|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$62.61 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna Medicare |
$65.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.90
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$62.61
|
| Rate for Payer: BCN Medicare Advantage |
$62.61
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$90.16
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.74
|
| Rate for Payer: Nomi Health Commercial |
$75.13
|
| Rate for Payer: PACE SWMI |
$62.61
|
| Rate for Payer: PHP Commercial |
$87.65
|
| Rate for Payer: PHP Medicare Advantage |
$62.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$62.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.61
|
| Rate for Payer: UHC Medicare Advantage |
$62.61
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 50430
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$193.86
|
| Rate for Payer: Aetna Medicare |
$150.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.86
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$144.67
|
| Rate for Payer: BCN Medicare Advantage |
$144.67
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$208.32
|
| Rate for Payer: Cofinity Commercial |
$193.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.90
|
| Rate for Payer: Nomi Health Commercial |
$173.60
|
| Rate for Payer: PACE SWMI |
$144.67
|
| Rate for Payer: PHP Commercial |
$202.54
|
| Rate for Payer: PHP Medicare Advantage |
$144.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$144.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.67
|
| Rate for Payer: UHC Medicare Advantage |
$144.67
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 36005
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$373.75 |
| Rate for Payer: Aetna Commercial |
$60.77
|
| Rate for Payer: Aetna Medicare |
$47.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.77
|
| Rate for Payer: BCBS Complete |
$230.00
|
| Rate for Payer: BCBS MAPPO |
$45.35
|
| Rate for Payer: BCN Medicare Advantage |
$45.35
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$60.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.62
|
| Rate for Payer: Nomi Health Commercial |
$54.42
|
| Rate for Payer: PACE SWMI |
$45.35
|
| Rate for Payer: PHP Commercial |
$63.49
|
| Rate for Payer: PHP Medicare Advantage |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.75
|
| Rate for Payer: Priority Health Medicare |
$45.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.35
|
| Rate for Payer: UHC Medicare Advantage |
$45.35
|
| Rate for Payer: UMR Bronson Commercial |
$264.50
|
|
|
PR NJX RETROGRADE URETHROCSTOGRAPY
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 51610
|
| Min. Negotiated Rate |
$61.59 |
| Max. Negotiated Rate |
$466.05 |
| Rate for Payer: Aetna Commercial |
$82.53
|
| Rate for Payer: Aetna Medicare |
$64.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.53
|
| Rate for Payer: BCBS Complete |
$286.80
|
| Rate for Payer: BCBS MAPPO |
$61.59
|
| Rate for Payer: BCN Medicare Advantage |
$61.59
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cofinity Commercial |
$88.69
|
| Rate for Payer: Cofinity Commercial |
$82.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.67
|
| Rate for Payer: Nomi Health Commercial |
$73.91
|
| Rate for Payer: PACE SWMI |
$61.59
|
| Rate for Payer: PHP Commercial |
$86.23
|
| Rate for Payer: PHP Medicare Advantage |
$61.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.05
|
| Rate for Payer: Priority Health Medicare |
$61.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.59
|
| Rate for Payer: UHC Medicare Advantage |
$61.59
|
| Rate for Payer: UMR Bronson Commercial |
$329.82
|
|
|
PR NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 50690
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$138.45 |
| Rate for Payer: Aetna Commercial |
$89.27
|
| Rate for Payer: Aetna Medicare |
$69.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.27
|
| Rate for Payer: BCBS Complete |
$85.20
|
| Rate for Payer: BCBS MAPPO |
$66.62
|
| Rate for Payer: BCN Medicare Advantage |
$66.62
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$95.93
|
| Rate for Payer: Cofinity Commercial |
$89.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.95
|
| Rate for Payer: Nomi Health Commercial |
$79.94
|
| Rate for Payer: PACE SWMI |
$66.62
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: PHP Medicare Advantage |
$66.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health Medicare |
$66.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.62
|
| Rate for Payer: UHC Medicare Advantage |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$97.98
|
|
|
PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 54250
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$165.97 |
| Rate for Payer: Aetna Commercial |
$154.45
|
| Rate for Payer: Aetna Medicare |
$119.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.45
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$115.26
|
| Rate for Payer: BCN Medicare Advantage |
$115.26
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Cofinity Commercial |
$154.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.02
|
| Rate for Payer: Nomi Health Commercial |
$138.31
|
| Rate for Payer: PACE SWMI |
$115.26
|
| Rate for Payer: PHP Commercial |
$161.36
|
| Rate for Payer: PHP Medicare Advantage |
$115.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$115.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.26
|
| Rate for Payer: UHC Medicare Advantage |
$115.26
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 94761
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$4.85
|
| Rate for Payer: Aetna Medicare |
$3.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.85
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$3.62
|
| Rate for Payer: BCN Medicare Advantage |
$3.62
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$5.21
|
| Rate for Payer: Cofinity Commercial |
$4.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.80
|
| Rate for Payer: Nomi Health Commercial |
$4.34
|
| Rate for Payer: PACE SWMI |
$3.62
|
| Rate for Payer: PHP Commercial |
$5.07
|
| Rate for Payer: PHP Medicare Advantage |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$3.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.62
|
| Rate for Payer: UHC Medicare Advantage |
$3.62
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 94762
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.52 |
| Rate for Payer: Aetna Commercial |
$29.33
|
| Rate for Payer: Aetna Medicare |
$22.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.33
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$21.89
|
| Rate for Payer: BCN Medicare Advantage |
$21.89
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Cofinity Commercial |
$29.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.98
|
| Rate for Payer: Nomi Health Commercial |
$26.27
|
| Rate for Payer: PACE SWMI |
$21.89
|
| Rate for Payer: PHP Commercial |
$30.65
|
| Rate for Payer: PHP Medicare Advantage |
$21.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$21.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.89
|
| Rate for Payer: UHC Medicare Advantage |
$21.89
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 94760
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$4.46
|
| Rate for Payer: Aetna Medicare |
$3.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.46
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$3.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.33
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.50
|
| Rate for Payer: Nomi Health Commercial |
$4.00
|
| Rate for Payer: PACE SWMI |
$3.33
|
| Rate for Payer: PHP Commercial |
$4.66
|
| Rate for Payer: PHP Medicare Advantage |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$3.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.33
|
| Rate for Payer: UHC Medicare Advantage |
$3.33
|
| Rate for Payer: UMR Bronson Commercial |
$20.70
|
|
|
PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 93923
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$167.90 |
| Rate for Payer: Aetna Commercial |
$156.24
|
| Rate for Payer: Aetna Commercial |
$156.24
|
| Rate for Payer: Aetna Medicare |
$121.26
|
| Rate for Payer: Aetna Medicare |
$121.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.24
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$116.60
|
| Rate for Payer: BCBS MAPPO |
$116.60
|
| Rate for Payer: BCN Medicare Advantage |
$116.60
|
| Rate for Payer: BCN Medicare Advantage |
$116.60
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$167.90
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$167.90
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.43
|
| Rate for Payer: Nomi Health Commercial |
$139.92
|
| Rate for Payer: Nomi Health Commercial |
$139.92
|
| Rate for Payer: PACE SWMI |
$116.60
|
| Rate for Payer: PACE SWMI |
$116.60
|
| Rate for Payer: PHP Commercial |
$163.24
|
| Rate for Payer: PHP Commercial |
$163.24
|
| Rate for Payer: PHP Medicare Advantage |
$116.60
|
| Rate for Payer: PHP Medicare Advantage |
$116.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$116.60
|
| Rate for Payer: Priority Health Medicare |
$116.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.60
|
| Rate for Payer: UHC Medicare Advantage |
$116.60
|
| Rate for Payer: UHC Medicare Advantage |
$116.60
|
| Rate for Payer: UMR Bronson Commercial |
$144.90
|
| Rate for Payer: UMR Bronson Commercial |
$20.70
|
|
|
PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 93922
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$105.61 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Medicare |
$76.27
|
| Rate for Payer: Aetna Medicare |
$76.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Complete |
$82.00
|
| Rate for Payer: BCBS MAPPO |
$73.34
|
| Rate for Payer: BCBS MAPPO |
$73.34
|
| Rate for Payer: BCN Medicare Advantage |
$73.34
|
| Rate for Payer: BCN Medicare Advantage |
$73.34
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$98.28
|
| Rate for Payer: Cofinity Commercial |
$98.28
|
| Rate for Payer: Cofinity Commercial |
$105.61
|
| Rate for Payer: Cofinity Commercial |
$105.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.01
|
| Rate for Payer: Nomi Health Commercial |
$88.01
|
| Rate for Payer: Nomi Health Commercial |
$88.01
|
| Rate for Payer: PACE SWMI |
$73.34
|
| Rate for Payer: PACE SWMI |
$73.34
|
| Rate for Payer: PHP Commercial |
$102.68
|
| Rate for Payer: PHP Commercial |
$102.68
|
| Rate for Payer: PHP Medicare Advantage |
$73.34
|
| Rate for Payer: PHP Medicare Advantage |
$73.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Medicare |
$73.34
|
| Rate for Payer: Priority Health Medicare |
$73.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.34
|
| Rate for Payer: UHC Medicare Advantage |
$73.34
|
| Rate for Payer: UHC Medicare Advantage |
$73.34
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$94.30
|
|
|
PR NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 36221
|
| Min. Negotiated Rate |
$191.63 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna Medicare |
$199.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.78
|
| Rate for Payer: BCBS Complete |
$456.00
|
| Rate for Payer: BCBS MAPPO |
$191.63
|
| Rate for Payer: BCN Medicare Advantage |
$191.63
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cofinity Commercial |
$275.95
|
| Rate for Payer: Cofinity Commercial |
$256.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.21
|
| Rate for Payer: Nomi Health Commercial |
$229.96
|
| Rate for Payer: PACE SWMI |
$191.63
|
| Rate for Payer: PHP Commercial |
$268.28
|
| Rate for Payer: PHP Medicare Advantage |
$191.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.00
|
| Rate for Payer: Priority Health Medicare |
$191.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.63
|
| Rate for Payer: UHC Medicare Advantage |
$191.63
|
| Rate for Payer: UMR Bronson Commercial |
$524.40
|
|
|
PR NORMAL SALINE SOLUTION INFUS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J7030
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna Medicare |
$2.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.61
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$1.95
|
| Rate for Payer: BCN Medicare Advantage |
$1.95
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.05
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: PACE SWMI |
$1.95
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: PHP Medicare Advantage |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$1.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.95
|
| Rate for Payer: UHC Medicare Advantage |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR NORMAL SALINE SOLUTION INFUS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J7040
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$1.26
|
| Rate for Payer: BCN Medicare Advantage |
$1.26
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.32
|
| Rate for Payer: Nomi Health Commercial |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.26
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: PHP Medicare Advantage |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$1.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.26
|
| Rate for Payer: UHC Medicare Advantage |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR NORMAL SALINE SOLUTION INFUS
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J7050
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.87
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.94
|
| Rate for Payer: Cofinity Commercial |
$0.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: Nomi Health Commercial |
$0.78
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$0.91
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 98971
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna Commercial |
$28.10
|
| Rate for Payer: Aetna Medicare |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.10
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$20.97
|
| Rate for Payer: BCN Medicare Advantage |
$20.97
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$30.20
|
| Rate for Payer: Cofinity Commercial |
$28.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$25.16
|
| Rate for Payer: PACE SWMI |
$20.97
|
| Rate for Payer: PHP Commercial |
$29.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$20.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.97
|
| Rate for Payer: UHC Medicare Advantage |
$20.97
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 98972
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna Commercial |
$42.09
|
| Rate for Payer: Aetna Medicare |
$32.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS MAPPO |
$31.41
|
| Rate for Payer: BCN Medicare Advantage |
$31.41
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$45.23
|
| Rate for Payer: Cofinity Commercial |
$42.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.98
|
| Rate for Payer: Nomi Health Commercial |
$37.69
|
| Rate for Payer: PACE SWMI |
$31.41
|
| Rate for Payer: PHP Commercial |
$43.97
|
| Rate for Payer: PHP Medicare Advantage |
$31.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: Priority Health Medicare |
$31.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.41
|
| Rate for Payer: UHC Medicare Advantage |
$31.41
|
| Rate for Payer: UMR Bronson Commercial |
$42.78
|
|
|
PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 98970
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: Nomi Health Commercial |
$13.34
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 31267
|
| Min. Negotiated Rate |
$252.83 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Aetna Commercial |
$338.79
|
| Rate for Payer: Aetna Medicare |
$262.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.79
|
| Rate for Payer: BCBS Complete |
$323.60
|
| Rate for Payer: BCBS MAPPO |
$252.83
|
| Rate for Payer: BCN Medicare Advantage |
$252.83
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$364.08
|
| Rate for Payer: Cofinity Commercial |
$338.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.47
|
| Rate for Payer: Nomi Health Commercial |
$303.40
|
| Rate for Payer: PACE SWMI |
$252.83
|
| Rate for Payer: PHP Commercial |
$353.96
|
| Rate for Payer: PHP Medicare Advantage |
$252.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health Medicare |
$252.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.83
|
| Rate for Payer: UHC Medicare Advantage |
$252.83
|
| Rate for Payer: UMR Bronson Commercial |
$372.14
|
|
|
PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 31288
|
| Min. Negotiated Rate |
$223.46 |
| Max. Negotiated Rate |
$499.85 |
| Rate for Payer: Aetna Commercial |
$299.44
|
| Rate for Payer: Aetna Medicare |
$232.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.44
|
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: BCBS MAPPO |
$223.46
|
| Rate for Payer: BCN Medicare Advantage |
$223.46
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$321.78
|
| Rate for Payer: Cofinity Commercial |
$299.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.63
|
| Rate for Payer: Nomi Health Commercial |
$268.15
|
| Rate for Payer: PACE SWMI |
$223.46
|
| Rate for Payer: PHP Commercial |
$312.84
|
| Rate for Payer: PHP Medicare Advantage |
$223.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health Medicare |
$223.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.46
|
| Rate for Payer: UHC Medicare Advantage |
$223.46
|
| Rate for Payer: UMR Bronson Commercial |
$353.74
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 99447
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$49.03 |
| Rate for Payer: Aetna Commercial |
$45.63
|
| Rate for Payer: Aetna Medicare |
$35.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.63
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$34.05
|
| Rate for Payer: BCN Medicare Advantage |
$34.05
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.75
|
| Rate for Payer: Nomi Health Commercial |
$40.86
|
| Rate for Payer: PACE SWMI |
$34.05
|
| Rate for Payer: PHP Commercial |
$47.67
|
| Rate for Payer: PHP Medicare Advantage |
$34.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$34.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$34.05
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 99448
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$72.79 |
| Rate for Payer: Aetna Commercial |
$67.74
|
| Rate for Payer: Aetna Medicare |
$52.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.74
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$50.55
|
| Rate for Payer: BCN Medicare Advantage |
$50.55
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$72.79
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.08
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: PACE SWMI |
$50.55
|
| Rate for Payer: PHP Commercial |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$50.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$50.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.55
|
| Rate for Payer: UHC Medicare Advantage |
$50.55
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 99449
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$98.50 |
| Rate for Payer: Aetna Commercial |
$91.66
|
| Rate for Payer: Aetna Medicare |
$71.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.66
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS MAPPO |
$68.40
|
| Rate for Payer: BCN Medicare Advantage |
$68.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$98.50
|
| Rate for Payer: Cofinity Commercial |
$91.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.82
|
| Rate for Payer: Nomi Health Commercial |
$82.08
|
| Rate for Payer: PACE SWMI |
$68.40
|
| Rate for Payer: PHP Commercial |
$95.76
|
| Rate for Payer: PHP Medicare Advantage |
$68.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Medicare |
$68.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.40
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99446
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$24.31 |
| Rate for Payer: Aetna Commercial |
$22.62
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.62
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.88
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$24.31
|
| Rate for Payer: Cofinity Commercial |
$22.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.72
|
| Rate for Payer: Nomi Health Commercial |
$20.26
|
| Rate for Payer: PACE SWMI |
$16.88
|
| Rate for Payer: PHP Commercial |
$23.63
|
| Rate for Payer: PHP Medicare Advantage |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Medicare |
$16.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.88
|
| Rate for Payer: UHC Medicare Advantage |
$16.88
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS
|
Professional
|
Both
|
$7,109.00
|
|
|
Service Code
|
HCPCS 62161
|
| Min. Negotiated Rate |
$1,512.00 |
| Max. Negotiated Rate |
$4,620.85 |
| Rate for Payer: Aetna Commercial |
$2,026.08
|
| Rate for Payer: Aetna Medicare |
$1,572.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,177.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.08
|
| Rate for Payer: BCBS Complete |
$2,843.60
|
| Rate for Payer: BCBS MAPPO |
$1,512.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,512.00
|
| Rate for Payer: Cash Price |
$5,687.20
|
| Rate for Payer: Cash Price |
$5,687.20
|
| Rate for Payer: Cofinity Commercial |
$2,177.28
|
| Rate for Payer: Cofinity Commercial |
$2,026.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,512.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,587.60
|
| Rate for Payer: Nomi Health Commercial |
$1,814.40
|
| Rate for Payer: PACE SWMI |
$1,512.00
|
| Rate for Payer: PHP Commercial |
$2,116.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,512.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,620.85
|
| Rate for Payer: Priority Health Medicare |
$1,512.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,512.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,512.00
|
| Rate for Payer: UMR Bronson Commercial |
$3,270.14
|
|
