|
PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 31032
|
| Min. Negotiated Rate |
$449.60 |
| Max. Negotiated Rate |
$800.28 |
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna Medicare |
$577.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.71
|
| Rate for Payer: BCBS Complete |
$449.60
|
| Rate for Payer: BCBS MAPPO |
$555.75
|
| Rate for Payer: BCN Medicare Advantage |
$555.75
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cash Price |
$899.20
|
| Rate for Payer: Cofinity Commercial |
$800.28
|
| Rate for Payer: Cofinity Commercial |
$744.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.54
|
| Rate for Payer: Nomi Health Commercial |
$666.90
|
| Rate for Payer: PACE SWMI |
$555.75
|
| Rate for Payer: PHP Commercial |
$778.05
|
| Rate for Payer: PHP Medicare Advantage |
$555.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.60
|
| Rate for Payer: Priority Health Medicare |
$555.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.75
|
| Rate for Payer: UHC Medicare Advantage |
$555.75
|
| Rate for Payer: UMR Bronson Commercial |
$517.04
|
|
|
PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 31080
|
| Min. Negotiated Rate |
$905.60 |
| Max. Negotiated Rate |
$1,471.60 |
| Rate for Payer: Aetna Commercial |
$1,360.07
|
| Rate for Payer: Aetna Medicare |
$1,055.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,360.07
|
| Rate for Payer: BCBS Complete |
$905.60
|
| Rate for Payer: BCBS MAPPO |
$1,014.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.98
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,461.57
|
| Rate for Payer: Cofinity Commercial |
$1,360.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,065.73
|
| Rate for Payer: Nomi Health Commercial |
$1,217.98
|
| Rate for Payer: PACE SWMI |
$1,014.98
|
| Rate for Payer: PHP Commercial |
$1,420.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,471.60
|
| Rate for Payer: Priority Health Medicare |
$1,014.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,014.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,041.44
|
|
|
PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 31070
|
| Min. Negotiated Rate |
$354.40 |
| Max. Negotiated Rate |
$632.72 |
| Rate for Payer: Aetna Commercial |
$588.78
|
| Rate for Payer: Aetna Medicare |
$456.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.78
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$439.39
|
| Rate for Payer: BCN Medicare Advantage |
$439.39
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$632.72
|
| Rate for Payer: Cofinity Commercial |
$588.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.36
|
| Rate for Payer: Nomi Health Commercial |
$527.27
|
| Rate for Payer: PACE SWMI |
$439.39
|
| Rate for Payer: PHP Commercial |
$615.15
|
| Rate for Payer: PHP Medicare Advantage |
$439.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$439.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.39
|
| Rate for Payer: UHC Medicare Advantage |
$439.39
|
| Rate for Payer: UMR Bronson Commercial |
$407.56
|
|
|
PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 31020
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$425.57
|
| Rate for Payer: Aetna Medicare |
$330.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.57
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$317.59
|
| Rate for Payer: BCN Medicare Advantage |
$317.59
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$457.33
|
| Rate for Payer: Cofinity Commercial |
$425.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.47
|
| Rate for Payer: Nomi Health Commercial |
$381.11
|
| Rate for Payer: PACE SWMI |
$317.59
|
| Rate for Payer: PHP Commercial |
$444.63
|
| Rate for Payer: PHP Medicare Advantage |
$317.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$317.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.59
|
| Rate for Payer: UHC Medicare Advantage |
$317.59
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 31030
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$751.40 |
| Rate for Payer: Aetna Commercial |
$645.67
|
| Rate for Payer: Aetna Medicare |
$501.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.67
|
| Rate for Payer: BCBS Complete |
$462.40
|
| Rate for Payer: BCBS MAPPO |
$481.84
|
| Rate for Payer: BCN Medicare Advantage |
$481.84
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$693.85
|
| Rate for Payer: Cofinity Commercial |
$645.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.93
|
| Rate for Payer: Nomi Health Commercial |
$578.21
|
| Rate for Payer: PACE SWMI |
$481.84
|
| Rate for Payer: PHP Commercial |
$674.58
|
| Rate for Payer: PHP Medicare Advantage |
$481.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health Medicare |
$481.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.84
|
| Rate for Payer: UHC Medicare Advantage |
$481.84
|
| Rate for Payer: UMR Bronson Commercial |
$531.76
|
|
|
PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
|
Professional
|
Both
|
$1,867.00
|
|
|
Service Code
|
HCPCS 31051
|
| Min. Negotiated Rate |
$642.02 |
| Max. Negotiated Rate |
$1,213.55 |
| Rate for Payer: Aetna Commercial |
$860.31
|
| Rate for Payer: Aetna Medicare |
$667.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.31
|
| Rate for Payer: BCBS Complete |
$746.80
|
| Rate for Payer: BCBS MAPPO |
$642.02
|
| Rate for Payer: BCN Medicare Advantage |
$642.02
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cash Price |
$1,493.60
|
| Rate for Payer: Cofinity Commercial |
$924.51
|
| Rate for Payer: Cofinity Commercial |
$860.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.12
|
| Rate for Payer: Nomi Health Commercial |
$770.42
|
| Rate for Payer: PACE SWMI |
$642.02
|
| Rate for Payer: PHP Commercial |
$898.83
|
| Rate for Payer: PHP Medicare Advantage |
$642.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.55
|
| Rate for Payer: Priority Health Medicare |
$642.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.02
|
| Rate for Payer: UHC Medicare Advantage |
$642.02
|
| Rate for Payer: UMR Bronson Commercial |
$858.82
|
|
|
PR SKIN LESION SHAVE/EXCISION (15 MIN)
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00367
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR SKIN LESION SHAVE/EXCISION (30 MIN)
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00368
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR SKYLA, 13.5 MG
|
Professional
|
Both
|
$1,462.00
|
|
|
Service Code
|
HCPCS J7301
|
| Min. Negotiated Rate |
$584.80 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Aetna Medicare |
$731.00
|
| Rate for Payer: BCBS Complete |
$584.80
|
| Rate for Payer: Cash Price |
$1,169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.30
|
| Rate for Payer: UMR Bronson Commercial |
$672.52
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 36251
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$324.47
|
| Rate for Payer: Aetna Medicare |
$251.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.47
|
| Rate for Payer: BCBS Complete |
$205.60
|
| Rate for Payer: BCBS MAPPO |
$242.14
|
| Rate for Payer: BCN Medicare Advantage |
$242.14
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$348.68
|
| Rate for Payer: Cofinity Commercial |
$324.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.25
|
| Rate for Payer: Nomi Health Commercial |
$290.57
|
| Rate for Payer: PACE SWMI |
$242.14
|
| Rate for Payer: PHP Commercial |
$339.00
|
| Rate for Payer: PHP Medicare Advantage |
$242.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.10
|
| Rate for Payer: Priority Health Medicare |
$242.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.14
|
| Rate for Payer: UHC Medicare Advantage |
$242.14
|
| Rate for Payer: UMR Bronson Commercial |
$236.44
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 36252
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$489.31 |
| Rate for Payer: Aetna Commercial |
$455.33
|
| Rate for Payer: Aetna Medicare |
$353.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.33
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$339.80
|
| Rate for Payer: BCN Medicare Advantage |
$339.80
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$489.31
|
| Rate for Payer: Cofinity Commercial |
$455.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.79
|
| Rate for Payer: Nomi Health Commercial |
$407.76
|
| Rate for Payer: PACE SWMI |
$339.80
|
| Rate for Payer: PHP Commercial |
$475.72
|
| Rate for Payer: PHP Medicare Advantage |
$339.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$339.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.80
|
| Rate for Payer: UHC Medicare Advantage |
$339.80
|
| Rate for Payer: UMR Bronson Commercial |
$307.74
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
HCPCS 36223
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,170.65 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Aetna Medicare |
$333.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.07
|
| Rate for Payer: BCBS Complete |
$720.40
|
| Rate for Payer: BCBS MAPPO |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$320.20
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cofinity Commercial |
$461.09
|
| Rate for Payer: Cofinity Commercial |
$429.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.21
|
| Rate for Payer: Nomi Health Commercial |
$384.24
|
| Rate for Payer: PACE SWMI |
$320.20
|
| Rate for Payer: PHP Commercial |
$448.28
|
| Rate for Payer: PHP Medicare Advantage |
$320.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.65
|
| Rate for Payer: Priority Health Medicare |
$320.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.20
|
| Rate for Payer: UHC Medicare Advantage |
$320.20
|
| Rate for Payer: UMR Bronson Commercial |
$828.46
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 36222
|
| Min. Negotiated Rate |
$275.22 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$368.79
|
| Rate for Payer: Aetna Medicare |
$286.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.79
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$275.22
|
| Rate for Payer: BCN Medicare Advantage |
$275.22
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$396.32
|
| Rate for Payer: Cofinity Commercial |
$368.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.98
|
| Rate for Payer: Nomi Health Commercial |
$330.26
|
| Rate for Payer: PACE SWMI |
$275.22
|
| Rate for Payer: PHP Commercial |
$385.31
|
| Rate for Payer: PHP Medicare Advantage |
$275.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$275.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.22
|
| Rate for Payer: UHC Medicare Advantage |
$275.22
|
| Rate for Payer: UMR Bronson Commercial |
$761.30
|
|
|
PR SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 36014
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$655.85 |
| Rate for Payer: Aetna Commercial |
$193.44
|
| Rate for Payer: Aetna Medicare |
$150.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.44
|
| Rate for Payer: BCBS Complete |
$403.60
|
| Rate for Payer: BCBS MAPPO |
$144.36
|
| Rate for Payer: BCN Medicare Advantage |
$144.36
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cofinity Commercial |
$207.88
|
| Rate for Payer: Cofinity Commercial |
$193.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.58
|
| Rate for Payer: Nomi Health Commercial |
$173.23
|
| Rate for Payer: PACE SWMI |
$144.36
|
| Rate for Payer: PHP Commercial |
$202.10
|
| Rate for Payer: PHP Medicare Advantage |
$144.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.85
|
| Rate for Payer: Priority Health Medicare |
$144.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.36
|
| Rate for Payer: UHC Medicare Advantage |
$144.36
|
| Rate for Payer: UMR Bronson Commercial |
$464.14
|
|
|
PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 36228
|
| Min. Negotiated Rate |
$244.43 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$327.54
|
| Rate for Payer: Aetna Medicare |
$254.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.54
|
| Rate for Payer: BCBS Complete |
$544.00
|
| Rate for Payer: BCBS MAPPO |
$244.43
|
| Rate for Payer: BCN Medicare Advantage |
$244.43
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$351.98
|
| Rate for Payer: Cofinity Commercial |
$327.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.65
|
| Rate for Payer: Nomi Health Commercial |
$293.32
|
| Rate for Payer: PACE SWMI |
$244.43
|
| Rate for Payer: PHP Commercial |
$342.20
|
| Rate for Payer: PHP Medicare Advantage |
$244.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health Medicare |
$244.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.43
|
| Rate for Payer: UHC Medicare Advantage |
$244.43
|
| Rate for Payer: UMR Bronson Commercial |
$625.60
|
|
|
PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART
|
Professional
|
Both
|
$1,258.00
|
|
|
Service Code
|
HCPCS 36224
|
| Min. Negotiated Rate |
$359.67 |
| Max. Negotiated Rate |
$817.70 |
| Rate for Payer: Aetna Commercial |
$481.96
|
| Rate for Payer: Aetna Medicare |
$374.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.96
|
| Rate for Payer: BCBS Complete |
$503.20
|
| Rate for Payer: BCBS MAPPO |
$359.67
|
| Rate for Payer: BCN Medicare Advantage |
$359.67
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cofinity Commercial |
$517.92
|
| Rate for Payer: Cofinity Commercial |
$481.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.65
|
| Rate for Payer: Nomi Health Commercial |
$431.60
|
| Rate for Payer: PACE SWMI |
$359.67
|
| Rate for Payer: PHP Commercial |
$503.54
|
| Rate for Payer: PHP Medicare Advantage |
$359.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.70
|
| Rate for Payer: Priority Health Medicare |
$359.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.67
|
| Rate for Payer: UHC Medicare Advantage |
$359.67
|
| Rate for Payer: UMR Bronson Commercial |
$578.68
|
|
|
PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$2,344.00
|
|
|
Service Code
|
HCPCS 36216
|
| Min. Negotiated Rate |
$260.65 |
| Max. Negotiated Rate |
$1,523.60 |
| Rate for Payer: Aetna Commercial |
$349.27
|
| Rate for Payer: Aetna Medicare |
$271.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.27
|
| Rate for Payer: BCBS Complete |
$937.60
|
| Rate for Payer: BCBS MAPPO |
$260.65
|
| Rate for Payer: BCN Medicare Advantage |
$260.65
|
| Rate for Payer: Cash Price |
$1,875.20
|
| Rate for Payer: Cash Price |
$1,875.20
|
| Rate for Payer: Cofinity Commercial |
$375.34
|
| Rate for Payer: Cofinity Commercial |
$349.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.68
|
| Rate for Payer: Nomi Health Commercial |
$312.78
|
| Rate for Payer: PACE SWMI |
$260.65
|
| Rate for Payer: PHP Commercial |
$364.91
|
| Rate for Payer: PHP Medicare Advantage |
$260.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.60
|
| Rate for Payer: Priority Health Medicare |
$260.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.65
|
| Rate for Payer: UHC Medicare Advantage |
$260.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,078.24
|
|
|
PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$1,042.00
|
|
|
Service Code
|
HCPCS 36246
|
| Min. Negotiated Rate |
$240.57 |
| Max. Negotiated Rate |
$677.30 |
| Rate for Payer: Aetna Commercial |
$322.36
|
| Rate for Payer: Aetna Medicare |
$250.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.36
|
| Rate for Payer: BCBS Complete |
$416.80
|
| Rate for Payer: BCBS MAPPO |
$240.57
|
| Rate for Payer: BCN Medicare Advantage |
$240.57
|
| Rate for Payer: Cash Price |
$833.60
|
| Rate for Payer: Cash Price |
$833.60
|
| Rate for Payer: Cofinity Commercial |
$346.42
|
| Rate for Payer: Cofinity Commercial |
$322.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.60
|
| Rate for Payer: Nomi Health Commercial |
$288.68
|
| Rate for Payer: PACE SWMI |
$240.57
|
| Rate for Payer: PHP Commercial |
$336.80
|
| Rate for Payer: PHP Medicare Advantage |
$240.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.30
|
| Rate for Payer: Priority Health Medicare |
$240.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.57
|
| Rate for Payer: UHC Medicare Advantage |
$240.57
|
| Rate for Payer: UMR Bronson Commercial |
$479.32
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH
|
Professional
|
Both
|
$1,304.00
|
|
|
Service Code
|
HCPCS 36247
|
| Min. Negotiated Rate |
$282.44 |
| Max. Negotiated Rate |
$847.60 |
| Rate for Payer: Aetna Commercial |
$378.47
|
| Rate for Payer: Aetna Medicare |
$293.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.47
|
| Rate for Payer: BCBS Complete |
$521.60
|
| Rate for Payer: BCBS MAPPO |
$282.44
|
| Rate for Payer: BCN Medicare Advantage |
$282.44
|
| Rate for Payer: Cash Price |
$1,043.20
|
| Rate for Payer: Cash Price |
$1,043.20
|
| Rate for Payer: Cofinity Commercial |
$406.71
|
| Rate for Payer: Cofinity Commercial |
$378.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.56
|
| Rate for Payer: Nomi Health Commercial |
$338.93
|
| Rate for Payer: PACE SWMI |
$282.44
|
| Rate for Payer: PHP Commercial |
$395.42
|
| Rate for Payer: PHP Medicare Advantage |
$282.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.60
|
| Rate for Payer: Priority Health Medicare |
$282.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.44
|
| Rate for Payer: UHC Medicare Advantage |
$282.44
|
| Rate for Payer: UMR Bronson Commercial |
$599.84
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 36217
|
| Min. Negotiated Rate |
$324.61 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Aetna Commercial |
$434.98
|
| Rate for Payer: Aetna Medicare |
$337.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.98
|
| Rate for Payer: BCBS Complete |
$550.80
|
| Rate for Payer: BCBS MAPPO |
$324.61
|
| Rate for Payer: BCN Medicare Advantage |
$324.61
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$467.44
|
| Rate for Payer: Cofinity Commercial |
$434.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.84
|
| Rate for Payer: Nomi Health Commercial |
$389.53
|
| Rate for Payer: PACE SWMI |
$324.61
|
| Rate for Payer: PHP Commercial |
$454.45
|
| Rate for Payer: PHP Medicare Advantage |
$324.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health Medicare |
$324.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.61
|
| Rate for Payer: UHC Medicare Advantage |
$324.61
|
| Rate for Payer: UMR Bronson Commercial |
$633.42
|
|
|
PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 36245
|
| Min. Negotiated Rate |
$224.63 |
| Max. Negotiated Rate |
$542.75 |
| Rate for Payer: Aetna Commercial |
$301.00
|
| Rate for Payer: Aetna Medicare |
$233.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.00
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: BCBS MAPPO |
$224.63
|
| Rate for Payer: BCN Medicare Advantage |
$224.63
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$323.47
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.86
|
| Rate for Payer: Nomi Health Commercial |
$269.56
|
| Rate for Payer: PACE SWMI |
$224.63
|
| Rate for Payer: PHP Commercial |
$314.48
|
| Rate for Payer: PHP Medicare Advantage |
$224.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: Priority Health Medicare |
$224.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.63
|
| Rate for Payer: UHC Medicare Advantage |
$224.63
|
| Rate for Payer: UMR Bronson Commercial |
$384.10
|
|
|
PR SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 36215
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$271.22
|
| Rate for Payer: Aetna Medicare |
$210.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.22
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$202.40
|
| Rate for Payer: BCN Medicare Advantage |
$202.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$291.46
|
| Rate for Payer: Cofinity Commercial |
$271.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.52
|
| Rate for Payer: Nomi Health Commercial |
$242.88
|
| Rate for Payer: PACE SWMI |
$202.40
|
| Rate for Payer: PHP Commercial |
$283.36
|
| Rate for Payer: PHP Medicare Advantage |
$202.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$202.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.40
|
| Rate for Payer: UHC Medicare Advantage |
$202.40
|
| Rate for Payer: UMR Bronson Commercial |
$422.28
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 36248
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$61.44
|
| Rate for Payer: Aetna Medicare |
$47.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$45.85
|
| Rate for Payer: BCN Medicare Advantage |
$45.85
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$66.02
|
| Rate for Payer: Cofinity Commercial |
$61.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.14
|
| Rate for Payer: Nomi Health Commercial |
$55.02
|
| Rate for Payer: PACE SWMI |
$45.85
|
| Rate for Payer: PHP Commercial |
$64.19
|
| Rate for Payer: PHP Medicare Advantage |
$45.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$45.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.85
|
| Rate for Payer: UHC Medicare Advantage |
$45.85
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 36218
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$67.48
|
| Rate for Payer: Aetna Medicare |
$52.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.48
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$50.36
|
| Rate for Payer: BCN Medicare Advantage |
$50.36
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$72.52
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.88
|
| Rate for Payer: Nomi Health Commercial |
$60.43
|
| Rate for Payer: PACE SWMI |
$50.36
|
| Rate for Payer: PHP Commercial |
$70.50
|
| Rate for Payer: PHP Medicare Advantage |
$50.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$50.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.36
|
| Rate for Payer: UHC Medicare Advantage |
$50.36
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 36015
|
| Min. Negotiated Rate |
$163.57 |
| Max. Negotiated Rate |
$621.40 |
| Rate for Payer: Aetna Commercial |
$219.18
|
| Rate for Payer: Aetna Medicare |
$170.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.18
|
| Rate for Payer: BCBS Complete |
$382.40
|
| Rate for Payer: BCBS MAPPO |
$163.57
|
| Rate for Payer: BCN Medicare Advantage |
$163.57
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$235.54
|
| Rate for Payer: Cofinity Commercial |
$219.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.75
|
| Rate for Payer: Nomi Health Commercial |
$196.28
|
| Rate for Payer: PACE SWMI |
$163.57
|
| Rate for Payer: PHP Commercial |
$229.00
|
| Rate for Payer: PHP Medicare Advantage |
$163.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health Medicare |
$163.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.57
|
| Rate for Payer: UHC Medicare Advantage |
$163.57
|
| Rate for Payer: UMR Bronson Commercial |
$439.76
|
|
