|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
HCPCS 21812
|
| Min. Negotiated Rate |
$694.60 |
| Max. Negotiated Rate |
$1,285.01 |
| Rate for Payer: Aetna Commercial |
$930.76
|
| Rate for Payer: Aetna Medicare |
$722.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$930.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.22
|
| Rate for Payer: BCBS Complete |
$705.20
|
| Rate for Payer: BCBS MAPPO |
$694.60
|
| Rate for Payer: BCN Medicare Advantage |
$694.60
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cofinity Commercial |
$930.76
|
| Rate for Payer: Cofinity Commercial |
$1,000.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.60
|
| Rate for Payer: Healthscope Commercial |
$1,285.01
|
| Rate for Payer: Healthscope Commercial |
$1,111.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,145.95
|
| Rate for Payer: Nomi Health Commercial |
$833.52
|
| Rate for Payer: PACE SWMI |
$694.60
|
| Rate for Payer: PHP Medicare Advantage |
$694.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,145.95
|
| Rate for Payer: Priority Health Medicare |
$694.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.60
|
| Rate for Payer: UHC Medicare Advantage |
$694.60
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 21813
|
| Min. Negotiated Rate |
$794.00 |
| Max. Negotiated Rate |
$1,764.75 |
| Rate for Payer: Aetna Commercial |
$1,278.25
|
| Rate for Payer: Aetna Medicare |
$992.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,278.25
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS MAPPO |
$953.92
|
| Rate for Payer: BCN Medicare Advantage |
$953.92
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,373.64
|
| Rate for Payer: Cofinity Commercial |
$1,278.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.92
|
| Rate for Payer: Healthscope Commercial |
$1,526.27
|
| Rate for Payer: Healthscope Commercial |
$1,764.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,001.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.25
|
| Rate for Payer: Nomi Health Commercial |
$1,144.70
|
| Rate for Payer: PACE SWMI |
$953.92
|
| Rate for Payer: PHP Medicare Advantage |
$953.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health Medicare |
$953.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$953.92
|
| Rate for Payer: UHC Medicare Advantage |
$953.92
|
|
|
PR OPEN TX SCAPULAR FX W/INT FIXATION WHEN PFRMD
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23585
|
| Min. Negotiated Rate |
$940.60 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,260.40
|
| Rate for Payer: Aetna Medicare |
$978.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,354.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.40
|
| Rate for Payer: BCBS Complete |
$1,276.80
|
| Rate for Payer: BCBS MAPPO |
$940.60
|
| Rate for Payer: BCN Medicare Advantage |
$940.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,354.46
|
| Rate for Payer: Cofinity Commercial |
$1,260.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$940.60
|
| Rate for Payer: Healthscope Commercial |
$1,740.11
|
| Rate for Payer: Healthscope Commercial |
$1,504.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$987.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,074.80
|
| Rate for Payer: Nomi Health Commercial |
$1,128.72
|
| Rate for Payer: PACE SWMI |
$940.60
|
| Rate for Payer: PHP Medicare Advantage |
$940.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$940.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$940.60
|
| Rate for Payer: UHC Medicare Advantage |
$940.60
|
|
|
PR OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 28531
|
| Min. Negotiated Rate |
$173.61 |
| Max. Negotiated Rate |
$435.50 |
| Rate for Payer: Aetna Commercial |
$232.64
|
| Rate for Payer: Aetna Medicare |
$180.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.64
|
| Rate for Payer: BCBS Complete |
$268.00
|
| Rate for Payer: BCBS MAPPO |
$173.61
|
| Rate for Payer: BCN Medicare Advantage |
$173.61
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Commercial |
$232.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.61
|
| Rate for Payer: Healthscope Commercial |
$277.78
|
| Rate for Payer: Healthscope Commercial |
$321.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.50
|
| Rate for Payer: Nomi Health Commercial |
$208.33
|
| Rate for Payer: PACE SWMI |
$173.61
|
| Rate for Payer: PHP Medicare Advantage |
$173.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.50
|
| Rate for Payer: Priority Health Medicare |
$173.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.61
|
| Rate for Payer: UHC Medicare Advantage |
$173.61
|
|
|
PR OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,451.00
|
|
|
Service Code
|
HCPCS 23530
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,593.15 |
| Rate for Payer: Aetna Commercial |
$748.03
|
| Rate for Payer: Aetna Medicare |
$580.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.03
|
| Rate for Payer: BCBS Complete |
$980.40
|
| Rate for Payer: BCBS MAPPO |
$558.23
|
| Rate for Payer: BCN Medicare Advantage |
$558.23
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cofinity Commercial |
$803.85
|
| Rate for Payer: Cofinity Commercial |
$748.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.23
|
| Rate for Payer: Healthscope Commercial |
$893.17
|
| Rate for Payer: Healthscope Commercial |
$1,032.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,593.15
|
| Rate for Payer: Nomi Health Commercial |
$669.88
|
| Rate for Payer: PACE SWMI |
$558.23
|
| Rate for Payer: PHP Medicare Advantage |
$558.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,593.15
|
| Rate for Payer: Priority Health Medicare |
$558.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.23
|
| Rate for Payer: UHC Medicare Advantage |
$558.23
|
|
|
PR OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 21825
|
| Min. Negotiated Rate |
$401.60 |
| Max. Negotiated Rate |
$985.96 |
| Rate for Payer: Aetna Commercial |
$714.15
|
| Rate for Payer: Aetna Medicare |
$554.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$714.15
|
| Rate for Payer: BCBS Complete |
$401.60
|
| Rate for Payer: BCBS MAPPO |
$532.95
|
| Rate for Payer: BCN Medicare Advantage |
$532.95
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cofinity Commercial |
$767.45
|
| Rate for Payer: Cofinity Commercial |
$714.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$532.95
|
| Rate for Payer: Healthscope Commercial |
$852.72
|
| Rate for Payer: Healthscope Commercial |
$985.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$559.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.60
|
| Rate for Payer: Nomi Health Commercial |
$639.54
|
| Rate for Payer: PACE SWMI |
$532.95
|
| Rate for Payer: PHP Medicare Advantage |
$532.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.60
|
| Rate for Payer: Priority Health Medicare |
$532.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$532.95
|
| Rate for Payer: UHC Medicare Advantage |
$532.95
|
|
|
PR OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 28465
|
| Min. Negotiated Rate |
$616.27 |
| Max. Negotiated Rate |
$1,140.10 |
| Rate for Payer: Aetna Commercial |
$825.80
|
| Rate for Payer: Aetna Medicare |
$640.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.80
|
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: BCBS MAPPO |
$616.27
|
| Rate for Payer: BCN Medicare Advantage |
$616.27
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$887.43
|
| Rate for Payer: Cofinity Commercial |
$825.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.27
|
| Rate for Payer: Healthscope Commercial |
$986.03
|
| Rate for Payer: Healthscope Commercial |
$1,140.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.15
|
| Rate for Payer: Nomi Health Commercial |
$739.52
|
| Rate for Payer: PACE SWMI |
$616.27
|
| Rate for Payer: PHP Medicare Advantage |
$616.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health Medicare |
$616.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.27
|
| Rate for Payer: UHC Medicare Advantage |
$616.27
|
|
|
PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$2,786.00
|
|
|
Service Code
|
HCPCS 27535
|
| Min. Negotiated Rate |
$864.44 |
| Max. Negotiated Rate |
$1,810.90 |
| Rate for Payer: Aetna Commercial |
$1,158.35
|
| Rate for Payer: Aetna Medicare |
$899.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.35
|
| Rate for Payer: BCBS Complete |
$1,114.40
|
| Rate for Payer: BCBS MAPPO |
$864.44
|
| Rate for Payer: BCN Medicare Advantage |
$864.44
|
| Rate for Payer: Cash Price |
$2,228.80
|
| Rate for Payer: Cash Price |
$2,228.80
|
| Rate for Payer: Cofinity Commercial |
$1,244.79
|
| Rate for Payer: Cofinity Commercial |
$1,158.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.44
|
| Rate for Payer: Healthscope Commercial |
$1,383.10
|
| Rate for Payer: Healthscope Commercial |
$1,599.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,810.90
|
| Rate for Payer: Nomi Health Commercial |
$1,037.33
|
| Rate for Payer: PACE SWMI |
$864.44
|
| Rate for Payer: PHP Medicare Advantage |
$864.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,810.90
|
| Rate for Payer: Priority Health Medicare |
$864.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.44
|
| Rate for Payer: UHC Medicare Advantage |
$864.44
|
|
|
PR OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC
|
Professional
|
Both
|
$2,108.00
|
|
|
Service Code
|
HCPCS 25685
|
| Min. Negotiated Rate |
$712.26 |
| Max. Negotiated Rate |
$1,370.20 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna Medicare |
$740.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.65
|
| Rate for Payer: BCBS Complete |
$843.20
|
| Rate for Payer: BCBS MAPPO |
$712.26
|
| Rate for Payer: BCN Medicare Advantage |
$712.26
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Cofinity Commercial |
$954.43
|
| Rate for Payer: Cofinity Commercial |
$1,025.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.26
|
| Rate for Payer: Healthscope Commercial |
$1,317.68
|
| Rate for Payer: Healthscope Commercial |
$1,139.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,370.20
|
| Rate for Payer: Nomi Health Commercial |
$854.71
|
| Rate for Payer: PACE SWMI |
$712.26
|
| Rate for Payer: PHP Medicare Advantage |
$712.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.20
|
| Rate for Payer: Priority Health Medicare |
$712.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.26
|
| Rate for Payer: UHC Medicare Advantage |
$712.26
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP
|
Professional
|
Both
|
$4,168.00
|
|
|
Service Code
|
HCPCS 27823
|
| Min. Negotiated Rate |
$939.78 |
| Max. Negotiated Rate |
$2,709.20 |
| Rate for Payer: Aetna Commercial |
$1,259.31
|
| Rate for Payer: Aetna Medicare |
$977.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.31
|
| Rate for Payer: BCBS Complete |
$1,667.20
|
| Rate for Payer: BCBS MAPPO |
$939.78
|
| Rate for Payer: BCN Medicare Advantage |
$939.78
|
| Rate for Payer: Cash Price |
$3,334.40
|
| Rate for Payer: Cash Price |
$3,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,353.28
|
| Rate for Payer: Cofinity Commercial |
$1,259.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.78
|
| Rate for Payer: Healthscope Commercial |
$1,503.65
|
| Rate for Payer: Healthscope Commercial |
$1,738.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,709.20
|
| Rate for Payer: Nomi Health Commercial |
$1,127.74
|
| Rate for Payer: PACE SWMI |
$939.78
|
| Rate for Payer: PHP Medicare Advantage |
$939.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,709.20
|
| Rate for Payer: Priority Health Medicare |
$939.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.78
|
| Rate for Payer: UHC Medicare Advantage |
$939.78
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 27822
|
| Min. Negotiated Rate |
$832.31 |
| Max. Negotiated Rate |
$2,299.05 |
| Rate for Payer: Aetna Commercial |
$1,115.30
|
| Rate for Payer: Aetna Medicare |
$865.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,198.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.30
|
| Rate for Payer: BCBS Complete |
$1,414.80
|
| Rate for Payer: BCBS MAPPO |
$832.31
|
| Rate for Payer: BCN Medicare Advantage |
$832.31
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,198.53
|
| Rate for Payer: Cofinity Commercial |
$1,115.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$832.31
|
| Rate for Payer: Healthscope Commercial |
$1,539.77
|
| Rate for Payer: Healthscope Commercial |
$1,331.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$873.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,299.05
|
| Rate for Payer: Nomi Health Commercial |
$998.77
|
| Rate for Payer: PACE SWMI |
$832.31
|
| Rate for Payer: PHP Medicare Advantage |
$832.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health Medicare |
$832.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$832.31
|
| Rate for Payer: UHC Medicare Advantage |
$832.31
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92014
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$129.76 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Aetna Medicare |
$72.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.00
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$70.14
|
| Rate for Payer: BCN Medicare Advantage |
$70.14
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$93.99
|
| Rate for Payer: Cofinity Commercial |
$101.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$112.22
|
| Rate for Payer: Healthscope Commercial |
$129.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$84.17
|
| Rate for Payer: PACE SWMI |
$70.14
|
| Rate for Payer: PHP Medicare Advantage |
$70.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$70.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.14
|
| Rate for Payer: UHC Medicare Advantage |
$70.14
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 92004
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$160.78 |
| Rate for Payer: Aetna Commercial |
$116.46
|
| Rate for Payer: Aetna Medicare |
$90.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.46
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$86.91
|
| Rate for Payer: BCN Medicare Advantage |
$86.91
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$125.15
|
| Rate for Payer: Cofinity Commercial |
$116.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.91
|
| Rate for Payer: Healthscope Commercial |
$160.78
|
| Rate for Payer: Healthscope Commercial |
$139.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.85
|
| Rate for Payer: Nomi Health Commercial |
$104.29
|
| Rate for Payer: PACE SWMI |
$86.91
|
| Rate for Payer: PHP Medicare Advantage |
$86.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$86.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.91
|
| Rate for Payer: UHC Medicare Advantage |
$86.91
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92012
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Commercial |
$62.32
|
| Rate for Payer: Aetna Medicare |
$48.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.32
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$46.51
|
| Rate for Payer: BCN Medicare Advantage |
$46.51
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$74.42
|
| Rate for Payer: Healthscope Commercial |
$86.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.50
|
| Rate for Payer: Nomi Health Commercial |
$55.81
|
| Rate for Payer: PACE SWMI |
$46.51
|
| Rate for Payer: PHP Medicare Advantage |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health Medicare |
$46.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.51
|
| Rate for Payer: UHC Medicare Advantage |
$46.51
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE NEW PT
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 92002
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$56.53
|
| Rate for Payer: Aetna Medicare |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.53
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$42.19
|
| Rate for Payer: BCN Medicare Advantage |
$42.19
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$60.75
|
| Rate for Payer: Cofinity Commercial |
$56.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.19
|
| Rate for Payer: Healthscope Commercial |
$78.05
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.15
|
| Rate for Payer: Nomi Health Commercial |
$50.63
|
| Rate for Payer: PACE SWMI |
$42.19
|
| Rate for Payer: PHP Medicare Advantage |
$42.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$42.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.19
|
| Rate for Payer: UHC Medicare Advantage |
$42.19
|
|
|
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE; PROXIMAL HUMERUS
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 23491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$7,064.95
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 34716
|
| Min. Negotiated Rate |
$314.80 |
| Max. Negotiated Rate |
$660.56 |
| Rate for Payer: Aetna Commercial |
$478.46
|
| Rate for Payer: Aetna Medicare |
$371.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.46
|
| Rate for Payer: BCBS Complete |
$314.80
|
| Rate for Payer: BCBS MAPPO |
$357.06
|
| Rate for Payer: BCN Medicare Advantage |
$357.06
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cofinity Commercial |
$514.17
|
| Rate for Payer: Cofinity Commercial |
$478.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.06
|
| Rate for Payer: Healthscope Commercial |
$660.56
|
| Rate for Payer: Healthscope Commercial |
$571.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.55
|
| Rate for Payer: Nomi Health Commercial |
$428.47
|
| Rate for Payer: PACE SWMI |
$357.06
|
| Rate for Payer: PHP Medicare Advantage |
$357.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.55
|
| Rate for Payer: Priority Health Medicare |
$357.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.06
|
| Rate for Payer: UHC Medicare Advantage |
$357.06
|
|
|
PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 34834
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$229.68 |
| Rate for Payer: Aetna Commercial |
$166.36
|
| Rate for Payer: Aetna Medicare |
$129.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.36
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$124.15
|
| Rate for Payer: BCN Medicare Advantage |
$124.15
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$178.78
|
| Rate for Payer: Cofinity Commercial |
$166.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.15
|
| Rate for Payer: Healthscope Commercial |
$198.64
|
| Rate for Payer: Healthscope Commercial |
$229.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.50
|
| Rate for Payer: Nomi Health Commercial |
$148.98
|
| Rate for Payer: PACE SWMI |
$124.15
|
| Rate for Payer: PHP Medicare Advantage |
$124.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Medicare |
$124.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.15
|
| Rate for Payer: UHC Medicare Advantage |
$124.15
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$1,267.00
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$197.63 |
| Max. Negotiated Rate |
$823.55 |
| Rate for Payer: Aetna Commercial |
$264.82
|
| Rate for Payer: Aetna Medicare |
$205.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.82
|
| Rate for Payer: BCBS Complete |
$506.80
|
| Rate for Payer: BCBS MAPPO |
$197.63
|
| Rate for Payer: BCN Medicare Advantage |
$197.63
|
| Rate for Payer: Cash Price |
$1,013.60
|
| Rate for Payer: Cash Price |
$1,013.60
|
| Rate for Payer: Cofinity Commercial |
$284.59
|
| Rate for Payer: Cofinity Commercial |
$264.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.63
|
| Rate for Payer: Healthscope Commercial |
$365.62
|
| Rate for Payer: Healthscope Commercial |
$316.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.55
|
| Rate for Payer: Nomi Health Commercial |
$237.16
|
| Rate for Payer: PACE SWMI |
$197.63
|
| Rate for Payer: PHP Medicare Advantage |
$197.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.55
|
| Rate for Payer: Priority Health Medicare |
$197.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.63
|
| Rate for Payer: UHC Medicare Advantage |
$197.63
|
|
|
PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 34714
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$477.84 |
| Rate for Payer: Aetna Commercial |
$346.11
|
| Rate for Payer: Aetna Medicare |
$268.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.11
|
| Rate for Payer: BCBS Complete |
$227.20
|
| Rate for Payer: BCBS MAPPO |
$258.29
|
| Rate for Payer: BCN Medicare Advantage |
$258.29
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cofinity Commercial |
$371.94
|
| Rate for Payer: Cofinity Commercial |
$346.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.29
|
| Rate for Payer: Healthscope Commercial |
$413.26
|
| Rate for Payer: Healthscope Commercial |
$477.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.20
|
| Rate for Payer: Nomi Health Commercial |
$309.95
|
| Rate for Payer: PACE SWMI |
$258.29
|
| Rate for Payer: PHP Medicare Advantage |
$258.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health Medicare |
$258.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.29
|
| Rate for Payer: UHC Medicare Advantage |
$258.29
|
|
|
PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP
|
Professional
|
Both
|
$2,232.00
|
|
|
Service Code
|
HCPCS 34833
|
| Min. Negotiated Rate |
$378.73 |
| Max. Negotiated Rate |
$1,450.80 |
| Rate for Payer: Aetna Commercial |
$507.50
|
| Rate for Payer: Aetna Medicare |
$393.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.50
|
| Rate for Payer: BCBS Complete |
$892.80
|
| Rate for Payer: BCBS MAPPO |
$378.73
|
| Rate for Payer: BCN Medicare Advantage |
$378.73
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cofinity Commercial |
$545.37
|
| Rate for Payer: Cofinity Commercial |
$507.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.73
|
| Rate for Payer: Healthscope Commercial |
$700.65
|
| Rate for Payer: Healthscope Commercial |
$605.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,450.80
|
| Rate for Payer: Nomi Health Commercial |
$454.48
|
| Rate for Payer: PACE SWMI |
$378.73
|
| Rate for Payer: PHP Medicare Advantage |
$378.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,450.80
|
| Rate for Payer: Priority Health Medicare |
$378.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.73
|
| Rate for Payer: UHC Medicare Advantage |
$378.73
|
|
|
PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH
|
Professional
|
Both
|
$4,812.00
|
|
|
Service Code
|
HCPCS 34830
|
| Min. Negotiated Rate |
$1,698.38 |
| Max. Negotiated Rate |
$3,142.00 |
| Rate for Payer: Aetna Commercial |
$2,275.83
|
| Rate for Payer: Aetna Medicare |
$1,766.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,445.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.83
|
| Rate for Payer: BCBS Complete |
$1,924.80
|
| Rate for Payer: BCBS MAPPO |
$1,698.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,698.38
|
| Rate for Payer: Cash Price |
$3,849.60
|
| Rate for Payer: Cash Price |
$3,849.60
|
| Rate for Payer: Cofinity Commercial |
$2,445.67
|
| Rate for Payer: Cofinity Commercial |
$2,275.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,698.38
|
| Rate for Payer: Healthscope Commercial |
$2,717.41
|
| Rate for Payer: Healthscope Commercial |
$3,142.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,783.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,127.80
|
| Rate for Payer: Nomi Health Commercial |
$2,038.06
|
| Rate for Payer: PACE SWMI |
$1,698.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,698.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,127.80
|
| Rate for Payer: Priority Health Medicare |
$1,698.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,698.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,698.38
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH
|
Professional
|
Both
|
$4,077.00
|
|
|
Service Code
|
HCPCS 34831
|
| Min. Negotiated Rate |
$1,630.80 |
| Max. Negotiated Rate |
$3,441.83 |
| Rate for Payer: Aetna Commercial |
$2,493.00
|
| Rate for Payer: Aetna Medicare |
$1,934.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,679.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,493.00
|
| Rate for Payer: BCBS Complete |
$1,630.80
|
| Rate for Payer: BCBS MAPPO |
$1,860.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,860.45
|
| Rate for Payer: Cash Price |
$3,261.60
|
| Rate for Payer: Cash Price |
$3,261.60
|
| Rate for Payer: Cofinity Commercial |
$2,679.05
|
| Rate for Payer: Cofinity Commercial |
$2,493.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,860.45
|
| Rate for Payer: Healthscope Commercial |
$3,441.83
|
| Rate for Payer: Healthscope Commercial |
$2,976.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,953.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,650.05
|
| Rate for Payer: Nomi Health Commercial |
$2,232.54
|
| Rate for Payer: PACE SWMI |
$1,860.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,860.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,650.05
|
| Rate for Payer: Priority Health Medicare |
$1,860.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,860.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,860.45
|
|
|
PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 33889
|
| Min. Negotiated Rate |
$766.74 |
| Max. Negotiated Rate |
$2,080.00 |
| Rate for Payer: Aetna Commercial |
$1,027.43
|
| Rate for Payer: Aetna Medicare |
$797.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.43
|
| Rate for Payer: BCBS Complete |
$1,280.00
|
| Rate for Payer: BCBS MAPPO |
$766.74
|
| Rate for Payer: BCN Medicare Advantage |
$766.74
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$1,104.11
|
| Rate for Payer: Cofinity Commercial |
$1,027.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.74
|
| Rate for Payer: Healthscope Commercial |
$1,226.78
|
| Rate for Payer: Healthscope Commercial |
$1,418.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$805.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.00
|
| Rate for Payer: Nomi Health Commercial |
$920.09
|
| Rate for Payer: PACE SWMI |
$766.74
|
| Rate for Payer: PHP Medicare Advantage |
$766.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,080.00
|
| Rate for Payer: Priority Health Medicare |
$766.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.74
|
| Rate for Payer: UHC Medicare Advantage |
$766.74
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$76.22
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: Aetna Commercial |
$64.79
|
| Rate for Payer: Aetna Medicare |
$38.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.54
|
| Rate for Payer: BCBS Complete |
$30.49
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.98
|
| Rate for Payer: Healthscope Commercial |
$68.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.79
|
| Rate for Payer: PHP Commercial |
$64.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.54
|
| Rate for Payer: Priority Health SBD |
$48.02
|
|
