|
PR NASAL/SINUS NDSC SURG W/LIG SPHENOPALATINE ART
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 31241
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$609.98 |
| Rate for Payer: Aetna Commercial |
$567.62
|
| Rate for Payer: Aetna Medicare |
$440.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.62
|
| Rate for Payer: BCBS Complete |
$369.60
|
| Rate for Payer: BCBS MAPPO |
$423.60
|
| Rate for Payer: BCN Medicare Advantage |
$423.60
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$609.98
|
| Rate for Payer: Cofinity Commercial |
$567.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.78
|
| Rate for Payer: Nomi Health Commercial |
$508.32
|
| Rate for Payer: PACE SWMI |
$423.60
|
| Rate for Payer: PHP Commercial |
$593.04
|
| Rate for Payer: PHP Medicare Advantage |
$423.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$423.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.60
|
| Rate for Payer: UHC Medicare Advantage |
$423.60
|
| Rate for Payer: UMR Bronson Commercial |
$425.04
|
|
|
PR NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN
|
Professional
|
Both
|
$2,591.00
|
|
|
Service Code
|
HCPCS 31294
|
| Min. Negotiated Rate |
$1,036.40 |
| Max. Negotiated Rate |
$1,684.15 |
| Rate for Payer: Aetna Commercial |
$1,563.55
|
| Rate for Payer: Aetna Medicare |
$1,213.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,680.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.55
|
| Rate for Payer: BCBS Complete |
$1,036.40
|
| Rate for Payer: BCBS MAPPO |
$1,166.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,166.83
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Cofinity Commercial |
$1,680.24
|
| Rate for Payer: Cofinity Commercial |
$1,563.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,166.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,225.17
|
| Rate for Payer: Nomi Health Commercial |
$1,400.20
|
| Rate for Payer: PACE SWMI |
$1,166.83
|
| Rate for Payer: PHP Commercial |
$1,633.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,166.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,684.15
|
| Rate for Payer: Priority Health Medicare |
$1,166.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,166.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,166.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,191.86
|
|
|
PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 31257
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna Commercial |
$569.49
|
| Rate for Payer: Aetna Medicare |
$441.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.49
|
| Rate for Payer: BCBS Complete |
$368.00
|
| Rate for Payer: BCBS MAPPO |
$424.99
|
| Rate for Payer: BCN Medicare Advantage |
$424.99
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$611.99
|
| Rate for Payer: Cofinity Commercial |
$569.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.24
|
| Rate for Payer: Nomi Health Commercial |
$509.99
|
| Rate for Payer: PACE SWMI |
$424.99
|
| Rate for Payer: PHP Commercial |
$594.99
|
| Rate for Payer: PHP Medicare Advantage |
$424.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.00
|
| Rate for Payer: Priority Health Medicare |
$424.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$424.99
|
| Rate for Payer: UHC Medicare Advantage |
$424.99
|
| Rate for Payer: UMR Bronson Commercial |
$423.20
|
|
|
PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL
|
Professional
|
Both
|
$1,019.00
|
|
|
Service Code
|
HCPCS 31253
|
| Min. Negotiated Rate |
$407.60 |
| Max. Negotiated Rate |
$686.28 |
| Rate for Payer: Aetna Commercial |
$638.62
|
| Rate for Payer: Aetna Medicare |
$495.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.62
|
| Rate for Payer: BCBS Complete |
$407.60
|
| Rate for Payer: BCBS MAPPO |
$476.58
|
| Rate for Payer: BCN Medicare Advantage |
$476.58
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cofinity Commercial |
$686.28
|
| Rate for Payer: Cofinity Commercial |
$638.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$500.41
|
| Rate for Payer: Nomi Health Commercial |
$571.90
|
| Rate for Payer: PACE SWMI |
$476.58
|
| Rate for Payer: PHP Commercial |
$667.21
|
| Rate for Payer: PHP Medicare Advantage |
$476.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.35
|
| Rate for Payer: Priority Health Medicare |
$476.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.58
|
| Rate for Payer: UHC Medicare Advantage |
$476.58
|
| Rate for Payer: UMR Bronson Commercial |
$468.74
|
|
|
PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 31259
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$648.17 |
| Rate for Payer: Aetna Commercial |
$603.16
|
| Rate for Payer: Aetna Medicare |
$468.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.16
|
| Rate for Payer: BCBS Complete |
$390.00
|
| Rate for Payer: BCBS MAPPO |
$450.12
|
| Rate for Payer: BCN Medicare Advantage |
$450.12
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$648.17
|
| Rate for Payer: Cofinity Commercial |
$603.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.63
|
| Rate for Payer: Nomi Health Commercial |
$540.14
|
| Rate for Payer: PACE SWMI |
$450.12
|
| Rate for Payer: PHP Commercial |
$630.17
|
| Rate for Payer: PHP Medicare Advantage |
$450.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health Medicare |
$450.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.12
|
| Rate for Payer: UHC Medicare Advantage |
$450.12
|
| Rate for Payer: UMR Bronson Commercial |
$448.50
|
|
|
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 31254
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$482.95 |
| Rate for Payer: Aetna Commercial |
$310.87
|
| Rate for Payer: Aetna Medicare |
$241.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.87
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$231.99
|
| Rate for Payer: BCN Medicare Advantage |
$231.99
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$334.07
|
| Rate for Payer: Cofinity Commercial |
$310.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.59
|
| Rate for Payer: Nomi Health Commercial |
$278.39
|
| Rate for Payer: PACE SWMI |
$231.99
|
| Rate for Payer: PHP Commercial |
$324.79
|
| Rate for Payer: PHP Medicare Advantage |
$231.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$231.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.99
|
| Rate for Payer: UHC Medicare Advantage |
$231.99
|
| Rate for Payer: UMR Bronson Commercial |
$341.78
|
|
|
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 31276
|
| Min. Negotiated Rate |
$360.72 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$483.36
|
| Rate for Payer: Aetna Medicare |
$375.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.36
|
| Rate for Payer: BCBS Complete |
$544.00
|
| Rate for Payer: BCBS MAPPO |
$360.72
|
| Rate for Payer: BCN Medicare Advantage |
$360.72
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$519.44
|
| Rate for Payer: Cofinity Commercial |
$483.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$378.76
|
| Rate for Payer: Nomi Health Commercial |
$432.86
|
| Rate for Payer: PACE SWMI |
$360.72
|
| Rate for Payer: PHP Commercial |
$505.01
|
| Rate for Payer: PHP Medicare Advantage |
$360.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health Medicare |
$360.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$360.72
|
| Rate for Payer: UHC Medicare Advantage |
$360.72
|
| Rate for Payer: UMR Bronson Commercial |
$625.60
|
|
|
PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 31255
|
| Min. Negotiated Rate |
$308.16 |
| Max. Negotiated Rate |
$614.25 |
| Rate for Payer: Aetna Commercial |
$412.93
|
| Rate for Payer: Aetna Medicare |
$320.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.93
|
| Rate for Payer: BCBS Complete |
$378.00
|
| Rate for Payer: BCBS MAPPO |
$308.16
|
| Rate for Payer: BCN Medicare Advantage |
$308.16
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cofinity Commercial |
$443.75
|
| Rate for Payer: Cofinity Commercial |
$412.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.57
|
| Rate for Payer: Nomi Health Commercial |
$369.79
|
| Rate for Payer: PACE SWMI |
$308.16
|
| Rate for Payer: PHP Commercial |
$431.42
|
| Rate for Payer: PHP Medicare Advantage |
$308.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$614.25
|
| Rate for Payer: Priority Health Medicare |
$308.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.16
|
| Rate for Payer: UHC Medicare Advantage |
$308.16
|
| Rate for Payer: UMR Bronson Commercial |
$434.70
|
|
|
PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 43752
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Commercial |
$51.26
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.26
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: Nomi Health Commercial |
$45.90
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 92511
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna Commercial |
$47.82
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.82
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS MAPPO |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$35.69
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.47
|
| Rate for Payer: Nomi Health Commercial |
$42.83
|
| Rate for Payer: PACE SWMI |
$35.69
|
| Rate for Payer: PHP Commercial |
$49.97
|
| Rate for Payer: PHP Medicare Advantage |
$35.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Medicare |
$35.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.69
|
| Rate for Payer: UHC Medicare Advantage |
$35.69
|
| Rate for Payer: UMR Bronson Commercial |
$106.26
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 95860
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$145.05 |
| Rate for Payer: Aetna Commercial |
$134.98
|
| Rate for Payer: Aetna Medicare |
$104.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.98
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$100.73
|
| Rate for Payer: BCN Medicare Advantage |
$100.73
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$145.05
|
| Rate for Payer: Cofinity Commercial |
$134.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.77
|
| Rate for Payer: Nomi Health Commercial |
$120.88
|
| Rate for Payer: PACE SWMI |
$100.73
|
| Rate for Payer: PHP Commercial |
$141.02
|
| Rate for Payer: PHP Medicare Advantage |
$100.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$100.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.73
|
| Rate for Payer: UHC Medicare Advantage |
$100.73
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 95861
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$203.28 |
| Rate for Payer: Aetna Commercial |
$189.17
|
| Rate for Payer: Aetna Medicare |
$146.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.17
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: BCBS MAPPO |
$141.17
|
| Rate for Payer: BCN Medicare Advantage |
$141.17
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$203.28
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.23
|
| Rate for Payer: Nomi Health Commercial |
$169.40
|
| Rate for Payer: PACE SWMI |
$141.17
|
| Rate for Payer: PHP Commercial |
$197.64
|
| Rate for Payer: PHP Medicare Advantage |
$141.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health Medicare |
$141.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.17
|
| Rate for Payer: UHC Medicare Advantage |
$141.17
|
| Rate for Payer: UMR Bronson Commercial |
$136.16
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 95863
|
| Min. Negotiated Rate |
$144.40 |
| Max. Negotiated Rate |
$275.21 |
| Rate for Payer: Aetna Commercial |
$256.10
|
| Rate for Payer: Aetna Medicare |
$198.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.10
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$191.12
|
| Rate for Payer: BCN Medicare Advantage |
$191.12
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$275.21
|
| Rate for Payer: Cofinity Commercial |
$256.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.68
|
| Rate for Payer: Nomi Health Commercial |
$229.34
|
| Rate for Payer: PACE SWMI |
$191.12
|
| Rate for Payer: PHP Commercial |
$267.57
|
| Rate for Payer: PHP Medicare Advantage |
$191.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health Medicare |
$191.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.12
|
| Rate for Payer: UHC Medicare Advantage |
$191.12
|
| Rate for Payer: UMR Bronson Commercial |
$166.06
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 95864
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$291.11 |
| Rate for Payer: Aetna Commercial |
$270.89
|
| Rate for Payer: Aetna Medicare |
$210.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.89
|
| Rate for Payer: BCBS Complete |
$165.20
|
| Rate for Payer: BCBS MAPPO |
$202.16
|
| Rate for Payer: BCN Medicare Advantage |
$202.16
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cofinity Commercial |
$291.11
|
| Rate for Payer: Cofinity Commercial |
$270.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.27
|
| Rate for Payer: Nomi Health Commercial |
$242.59
|
| Rate for Payer: PACE SWMI |
$202.16
|
| Rate for Payer: PHP Commercial |
$283.02
|
| Rate for Payer: PHP Medicare Advantage |
$202.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.45
|
| Rate for Payer: Priority Health Medicare |
$202.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.16
|
| Rate for Payer: UHC Medicare Advantage |
$202.16
|
| Rate for Payer: UMR Bronson Commercial |
$189.98
|
|
|
PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 92265
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$114.35 |
| Rate for Payer: Aetna Commercial |
$106.41
|
| Rate for Payer: Aetna Medicare |
$82.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.41
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$79.41
|
| Rate for Payer: BCN Medicare Advantage |
$79.41
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$114.35
|
| Rate for Payer: Cofinity Commercial |
$106.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.38
|
| Rate for Payer: Nomi Health Commercial |
$95.29
|
| Rate for Payer: PACE SWMI |
$79.41
|
| Rate for Payer: PHP Commercial |
$111.17
|
| Rate for Payer: PHP Medicare Advantage |
$79.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$79.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.41
|
| Rate for Payer: UHC Medicare Advantage |
$79.41
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 44385
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$567.45 |
| Rate for Payer: Aetna Commercial |
$92.14
|
| Rate for Payer: Aetna Medicare |
$71.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.14
|
| Rate for Payer: BCBS Complete |
$349.20
|
| Rate for Payer: BCBS MAPPO |
$68.76
|
| Rate for Payer: BCN Medicare Advantage |
$68.76
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$99.01
|
| Rate for Payer: Cofinity Commercial |
$92.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.20
|
| Rate for Payer: Nomi Health Commercial |
$82.51
|
| Rate for Payer: PACE SWMI |
$68.76
|
| Rate for Payer: PHP Commercial |
$96.26
|
| Rate for Payer: PHP Medicare Advantage |
$68.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health Medicare |
$68.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.76
|
| Rate for Payer: UHC Medicare Advantage |
$68.76
|
| Rate for Payer: UMR Bronson Commercial |
$401.58
|
|
|
PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 44386
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$674.70 |
| Rate for Payer: Aetna Commercial |
$112.47
|
| Rate for Payer: Aetna Medicare |
$87.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.47
|
| Rate for Payer: BCBS Complete |
$415.20
|
| Rate for Payer: BCBS MAPPO |
$83.93
|
| Rate for Payer: BCN Medicare Advantage |
$83.93
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.13
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: PACE SWMI |
$83.93
|
| Rate for Payer: PHP Commercial |
$117.50
|
| Rate for Payer: PHP Medicare Advantage |
$83.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.70
|
| Rate for Payer: Priority Health Medicare |
$83.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.93
|
| Rate for Payer: UHC Medicare Advantage |
$83.93
|
| Rate for Payer: UMR Bronson Commercial |
$477.48
|
|
|
PR NDSC NJX IMPLT MATRL URT&/BLDR NCK
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 51715
|
| Min. Negotiated Rate |
$190.39 |
| Max. Negotiated Rate |
$1,136.85 |
| Rate for Payer: Aetna Commercial |
$255.12
|
| Rate for Payer: Aetna Medicare |
$198.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.12
|
| Rate for Payer: BCBS Complete |
$699.60
|
| Rate for Payer: BCBS MAPPO |
$190.39
|
| Rate for Payer: BCN Medicare Advantage |
$190.39
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$274.16
|
| Rate for Payer: Cofinity Commercial |
$255.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.91
|
| Rate for Payer: Nomi Health Commercial |
$228.47
|
| Rate for Payer: PACE SWMI |
$190.39
|
| Rate for Payer: PHP Commercial |
$266.55
|
| Rate for Payer: PHP Medicare Advantage |
$190.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.85
|
| Rate for Payer: Priority Health Medicare |
$190.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.39
|
| Rate for Payer: UHC Medicare Advantage |
$190.39
|
| Rate for Payer: UMR Bronson Commercial |
$804.54
|
|
|
PR NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 33508
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$20.56
|
| Rate for Payer: Aetna Medicare |
$15.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.56
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: BCBS MAPPO |
$15.34
|
| Rate for Payer: BCN Medicare Advantage |
$15.34
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$22.09
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.11
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: PACE SWMI |
$15.34
|
| Rate for Payer: PHP Commercial |
$21.48
|
| Rate for Payer: PHP Medicare Advantage |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health Medicare |
$15.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.34
|
| Rate for Payer: UHC Medicare Advantage |
$15.34
|
| Rate for Payer: UMR Bronson Commercial |
$157.32
|
|
|
PR NDSC URETEROTOMY RMVL FB/CALCULUS
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 50980
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$485.61 |
| Rate for Payer: Aetna Commercial |
$451.89
|
| Rate for Payer: Aetna Medicare |
$350.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.89
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$337.23
|
| Rate for Payer: BCN Medicare Advantage |
$337.23
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$485.61
|
| Rate for Payer: Cofinity Commercial |
$451.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.09
|
| Rate for Payer: Nomi Health Commercial |
$404.68
|
| Rate for Payer: PACE SWMI |
$337.23
|
| Rate for Payer: PHP Commercial |
$472.12
|
| Rate for Payer: PHP Medicare Advantage |
$337.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$337.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.23
|
| Rate for Payer: UHC Medicare Advantage |
$337.23
|
| Rate for Payer: UMR Bronson Commercial |
$317.86
|
|
|
PR NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 50972
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$488.87 |
| Rate for Payer: Aetna Commercial |
$454.92
|
| Rate for Payer: Aetna Medicare |
$353.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.92
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS MAPPO |
$339.49
|
| Rate for Payer: BCN Medicare Advantage |
$339.49
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$488.87
|
| Rate for Payer: Cofinity Commercial |
$454.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.46
|
| Rate for Payer: Nomi Health Commercial |
$407.39
|
| Rate for Payer: PACE SWMI |
$339.49
|
| Rate for Payer: PHP Commercial |
$475.29
|
| Rate for Payer: PHP Medicare Advantage |
$339.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health Medicare |
$339.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.49
|
| Rate for Payer: UHC Medicare Advantage |
$339.49
|
| Rate for Payer: UMR Bronson Commercial |
$318.78
|
|
|
PR NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$1,877.00
|
|
|
Service Code
|
HCPCS 29848
|
| Min. Negotiated Rate |
$495.71 |
| Max. Negotiated Rate |
$1,220.05 |
| Rate for Payer: Aetna Commercial |
$664.25
|
| Rate for Payer: Aetna Medicare |
$515.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.25
|
| Rate for Payer: BCBS Complete |
$750.80
|
| Rate for Payer: BCBS MAPPO |
$495.71
|
| Rate for Payer: BCN Medicare Advantage |
$495.71
|
| Rate for Payer: Cash Price |
$1,501.60
|
| Rate for Payer: Cash Price |
$1,501.60
|
| Rate for Payer: Cofinity Commercial |
$713.82
|
| Rate for Payer: Cofinity Commercial |
$664.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$520.50
|
| Rate for Payer: Nomi Health Commercial |
$594.85
|
| Rate for Payer: PACE SWMI |
$495.71
|
| Rate for Payer: PHP Commercial |
$693.99
|
| Rate for Payer: PHP Medicare Advantage |
$495.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,220.05
|
| Rate for Payer: Priority Health Medicare |
$495.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.71
|
| Rate for Payer: UHC Medicare Advantage |
$495.71
|
| Rate for Payer: UMR Bronson Commercial |
$863.42
|
|
|
PR NECK LIFT
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 00541
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: UMR Bronson Commercial |
$938.40
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 95868
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Aetna Commercial |
$153.19
|
| Rate for Payer: Aetna Medicare |
$118.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.62
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: BCBS MAPPO |
$114.32
|
| Rate for Payer: BCN Medicare Advantage |
$114.32
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$153.19
|
| Rate for Payer: Cofinity Commercial |
$164.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.04
|
| Rate for Payer: Nomi Health Commercial |
$137.18
|
| Rate for Payer: PACE SWMI |
$114.32
|
| Rate for Payer: PHP Commercial |
$160.05
|
| Rate for Payer: PHP Medicare Advantage |
$114.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.85
|
| Rate for Payer: Priority Health Medicare |
$114.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.32
|
| Rate for Payer: UHC Medicare Advantage |
$114.32
|
| Rate for Payer: UMR Bronson Commercial |
$123.74
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 95867
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$126.42
|
| Rate for Payer: Aetna Medicare |
$98.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.42
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$94.34
|
| Rate for Payer: BCN Medicare Advantage |
$94.34
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$135.85
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.06
|
| Rate for Payer: Nomi Health Commercial |
$113.21
|
| Rate for Payer: PACE SWMI |
$94.34
|
| Rate for Payer: PHP Commercial |
$132.08
|
| Rate for Payer: PHP Medicare Advantage |
$94.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$94.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.34
|
| Rate for Payer: UHC Medicare Advantage |
$94.34
|
| Rate for Payer: UMR Bronson Commercial |
$89.70
|
|
