Code
|
HCPCS 31239
|
| Min. Negotiated Rate |
$532.80 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Aetna Commercial |
$767.93
|
| Rate for Payer: Aetna Medicare |
$596.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.93
|
| Rate for Payer: BCBS Complete |
$532.80
|
| Rate for Payer: BCBS MAPPO |
$573.08
|
| Rate for Payer: BCN Medicare Advantage |
$573.08
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cofinity Commercial |
$825.24
|
| Rate for Payer: Cofinity Commercial |
$767.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.73
|
| Rate for Payer: Nomi Health Commercial |
$687.70
|
| Rate for Payer: PACE SWMI |
$573.08
|
| Rate for Payer: PHP Commercial |
$802.31
|
| Rate for Payer: PHP Medicare Advantage |
$573.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.80
|
| Rate for Payer: Priority Health Medicare |
$573.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.08
|
| Rate for Payer: UHC Medicare Advantage |
$573.08
|
| Rate for Payer: UMR Bronson Commercial |
$612.72
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 31296
|
| Min. Negotiated Rate |
$172.33 |
| Max. Negotiated Rate |
$371.15 |
| Rate for Payer: Aetna Commercial |
$230.92
|
| Rate for Payer: Aetna Medicare |
$179.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.92
|
| Rate for Payer: BCBS Complete |
$228.40
|
| Rate for Payer: BCBS MAPPO |
$172.33
|
| Rate for Payer: BCN Medicare Advantage |
$172.33
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cofinity Commercial |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$230.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.95
|
| Rate for Payer: Nomi Health Commercial |
$206.80
|
| Rate for Payer: PACE SWMI |
$172.33
|
| Rate for Payer: PHP Commercial |
$241.26
|
| Rate for Payer: PHP Medicare Advantage |
$172.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.15
|
| Rate for Payer: Priority Health Medicare |
$172.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.33
|
| Rate for Payer: UHC Medicare Advantage |
$172.33
|
| Rate for Payer: UMR Bronson Commercial |
$262.66
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS
|
Professional
|
Both
|
$3,993.00
|
|
|
Service Code
|
HCPCS 31295
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$2,595.45 |
| Rate for Payer: Aetna Commercial |
$202.00
|
| Rate for Payer: Aetna Medicare |
$156.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.00
|
| Rate for Payer: BCBS Complete |
$1,597.20
|
| Rate for Payer: BCBS MAPPO |
$150.75
|
| Rate for Payer: BCN Medicare Advantage |
$150.75
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.29
|
| Rate for Payer: Nomi Health Commercial |
$180.90
|
| Rate for Payer: PACE SWMI |
$150.75
|
| Rate for Payer: PHP Commercial |
$211.05
|
| Rate for Payer: PHP Medicare Advantage |
$150.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,595.45
|
| Rate for Payer: Priority Health Medicare |
$150.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.75
|
| Rate for Payer: UHC Medicare Advantage |
$150.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,836.78
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS
|
Professional
|
Both
|
$3,272.00
|
|
|
Service Code
|
HCPCS 31297
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$2,126.80 |
| Rate for Payer: Aetna Commercial |
$184.09
|
| Rate for Payer: Aetna Medicare |
$142.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.09
|
| Rate for Payer: BCBS Complete |
$1,308.80
|
| Rate for Payer: BCBS MAPPO |
$137.38
|
| Rate for Payer: BCN Medicare Advantage |
$137.38
|
| Rate for Payer: Cash Price |
$2,617.60
|
| Rate for Payer: Cash Price |
$2,617.60
|
| Rate for Payer: Cofinity Commercial |
$197.83
|
| Rate for Payer: Cofinity Commercial |
$184.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.25
|
| Rate for Payer: Nomi Health Commercial |
$164.86
|
| Rate for Payer: PACE SWMI |
$137.38
|
| Rate for Payer: PHP Commercial |
$192.33
|
| Rate for Payer: PHP Medicare Advantage |
$137.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.80
|
| Rate for Payer: Priority Health Medicare |
$137.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.38
|
| Rate for Payer: UHC Medicare Advantage |
$137.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,505.12
|
|
