|
PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 31290
|
| Min. Negotiated Rate |
$733.79 |
| Max. Negotiated Rate |
$1,674.21 |
| 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 |
$770.48
|
| Rate for Payer: BCBS MAPPO |
$1,094.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.13
|
| Rate for Payer: BCN Commercial |
$1,674.21
|
| 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: Meridian Medicaid |
$770.48
|
| 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 Choice Medicaid |
$733.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.90
|
| Rate for Payer: Priority Health Medicare |
$1,094.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,586.90
|
| Rate for Payer: Priority Health SBD |
$1,586.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,094.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.16
|
| Rate for Payer: UHCCP Medicaid |
$733.79
|
| 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 |
$785.54 |
| Max. Negotiated Rate |
$1,781.23 |
| Rate for Payer: Aetna Commercial |
$1,573.86
|
| Rate for Payer: Aetna Medicare |
$1,221.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,573.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.31
|
| Rate for Payer: BCBS Complete |
$824.82
|
| Rate for Payer: BCBS MAPPO |
$1,174.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,581.20
|
| Rate for Payer: BCN Commercial |
$1,781.23
|
| 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 |
$1,573.86
|
| Rate for Payer: Cofinity Commercial |
$1,691.31
|
| 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: Meridian Medicaid |
$824.82
|
| 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 Choice Medicaid |
$785.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,702.31
|
| Rate for Payer: Priority Health Medicare |
$1,174.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,702.31
|
| Rate for Payer: Priority Health SBD |
$1,702.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,174.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,174.52
|
| Rate for Payer: UHCCP Medicaid |
$785.54
|
| 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 |
$633.25 |
| Max. Negotiated Rate |
$1,608.67 |
| Rate for Payer: Aetna Commercial |
$1,262.19
|
| Rate for Payer: Aetna Medicare |
$979.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,356.38
|
| Rate for Payer: BCBS Complete |
$664.91
|
| Rate for Payer: BCBS MAPPO |
$941.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,608.67
|
| Rate for Payer: BCN Commercial |
$1,455.28
|
| 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 |
$1,262.19
|
| Rate for Payer: Cofinity Commercial |
$1,356.38
|
| 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: Meridian Medicaid |
$664.91
|
| 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 Choice Medicaid |
$633.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,375.10
|
| Rate for Payer: Priority Health Medicare |
$941.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,375.10
|
| Rate for Payer: Priority Health SBD |
$1,375.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$941.93
|
| Rate for Payer: UHC Medicare Advantage |
$941.93
|
| Rate for Payer: UHCCP Medicaid |
$633.25
|
| 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 |
$102.88 |
| Max. Negotiated Rate |
$1,028.07 |
| Rate for Payer: Aetna Commercial |
$205.18
|
| Rate for Payer: Aetna Medicare |
$159.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.49
|
| Rate for Payer: BCBS Complete |
$108.02
|
| Rate for Payer: BCBS MAPPO |
$153.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.07
|
| Rate for Payer: BCN Commercial |
$303.13
|
| 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 |
$205.18
|
| Rate for Payer: Cofinity Commercial |
$220.49
|
| 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: Meridian Medicaid |
$108.02
|
| 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 Choice Medicaid |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.00
|
| Rate for Payer: Priority Health Medicare |
$153.12
|
| Rate for Payer: Priority Health Narrow Network |
$222.00
|
| Rate for Payer: Priority Health SBD |
$222.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.12
|
| Rate for Payer: UHC Medicare Advantage |
$153.12
|
| Rate for Payer: UHCCP Medicaid |
$102.88
|
| 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 |
$102.03 |
| Max. Negotiated Rate |
$1,226.18 |
| Rate for Payer: Aetna Commercial |
$203.64
|
| Rate for Payer: Aetna Medicare |
$158.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.84
|
| Rate for Payer: BCBS Complete |
$107.13
|
| Rate for Payer: BCBS MAPPO |
$151.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.18
|
| Rate for Payer: BCN Commercial |
$231.15
|
| 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 |
$203.64
|
| Rate for Payer: Cofinity Commercial |
$218.84
|
| 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: Meridian Medicaid |
$107.13
|
| 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 Choice Medicaid |
$102.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.61
|
| Rate for Payer: Priority Health Medicare |
$151.97
|
| Rate for Payer: Priority Health Narrow Network |
$220.61
|
| Rate for Payer: Priority Health SBD |
$220.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.97
|
| Rate for Payer: UHC Medicare Advantage |
$151.97
|
| Rate for Payer: UHCCP Medicaid |
$102.03
|
| 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 |
$107.14 |
| Max. Negotiated Rate |
$993.73 |
| Rate for Payer: Aetna Commercial |
$213.62
|
| Rate for Payer: Aetna Medicare |
$165.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.56
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$159.42
|
| Rate for Payer: BCBS Trust/PPO |
$993.73
|
| Rate for Payer: BCN Commercial |
$367.97
|
| 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 |
$213.62
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| 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: Meridian Medicaid |
$112.50
|
| 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 Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.20
|
| Rate for Payer: Priority Health Medicare |
$159.42
|
| Rate for Payer: Priority Health Narrow Network |
$232.20
|
| Rate for Payer: Priority Health SBD |
$232.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.42
|
| Rate for Payer: UHC Medicare Advantage |
$159.42
|
| Rate for Payer: UHCCP Medicaid |
$107.14
|
| 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 |
$389.36 |
| Max. Negotiated Rate |
$1,144.83 |
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Aetna Commercial |
$767.93
|
| Rate for Payer: Aetna Medicare |
$596.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.24
|
| Rate for Payer: BCBS Complete |
$408.83
|
| Rate for Payer: BCBS MAPPO |
$573.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.83
|
| Rate for Payer: BCN Commercial |
$883.53
|
| Rate for Payer: BCN Medicare Advantage |
$573.08
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cofinity Commercial |
$767.93
|
| Rate for Payer: Cofinity Commercial |
$825.24
|
| 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: Meridian Medicaid |
$408.83
|
| 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 Choice Medicaid |
$389.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$842.59
|
| Rate for Payer: Priority Health Medicare |
$573.08
|
| Rate for Payer: Priority Health Narrow Network |
$842.59
|
| Rate for Payer: Priority Health SBD |
$842.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.08
|
| Rate for Payer: UHC Medicare Advantage |
$573.08
|
| Rate for Payer: UHCCP Medicaid |
$389.36
|
| 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 |
$115.23 |
| Max. Negotiated Rate |
$2,519.62 |
| Rate for Payer: Aetna Commercial |
$230.92
|
| Rate for Payer: Aetna Medicare |
$179.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.16
|
| Rate for Payer: BCBS Complete |
$120.99
|
| Rate for Payer: BCBS MAPPO |
$172.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.37
|
| Rate for Payer: BCN Commercial |
$2,519.62
|
| 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 |
$230.92
|
| Rate for Payer: Cofinity Commercial |
$248.16
|
| 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: Meridian Medicaid |
$120.99
|
| 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 Choice Medicaid |
$115.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.96
|
| Rate for Payer: Priority Health Medicare |
$172.33
|
| Rate for Payer: Priority Health Narrow Network |
$247.96
|
| Rate for Payer: Priority Health SBD |
$247.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.33
|
| Rate for Payer: UHC Medicare Advantage |
$172.33
|
| Rate for Payer: UHCCP Medicaid |
$115.23
|
| 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 |
$100.96 |
| 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) |
$202.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.08
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS MAPPO |
$150.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,788.82
|
| Rate for Payer: BCN Commercial |
$2,482.00
|
| 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 |
$202.00
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| 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: Meridian Medicaid |
$106.01
|
| 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 Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,595.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.29
|
| Rate for Payer: Priority Health Medicare |
$150.75
|
| Rate for Payer: Priority Health Narrow Network |
$218.29
|
| Rate for Payer: Priority Health SBD |
$218.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.75
|
| Rate for Payer: UHC Medicare Advantage |
$150.75
|
| Rate for Payer: UHCCP Medicaid |
$100.96
|
| 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 |
$92.02 |
| Max. Negotiated Rate |
$2,461.47 |
| Rate for Payer: Aetna Commercial |
$184.09
|
| Rate for Payer: Aetna Medicare |
$142.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.83
|
| Rate for Payer: BCBS Complete |
$96.62
|
| Rate for Payer: BCBS MAPPO |
$137.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.49
|
| Rate for Payer: BCN Commercial |
$2,461.47
|
| 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 |
$184.09
|
| Rate for Payer: Cofinity Commercial |
$197.83
|
| 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: Meridian Medicaid |
$96.62
|
| 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 Choice Medicaid |
$92.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.30
|
| Rate for Payer: Priority Health Medicare |
$137.38
|
| Rate for Payer: Priority Health Narrow Network |
$199.30
|
| Rate for Payer: Priority Health SBD |
$199.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.38
|
| Rate for Payer: UHC Medicare Advantage |
$137.38
|
| Rate for Payer: UHCCP Medicaid |
$92.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,505.12
|
|
|
PR NASAL/SINUS NDSC SURG W/LIG SPHENOPALATINE ART
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 31241
|
| Min. Negotiated Rate |
$282.44 |
| Max. Negotiated Rate |
$1,456.52 |
| Rate for Payer: Aetna Commercial |
$567.62
|
| Rate for Payer: Aetna Medicare |
$440.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.98
|
| Rate for Payer: BCBS Complete |
$296.56
|
| Rate for Payer: BCBS MAPPO |
$423.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,456.52
|
| Rate for Payer: BCN Commercial |
$645.54
|
| 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 |
$567.62
|
| Rate for Payer: Cofinity Commercial |
$609.98
|
| 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: Meridian Medicaid |
$296.56
|
| 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 Choice Medicaid |
$282.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.03
|
| Rate for Payer: Priority Health Medicare |
$423.60
|
| Rate for Payer: Priority Health Narrow Network |
$615.03
|
| Rate for Payer: Priority Health SBD |
$615.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.60
|
| Rate for Payer: UHC Medicare Advantage |
$423.60
|
| Rate for Payer: UHCCP Medicaid |
$282.44
|
| 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 |
$783.20 |
| Max. Negotiated Rate |
$1,797.36 |
| Rate for Payer: Aetna Commercial |
$1,563.55
|
| Rate for Payer: Aetna Medicare |
$1,213.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,680.24
|
| Rate for Payer: BCBS Complete |
$822.36
|
| Rate for Payer: BCBS MAPPO |
$1,166.83
|
| Rate for Payer: BCN Commercial |
$1,797.36
|
| 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 |
$1,563.55
|
| Rate for Payer: Cofinity Commercial |
$1,680.24
|
| 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: Meridian Medicaid |
$822.36
|
| 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 Choice Medicaid |
$783.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,684.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,704.62
|
| Rate for Payer: Priority Health Medicare |
$1,166.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,704.62
|
| Rate for Payer: Priority Health SBD |
$1,704.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,166.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,166.83
|
| Rate for Payer: UHCCP Medicaid |
$783.20
|
| 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 |
$283.50 |
| Max. Negotiated Rate |
$1,077.73 |
| Rate for Payer: Aetna Commercial |
$569.49
|
| Rate for Payer: Aetna Medicare |
$441.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.99
|
| Rate for Payer: BCBS Complete |
$297.68
|
| Rate for Payer: BCBS MAPPO |
$424.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.73
|
| Rate for Payer: BCN Commercial |
$647.50
|
| 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 |
$569.49
|
| Rate for Payer: Cofinity Commercial |
$611.99
|
| 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: Meridian Medicaid |
$297.68
|
| 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 Choice Medicaid |
$283.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.49
|
| Rate for Payer: Priority Health Medicare |
$424.99
|
| Rate for Payer: Priority Health Narrow Network |
$615.49
|
| Rate for Payer: Priority Health SBD |
$615.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$424.99
|
| Rate for Payer: UHC Medicare Advantage |
$424.99
|
| Rate for Payer: UHCCP Medicaid |
$283.50
|
| 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 |
$317.80 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$638.62
|
| Rate for Payer: Aetna Medicare |
$495.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.28
|
| Rate for Payer: BCBS Complete |
$333.69
|
| Rate for Payer: BCBS MAPPO |
$476.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$726.66
|
| 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 |
$638.62
|
| Rate for Payer: Cofinity Commercial |
$686.28
|
| 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: Meridian Medicaid |
$333.69
|
| 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 Choice Medicaid |
$317.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.64
|
| Rate for Payer: Priority Health Medicare |
$476.58
|
| Rate for Payer: Priority Health Narrow Network |
$689.64
|
| Rate for Payer: Priority Health SBD |
$689.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.58
|
| Rate for Payer: UHC Medicare Advantage |
$476.58
|
| Rate for Payer: UHCCP Medicaid |
$317.80
|
| 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 |
$300.12 |
| Max. Negotiated Rate |
$1,218.26 |
| Rate for Payer: Aetna Commercial |
$603.16
|
| Rate for Payer: Aetna Medicare |
$468.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.17
|
| Rate for Payer: BCBS Complete |
$315.13
|
| Rate for Payer: BCBS MAPPO |
$450.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.26
|
| Rate for Payer: BCN Commercial |
$685.13
|
| 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 |
$603.16
|
| Rate for Payer: Cofinity Commercial |
$648.17
|
| 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: Meridian Medicaid |
$315.13
|
| 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 Choice Medicaid |
$300.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$650.24
|
| Rate for Payer: Priority Health Medicare |
$450.12
|
| Rate for Payer: Priority Health Narrow Network |
$650.24
|
| Rate for Payer: Priority Health SBD |
$650.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.12
|
| Rate for Payer: UHC Medicare Advantage |
$450.12
|
| Rate for Payer: UHCCP Medicaid |
$300.12
|
| 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 |
$155.06 |
| Max. Negotiated Rate |
$1,345.05 |
| Rate for Payer: Aetna Commercial |
$310.87
|
| Rate for Payer: Aetna Medicare |
$241.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.07
|
| Rate for Payer: BCBS Complete |
$162.81
|
| Rate for Payer: BCBS MAPPO |
$231.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,345.05
|
| Rate for Payer: BCN Commercial |
$646.03
|
| 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 |
$310.87
|
| Rate for Payer: Cofinity Commercial |
$334.07
|
| 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: Meridian Medicaid |
$162.81
|
| 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 Choice Medicaid |
$155.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.01
|
| Rate for Payer: Priority Health Medicare |
$231.99
|
| Rate for Payer: Priority Health Narrow Network |
$336.01
|
| Rate for Payer: Priority Health SBD |
$336.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.99
|
| Rate for Payer: UHC Medicare Advantage |
$231.99
|
| Rate for Payer: UHCCP Medicaid |
$155.06
|
| 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 |
$240.69 |
| Max. Negotiated Rate |
$1,458.11 |
| Rate for Payer: Aetna Commercial |
$483.36
|
| Rate for Payer: Aetna Medicare |
$375.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.44
|
| Rate for Payer: BCBS Complete |
$252.72
|
| Rate for Payer: BCBS MAPPO |
$360.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.11
|
| Rate for Payer: BCN Commercial |
$548.78
|
| 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 |
$483.36
|
| Rate for Payer: Cofinity Commercial |
$519.44
|
| 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: Meridian Medicaid |
$252.72
|
| 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 Choice Medicaid |
$240.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.33
|
| Rate for Payer: Priority Health Medicare |
$360.72
|
| Rate for Payer: Priority Health Narrow Network |
$522.33
|
| Rate for Payer: Priority Health SBD |
$522.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$360.72
|
| Rate for Payer: UHC Medicare Advantage |
$360.72
|
| Rate for Payer: UHCCP Medicaid |
$240.69
|
| 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 |
$205.76 |
| Max. Negotiated Rate |
$1,500.90 |
| Rate for Payer: Aetna Commercial |
$412.93
|
| Rate for Payer: Aetna Medicare |
$320.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.75
|
| Rate for Payer: BCBS Complete |
$216.05
|
| Rate for Payer: BCBS MAPPO |
$308.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.90
|
| Rate for Payer: BCN Commercial |
$470.10
|
| 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 |
$412.93
|
| Rate for Payer: Cofinity Commercial |
$443.75
|
| 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: Meridian Medicaid |
$216.05
|
| 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 Choice Medicaid |
$205.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$614.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.32
|
| Rate for Payer: Priority Health Medicare |
$308.16
|
| Rate for Payer: Priority Health Narrow Network |
$446.32
|
| Rate for Payer: Priority Health SBD |
$446.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.16
|
| Rate for Payer: UHC Medicare Advantage |
$308.16
|
| Rate for Payer: UHCCP Medicaid |
$205.76
|
| 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 |
$25.35 |
| Max. Negotiated Rate |
$1,612.37 |
| Rate for Payer: Aetna Commercial |
$51.26
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.08
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.37
|
| Rate for Payer: BCN Commercial |
$58.15
|
| 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 |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| 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: Meridian Medicaid |
$26.62
|
| 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 Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.40
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: Priority Health Narrow Network |
$70.40
|
| Rate for Payer: Priority Health SBD |
$70.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$25.35
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 92511
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$47.82
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.39
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS MAPPO |
$35.69
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$139.00
|
| 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 |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$51.39
|
| 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: Meridian Medicaid |
$25.49
|
| 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 Choice Medicaid |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.10
|
| Rate for Payer: Priority Health Medicare |
$35.69
|
| Rate for Payer: Priority Health Narrow Network |
$51.10
|
| Rate for Payer: Priority Health SBD |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.69
|
| Rate for Payer: UHC Medicare Advantage |
$35.69
|
| Rate for Payer: UHCCP Medicaid |
$24.28
|
| 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 |
$31.74 |
| Max. Negotiated Rate |
$1,210.86 |
| Rate for Payer: Aetna Commercial |
$134.98
|
| Rate for Payer: Aetna Medicare |
$104.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.05
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$100.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,210.86
|
| Rate for Payer: BCN Commercial |
$163.71
|
| 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 |
$134.98
|
| Rate for Payer: Cofinity Commercial |
$145.05
|
| 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: Meridian Medicaid |
$33.33
|
| 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 Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.43
|
| Rate for Payer: Priority Health Medicare |
$100.73
|
| Rate for Payer: Priority Health Narrow Network |
$152.43
|
| Rate for Payer: Priority Health SBD |
$67.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.73
|
| Rate for Payer: UHC Medicare Advantage |
$100.73
|
| Rate for Payer: UHCCP Medicaid |
$31.74
|
| 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 |
$50.48 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$189.17
|
| Rate for Payer: Aetna Medicare |
$146.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.28
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$141.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.84
|
| Rate for Payer: BCN Commercial |
$234.08
|
| 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 |
$189.17
|
| Rate for Payer: Cofinity Commercial |
$203.28
|
| 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: Meridian Medicaid |
$53.00
|
| 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 Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.20
|
| Rate for Payer: Priority Health Medicare |
$141.17
|
| Rate for Payer: Priority Health Narrow Network |
$216.20
|
| Rate for Payer: Priority Health SBD |
$107.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.17
|
| Rate for Payer: UHC Medicare Advantage |
$141.17
|
| Rate for Payer: UHCCP Medicaid |
$50.48
|
| 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 |
$61.77 |
| Max. Negotiated Rate |
$706.87 |
| Rate for Payer: Aetna Commercial |
$256.10
|
| Rate for Payer: Aetna Medicare |
$198.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.21
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS MAPPO |
$191.12
|
| Rate for Payer: BCBS Trust/PPO |
$706.87
|
| Rate for Payer: BCN Commercial |
$303.96
|
| 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 |
$256.10
|
| Rate for Payer: Cofinity Commercial |
$275.21
|
| 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: Meridian Medicaid |
$64.86
|
| 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 Choice Medicaid |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.89
|
| Rate for Payer: Priority Health Medicare |
$191.12
|
| Rate for Payer: Priority Health Narrow Network |
$280.89
|
| Rate for Payer: Priority Health SBD |
$131.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.12
|
| Rate for Payer: UHC Medicare Advantage |
$191.12
|
| Rate for Payer: UHCCP Medicaid |
$61.77
|
| 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 |
$65.60 |
| Max. Negotiated Rate |
$953.58 |
| Rate for Payer: Aetna Commercial |
$270.89
|
| Rate for Payer: Aetna Medicare |
$210.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.11
|
| Rate for Payer: BCBS Complete |
$68.88
|
| Rate for Payer: BCBS MAPPO |
$202.16
|
| Rate for Payer: BCBS Trust/PPO |
$953.58
|
| Rate for Payer: BCN Commercial |
$340.61
|
| 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 |
$270.89
|
| Rate for Payer: Cofinity Commercial |
$291.11
|
| 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: Meridian Medicaid |
$68.88
|
| 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 Choice Medicaid |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.91
|
| Rate for Payer: Priority Health Medicare |
$202.16
|
| Rate for Payer: Priority Health Narrow Network |
$313.91
|
| Rate for Payer: Priority Health SBD |
$139.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.16
|
| Rate for Payer: UHC Medicare Advantage |
$202.16
|
| Rate for Payer: UHCCP Medicaid |
$65.60
|
| 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 |
$28.76 |
| Max. Negotiated Rate |
$1,168.07 |
| Rate for Payer: Aetna Commercial |
$106.41
|
| Rate for Payer: Aetna Medicare |
$82.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.35
|
| Rate for Payer: BCBS Complete |
$30.20
|
| Rate for Payer: BCBS MAPPO |
$79.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,168.07
|
| Rate for Payer: BCN Commercial |
$126.08
|
| 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 |
$106.41
|
| Rate for Payer: Cofinity Commercial |
$114.35
|
| 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: Meridian Medicaid |
$30.20
|
| 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 Choice Medicaid |
$28.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.37
|
| Rate for Payer: Priority Health Medicare |
$79.41
|
| Rate for Payer: Priority Health Narrow Network |
$108.37
|
| Rate for Payer: Priority Health SBD |
$55.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.41
|
| Rate for Payer: UHC Medicare Advantage |
$79.41
|
| Rate for Payer: UHCCP Medicaid |
$28.76
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
