|
PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$5,157.00
|
|
|
Service Code
|
HCPCS 27447
|
| Min. Negotiated Rate |
$739.32 |
| Max. Negotiated Rate |
$3,867.75 |
| Rate for Payer: Aetna Commercial |
$1,531.65
|
| Rate for Payer: Aetna Medicare |
$1,188.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,645.95
|
| Rate for Payer: BCBS Complete |
$776.29
|
| Rate for Payer: BCBS MAPPO |
$1,143.02
|
| Rate for Payer: BCN Commercial |
$2,127.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,143.02
|
| Rate for Payer: Cash Price |
$4,125.60
|
| Rate for Payer: Cash Price |
$4,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,645.95
|
| Rate for Payer: Cofinity Commercial |
$1,531.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,143.02
|
| Rate for Payer: Healthscope Commercial |
$2,114.59
|
| Rate for Payer: Healthscope Commercial |
$1,828.83
|
| Rate for Payer: Mclaren Medicaid |
$739.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,200.17
|
| Rate for Payer: Meridian Medicaid |
$776.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.00
|
| Rate for Payer: Nomi Health Commercial |
$1,371.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,867.75
|
| Rate for Payer: PACE SWMI |
$1,143.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,143.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$739.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,069.69
|
| Rate for Payer: Priority Health Medicare |
$1,143.02
|
| Rate for Payer: Priority Health SBD |
$2,069.69
|
| Rate for Payer: Priority Health Tiered Network |
$2,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,143.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,382.23
|
| Rate for Payer: UHC Core |
$2,382.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,143.02
|
| Rate for Payer: UHC Exchange |
$2,382.23
|
| Rate for Payer: UHC Medicaid |
$739.32
|
| Rate for Payer: UHCCP Medicaid |
$739.32
|
|
|
PR ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT
|
Professional
|
Both
|
$3,318.00
|
|
|
Service Code
|
HCPCS 27446
|
| Min. Negotiated Rate |
$667.97 |
| Max. Negotiated Rate |
$2,488.50 |
| Rate for Payer: Aetna Commercial |
$1,380.63
|
| Rate for Payer: Aetna Medicare |
$1,071.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,380.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,483.66
|
| Rate for Payer: BCBS Complete |
$701.37
|
| Rate for Payer: BCBS MAPPO |
$1,030.32
|
| Rate for Payer: BCN Commercial |
$1,736.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,030.32
|
| Rate for Payer: Cash Price |
$2,654.40
|
| Rate for Payer: Cash Price |
$2,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,483.66
|
| Rate for Payer: Cofinity Commercial |
$1,380.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,030.32
|
| Rate for Payer: Healthscope Commercial |
$1,906.09
|
| Rate for Payer: Healthscope Commercial |
$1,648.51
|
| Rate for Payer: Mclaren Medicaid |
$667.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,081.84
|
| Rate for Payer: Meridian Medicaid |
$701.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,133.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,034.97
|
| Rate for Payer: Nomi Health Commercial |
$1,236.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,488.50
|
| Rate for Payer: PACE SWMI |
$1,030.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,030.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$667.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,856.22
|
| Rate for Payer: Priority Health Medicare |
$1,030.32
|
| Rate for Payer: Priority Health SBD |
$1,856.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,856.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,030.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,035.73
|
| Rate for Payer: UHC Core |
$2,035.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,030.32
|
| Rate for Payer: UHC Exchange |
$2,035.73
|
| Rate for Payer: UHC Medicaid |
$667.97
|
| Rate for Payer: UHCCP Medicaid |
$667.97
|
|
|
PR ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT
|
Professional
|
Both
|
$1,741.00
|
|
|
Service Code
|
HCPCS 27441
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,464.75 |
| Rate for Payer: Aetna Commercial |
$1,007.28
|
| Rate for Payer: Aetna Medicare |
$781.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.45
|
| Rate for Payer: BCBS Complete |
$514.62
|
| Rate for Payer: BCBS MAPPO |
$751.70
|
| Rate for Payer: BCN Commercial |
$1,256.41
|
| Rate for Payer: BCN Medicare Advantage |
$751.70
|
| Rate for Payer: Cash Price |
$1,392.80
|
| Rate for Payer: Cash Price |
$1,392.80
|
| Rate for Payer: Cofinity Commercial |
$1,082.45
|
| Rate for Payer: Cofinity Commercial |
$1,007.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.70
|
| Rate for Payer: Healthscope Commercial |
$1,390.64
|
| Rate for Payer: Healthscope Commercial |
$1,202.72
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.28
|
| Rate for Payer: Meridian Medicaid |
$514.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$826.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,464.75
|
| Rate for Payer: Nomi Health Commercial |
$902.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,305.75
|
| Rate for Payer: PACE SWMI |
$751.70
|
| Rate for Payer: PHP Medicare Advantage |
$751.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,343.06
|
| Rate for Payer: Priority Health Medicare |
$751.70
|
| Rate for Payer: Priority Health SBD |
$1,343.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,343.06
|
| Rate for Payer: Railroad Medicare Medicare |
$751.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,441.19
|
| Rate for Payer: UHC Core |
$1,441.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$751.70
|
| Rate for Payer: UHC Exchange |
$1,441.19
|
| Rate for Payer: UHC Medicaid |
$490.11
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
|
|
PR ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT
|
Professional
|
Both
|
$2,246.00
|
|
|
Service Code
|
HCPCS 26531
|
| Min. Negotiated Rate |
$375.09 |
| Max. Negotiated Rate |
$1,684.50 |
| Rate for Payer: Aetna Commercial |
$764.89
|
| Rate for Payer: Aetna Medicare |
$593.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.97
|
| Rate for Payer: BCBS Complete |
$393.84
|
| Rate for Payer: BCBS MAPPO |
$570.81
|
| Rate for Payer: BCN Commercial |
$973.05
|
| Rate for Payer: BCN Medicare Advantage |
$570.81
|
| Rate for Payer: Cash Price |
$1,796.80
|
| Rate for Payer: Cash Price |
$1,796.80
|
| Rate for Payer: Cofinity Commercial |
$821.97
|
| Rate for Payer: Cofinity Commercial |
$764.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.81
|
| Rate for Payer: Healthscope Commercial |
$913.30
|
| Rate for Payer: Healthscope Commercial |
$1,056.00
|
| Rate for Payer: Mclaren Medicaid |
$375.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.35
|
| Rate for Payer: Meridian Medicaid |
$393.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$627.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,121.69
|
| Rate for Payer: Nomi Health Commercial |
$684.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,684.50
|
| Rate for Payer: PACE SWMI |
$570.81
|
| Rate for Payer: PHP Medicare Advantage |
$570.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,040.17
|
| Rate for Payer: Priority Health Medicare |
$570.81
|
| Rate for Payer: Priority Health SBD |
$1,040.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,040.17
|
| Rate for Payer: Railroad Medicare Medicare |
$570.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.26
|
| Rate for Payer: UHC Core |
$1,089.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$570.81
|
| Rate for Payer: UHC Exchange |
$1,089.26
|
| Rate for Payer: UHC Medicaid |
$375.09
|
| Rate for Payer: UHCCP Medicaid |
$375.09
|
|
|
PR ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/ENTIR CARPS
|
Professional
|
Both
|
$2,157.00
|
|
|
Service Code
|
HCPCS 25446
|
| Min. Negotiated Rate |
$670.74 |
| Max. Negotiated Rate |
$2,078.69 |
| Rate for Payer: Aetna Commercial |
$1,384.18
|
| Rate for Payer: Aetna Medicare |
$1,074.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,384.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.48
|
| Rate for Payer: BCBS Complete |
$704.28
|
| Rate for Payer: BCBS MAPPO |
$1,032.97
|
| Rate for Payer: BCN Commercial |
$1,777.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,032.97
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cofinity Commercial |
$1,487.48
|
| Rate for Payer: Cofinity Commercial |
$1,384.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,032.97
|
| Rate for Payer: Healthscope Commercial |
$1,910.99
|
| Rate for Payer: Healthscope Commercial |
$1,652.75
|
| Rate for Payer: Mclaren Medicaid |
$670.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,084.62
|
| Rate for Payer: Meridian Medicaid |
$704.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,136.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.69
|
| Rate for Payer: Nomi Health Commercial |
$1,239.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,617.75
|
| Rate for Payer: PACE SWMI |
$1,032.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,032.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,899.88
|
| Rate for Payer: Priority Health Medicare |
$1,032.97
|
| Rate for Payer: Priority Health SBD |
$1,899.88
|
| Rate for Payer: Priority Health Tiered Network |
$1,899.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,032.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,054.38
|
| Rate for Payer: UHC Core |
$2,054.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,032.97
|
| Rate for Payer: UHC Exchange |
$2,054.38
|
| Rate for Payer: UHC Medicaid |
$670.74
|
| Rate for Payer: UHCCP Medicaid |
$670.74
|
|
|
PR ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ
|
Professional
|
Both
|
$3,795.00
|
|
|
Service Code
|
HCPCS 25332
|
| Min. Negotiated Rate |
$494.16 |
| Max. Negotiated Rate |
$2,846.25 |
| Rate for Payer: Aetna Commercial |
$1,014.07
|
| Rate for Payer: Aetna Medicare |
$787.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.75
|
| Rate for Payer: BCBS Complete |
$518.87
|
| Rate for Payer: BCBS MAPPO |
$756.77
|
| Rate for Payer: BCN Commercial |
$1,290.77
|
| Rate for Payer: BCN Medicare Advantage |
$756.77
|
| Rate for Payer: Cash Price |
$3,036.00
|
| Rate for Payer: Cash Price |
$3,036.00
|
| Rate for Payer: Cofinity Commercial |
$1,089.75
|
| Rate for Payer: Cofinity Commercial |
$1,014.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.77
|
| Rate for Payer: Healthscope Commercial |
$1,400.02
|
| Rate for Payer: Healthscope Commercial |
$1,210.83
|
| Rate for Payer: Mclaren Medicaid |
$494.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.61
|
| Rate for Payer: Meridian Medicaid |
$518.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$832.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,500.53
|
| Rate for Payer: Nomi Health Commercial |
$908.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,846.25
|
| Rate for Payer: PACE SWMI |
$756.77
|
| Rate for Payer: PHP Medicare Advantage |
$756.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,379.79
|
| Rate for Payer: Priority Health Medicare |
$756.77
|
| Rate for Payer: Priority Health SBD |
$1,379.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,379.79
|
| Rate for Payer: Railroad Medicare Medicare |
$756.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,470.82
|
| Rate for Payer: UHC Core |
$1,470.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$756.77
|
| Rate for Payer: UHC Exchange |
$1,470.82
|
| Rate for Payer: UHC Medicaid |
$494.16
|
| Rate for Payer: UHCCP Medicaid |
$494.16
|
|
|
PR ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 29888
|
| Min. Negotiated Rate |
$567.22 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Priority Health SBD |
$1,575.70
|
| Rate for Payer: Aetna Commercial |
$1,168.96
|
| Rate for Payer: Aetna Medicare |
$907.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,168.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,256.20
|
| Rate for Payer: BCBS Complete |
$595.58
|
| Rate for Payer: BCBS MAPPO |
$872.36
|
| Rate for Payer: BCN Commercial |
$1,619.33
|
| Rate for Payer: BCN Medicare Advantage |
$872.36
|
| Rate for Payer: Cash Price |
$3,360.00
|
| Rate for Payer: Cash Price |
$3,360.00
|
| Rate for Payer: Cofinity Commercial |
$1,256.20
|
| Rate for Payer: Cofinity Commercial |
$1,168.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.36
|
| Rate for Payer: Healthscope Commercial |
$1,613.87
|
| Rate for Payer: Healthscope Commercial |
$1,395.78
|
| Rate for Payer: Mclaren Medicaid |
$567.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.98
|
| Rate for Payer: Meridian Medicaid |
$595.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$959.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.73
|
| Rate for Payer: Nomi Health Commercial |
$1,046.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,150.00
|
| Rate for Payer: PACE SWMI |
$872.36
|
| Rate for Payer: PHP Medicare Advantage |
$872.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,575.70
|
| Rate for Payer: Priority Health Medicare |
$872.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,575.70
|
| Rate for Payer: Railroad Medicare Medicare |
$872.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,717.90
|
| Rate for Payer: UHC Core |
$1,717.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$872.36
|
| Rate for Payer: UHC Exchange |
$1,717.90
|
| Rate for Payer: UHC Medicaid |
$567.22
|
| Rate for Payer: UHCCP Medicaid |
$567.22
|
|
|
PR ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$4,364.00
|
|
|
Service Code
|
HCPCS 29889
|
| Min. Negotiated Rate |
$722.07 |
| Max. Negotiated Rate |
$3,273.00 |
| Rate for Payer: Aetna Commercial |
$1,486.25
|
| Rate for Payer: Aetna Medicare |
$1,153.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,486.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.16
|
| Rate for Payer: BCBS Complete |
$758.17
|
| Rate for Payer: BCBS MAPPO |
$1,109.14
|
| Rate for Payer: BCN Commercial |
$1,859.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,109.14
|
| Rate for Payer: Cash Price |
$3,491.20
|
| Rate for Payer: Cash Price |
$3,491.20
|
| Rate for Payer: Cofinity Commercial |
$1,597.16
|
| Rate for Payer: Cofinity Commercial |
$1,486.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,109.14
|
| Rate for Payer: Healthscope Commercial |
$2,051.91
|
| Rate for Payer: Healthscope Commercial |
$1,774.62
|
| Rate for Payer: Mclaren Medicaid |
$722.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,164.60
|
| Rate for Payer: Meridian Medicaid |
$758.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,220.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,169.56
|
| Rate for Payer: Nomi Health Commercial |
$1,330.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,273.00
|
| Rate for Payer: PACE SWMI |
$1,109.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,109.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$722.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,987.71
|
| Rate for Payer: Priority Health Medicare |
$1,109.14
|
| Rate for Payer: Priority Health SBD |
$1,987.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,987.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,109.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,140.55
|
| Rate for Payer: UHC Core |
$2,140.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,109.14
|
| Rate for Payer: UHC Exchange |
$2,140.55
|
| Rate for Payer: UHC Medicaid |
$722.07
|
| Rate for Payer: UHCCP Medicaid |
$722.07
|
|
|
PR ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX
|
Professional
|
Both
|
$2,769.00
|
|
|
Service Code
|
HCPCS 29892
|
| Min. Negotiated Rate |
$381.06 |
| Max. Negotiated Rate |
$2,076.75 |
| Rate for Payer: Aetna Commercial |
$782.20
|
| Rate for Payer: Aetna Medicare |
$607.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.57
|
| Rate for Payer: BCBS Complete |
$400.11
|
| Rate for Payer: BCBS MAPPO |
$583.73
|
| Rate for Payer: BCN Commercial |
$974.55
|
| Rate for Payer: BCN Medicare Advantage |
$583.73
|
| Rate for Payer: Cash Price |
$2,215.20
|
| Rate for Payer: Cash Price |
$2,215.20
|
| Rate for Payer: Cofinity Commercial |
$840.57
|
| Rate for Payer: Cofinity Commercial |
$782.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.73
|
| Rate for Payer: Healthscope Commercial |
$933.97
|
| Rate for Payer: Healthscope Commercial |
$1,079.90
|
| Rate for Payer: Mclaren Medicaid |
$381.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$612.92
|
| Rate for Payer: Meridian Medicaid |
$400.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$642.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.36
|
| Rate for Payer: Nomi Health Commercial |
$700.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,076.75
|
| Rate for Payer: PACE SWMI |
$583.73
|
| Rate for Payer: PHP Medicare Advantage |
$583.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,041.76
|
| Rate for Payer: Priority Health Medicare |
$583.73
|
| Rate for Payer: Priority Health SBD |
$1,041.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,041.76
|
| Rate for Payer: Railroad Medicare Medicare |
$583.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,140.48
|
| Rate for Payer: UHC Core |
$1,140.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$583.73
|
| Rate for Payer: UHC Exchange |
$1,140.48
|
| Rate for Payer: UHC Medicaid |
$381.06
|
| Rate for Payer: UHCCP Medicaid |
$381.06
|
|
|
PR ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$2,618.00
|
|
|
Service Code
|
HCPCS 29855
|
| Min. Negotiated Rate |
$465.41 |
| Max. Negotiated Rate |
$1,963.50 |
| Rate for Payer: Aetna Commercial |
$954.59
|
| Rate for Payer: Aetna Medicare |
$740.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.59
|
| Rate for Payer: BCBS Complete |
$488.68
|
| Rate for Payer: BCBS MAPPO |
$712.38
|
| Rate for Payer: BCN Commercial |
$1,189.68
|
| Rate for Payer: BCN Medicare Advantage |
$712.38
|
| Rate for Payer: Cash Price |
$2,094.40
|
| Rate for Payer: Cash Price |
$2,094.40
|
| Rate for Payer: Cofinity Commercial |
$954.59
|
| Rate for Payer: Cofinity Commercial |
$1,025.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.38
|
| Rate for Payer: Healthscope Commercial |
$1,317.90
|
| Rate for Payer: Healthscope Commercial |
$1,139.81
|
| Rate for Payer: Mclaren Medicaid |
$465.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$748.00
|
| Rate for Payer: Meridian Medicaid |
$488.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$783.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.74
|
| Rate for Payer: Nomi Health Commercial |
$854.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,963.50
|
| Rate for Payer: PACE SWMI |
$712.38
|
| Rate for Payer: PHP Medicare Advantage |
$712.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,271.73
|
| Rate for Payer: Priority Health Medicare |
$712.38
|
| Rate for Payer: Priority Health SBD |
$1,271.73
|
| Rate for Payer: Priority Health Tiered Network |
$1,271.73
|
| Rate for Payer: Railroad Medicare Medicare |
$712.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,365.19
|
| Rate for Payer: UHC Core |
$1,365.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$712.38
|
| Rate for Payer: UHC Exchange |
$1,365.19
|
| Rate for Payer: UHC Medicaid |
$465.41
|
| Rate for Payer: UHCCP Medicaid |
$465.41
|
|
|
PR ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR
|
Professional
|
Both
|
$1,840.00
|
|
|
Service Code
|
HCPCS 29856
|
| Min. Negotiated Rate |
$585.32 |
| Max. Negotiated Rate |
$1,761.23 |
| Rate for Payer: Aetna Commercial |
$1,205.84
|
| Rate for Payer: Aetna Medicare |
$935.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,295.83
|
| Rate for Payer: BCBS Complete |
$614.59
|
| Rate for Payer: BCBS MAPPO |
$899.88
|
| Rate for Payer: BCN Commercial |
$1,508.39
|
| Rate for Payer: BCN Medicare Advantage |
$899.88
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cofinity Commercial |
$1,295.83
|
| Rate for Payer: Cofinity Commercial |
$1,205.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.88
|
| Rate for Payer: Healthscope Commercial |
$1,664.78
|
| Rate for Payer: Healthscope Commercial |
$1,439.81
|
| Rate for Payer: Mclaren Medicaid |
$585.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$944.87
|
| Rate for Payer: Meridian Medicaid |
$614.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$989.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.23
|
| Rate for Payer: Nomi Health Commercial |
$1,079.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,380.00
|
| Rate for Payer: PACE SWMI |
$899.88
|
| Rate for Payer: PHP Medicare Advantage |
$899.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,612.43
|
| Rate for Payer: Priority Health Medicare |
$899.88
|
| Rate for Payer: Priority Health SBD |
$1,612.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,612.43
|
| Rate for Payer: Railroad Medicare Medicare |
$899.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,734.29
|
| Rate for Payer: UHC Core |
$1,734.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$899.88
|
| Rate for Payer: UHC Exchange |
$1,734.29
|
| Rate for Payer: UHC Medicaid |
$585.32
|
| Rate for Payer: UHCCP Medicaid |
$585.32
|
|
|
PR ARTHRS ANKLE EXC OSTCHNDRL DFCT TALUS&/TIB DRLG
|
Professional
|
Both
|
$2,501.00
|
|
|
Service Code
|
HCPCS 29891
|
| Min. Negotiated Rate |
$404.27 |
| Max. Negotiated Rate |
$1,875.75 |
| Rate for Payer: Aetna Commercial |
$827.48
|
| Rate for Payer: Aetna Medicare |
$642.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.23
|
| Rate for Payer: BCBS Complete |
$424.48
|
| Rate for Payer: BCBS MAPPO |
$617.52
|
| Rate for Payer: BCN Commercial |
$1,026.84
|
| Rate for Payer: BCN Medicare Advantage |
$617.52
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cofinity Commercial |
$889.23
|
| Rate for Payer: Cofinity Commercial |
$827.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$617.52
|
| Rate for Payer: Healthscope Commercial |
$988.03
|
| Rate for Payer: Healthscope Commercial |
$1,142.41
|
| Rate for Payer: Mclaren Medicaid |
$404.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$648.40
|
| Rate for Payer: Meridian Medicaid |
$424.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$679.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.26
|
| Rate for Payer: Nomi Health Commercial |
$741.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.75
|
| Rate for Payer: PACE SWMI |
$617.52
|
| Rate for Payer: PHP Medicare Advantage |
$617.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,097.65
|
| Rate for Payer: Priority Health Medicare |
$617.52
|
| Rate for Payer: Priority Health SBD |
$1,097.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,097.65
|
| Rate for Payer: Railroad Medicare Medicare |
$617.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,169.63
|
| Rate for Payer: UHC Core |
$1,169.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$617.52
|
| Rate for Payer: UHC Exchange |
$1,169.63
|
| Rate for Payer: UHC Medicaid |
$404.27
|
| Rate for Payer: UHCCP Medicaid |
$404.27
|
|
|
PR ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG
|
Professional
|
Both
|
$2,841.00
|
|
|
Service Code
|
HCPCS 29862
|
| Min. Negotiated Rate |
$484.58 |
| Max. Negotiated Rate |
$2,130.75 |
| Rate for Payer: Aetna Commercial |
$993.02
|
| Rate for Payer: Aetna Medicare |
$770.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,067.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.02
|
| Rate for Payer: BCBS Complete |
$508.81
|
| Rate for Payer: BCBS MAPPO |
$741.06
|
| Rate for Payer: BCN Commercial |
$1,234.99
|
| Rate for Payer: BCN Medicare Advantage |
$741.06
|
| Rate for Payer: Cash Price |
$2,272.80
|
| Rate for Payer: Cash Price |
$2,272.80
|
| Rate for Payer: Cofinity Commercial |
$993.02
|
| Rate for Payer: Cofinity Commercial |
$1,067.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$741.06
|
| Rate for Payer: Healthscope Commercial |
$1,370.96
|
| Rate for Payer: Healthscope Commercial |
$1,185.70
|
| Rate for Payer: Mclaren Medicaid |
$484.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$778.11
|
| Rate for Payer: Meridian Medicaid |
$508.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$815.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.15
|
| Rate for Payer: Nomi Health Commercial |
$889.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,130.75
|
| Rate for Payer: PACE SWMI |
$741.06
|
| Rate for Payer: PHP Medicare Advantage |
$741.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,320.17
|
| Rate for Payer: Priority Health Medicare |
$741.06
|
| Rate for Payer: Priority Health SBD |
$1,320.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,320.17
|
| Rate for Payer: Railroad Medicare Medicare |
$741.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,418.26
|
| Rate for Payer: UHC Core |
$1,418.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$741.06
|
| Rate for Payer: UHC Exchange |
$1,418.26
|
| Rate for Payer: UHC Medicaid |
$484.58
|
| Rate for Payer: UHCCP Medicaid |
$484.58
|
|
|
PR ARTHRS KNEE SURG DEBRIDEMENT/SHVG ARTCLR CRTLG
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 29877
|
| Min. Negotiated Rate |
$374.24 |
| Max. Negotiated Rate |
$1,749.75 |
| Rate for Payer: Priority Health SBD |
$1,014.61
|
| Rate for Payer: Aetna Commercial |
$765.52
|
| Rate for Payer: Aetna Medicare |
$594.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.64
|
| Rate for Payer: BCBS Complete |
$392.95
|
| Rate for Payer: BCBS MAPPO |
$571.28
|
| Rate for Payer: BCN Commercial |
$1,042.71
|
| Rate for Payer: BCN Medicare Advantage |
$571.28
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$822.64
|
| Rate for Payer: Cofinity Commercial |
$765.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.28
|
| Rate for Payer: Healthscope Commercial |
$914.05
|
| Rate for Payer: Healthscope Commercial |
$1,056.87
|
| Rate for Payer: Mclaren Medicaid |
$374.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.84
|
| Rate for Payer: Meridian Medicaid |
$392.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$628.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.71
|
| Rate for Payer: Nomi Health Commercial |
$685.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,749.75
|
| Rate for Payer: PACE SWMI |
$571.28
|
| Rate for Payer: PHP Medicare Advantage |
$571.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,014.61
|
| Rate for Payer: Priority Health Medicare |
$571.28
|
| Rate for Payer: Priority Health Tiered Network |
$1,014.61
|
| Rate for Payer: Railroad Medicare Medicare |
$571.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,081.88
|
| Rate for Payer: UHC Core |
$1,081.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$571.28
|
| Rate for Payer: UHC Exchange |
$1,081.88
|
| Rate for Payer: UHC Medicaid |
$374.24
|
| Rate for Payer: UHCCP Medicaid |
$374.24
|
|
|
PR ARTHRS KNEE SURG DRILLING NTC OSTEO DISS LESION
|
Professional
|
Both
|
$2,467.00
|
|
|
Service Code
|
HCPCS 29886
|
| Min. Negotiated Rate |
$385.74 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Aetna Commercial |
$789.29
|
| Rate for Payer: Aetna Medicare |
$612.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.19
|
| Rate for Payer: BCBS Complete |
$405.03
|
| Rate for Payer: BCBS MAPPO |
$589.02
|
| Rate for Payer: BCN Commercial |
$976.05
|
| Rate for Payer: BCN Medicare Advantage |
$589.02
|
| Rate for Payer: Cash Price |
$1,973.60
|
| Rate for Payer: Cash Price |
$1,973.60
|
| Rate for Payer: Cofinity Commercial |
$848.19
|
| Rate for Payer: Cofinity Commercial |
$789.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.02
|
| Rate for Payer: Healthscope Commercial |
$942.43
|
| Rate for Payer: Healthscope Commercial |
$1,089.69
|
| Rate for Payer: Mclaren Medicaid |
$385.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.47
|
| Rate for Payer: Meridian Medicaid |
$405.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$647.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.20
|
| Rate for Payer: Nomi Health Commercial |
$706.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,850.25
|
| Rate for Payer: PACE SWMI |
$589.02
|
| Rate for Payer: PHP Medicare Advantage |
$589.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,043.36
|
| Rate for Payer: Priority Health Medicare |
$589.02
|
| Rate for Payer: Priority Health SBD |
$1,043.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,043.36
|
| Rate for Payer: Railroad Medicare Medicare |
$589.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,108.54
|
| Rate for Payer: UHC Core |
$1,108.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$589.02
|
| Rate for Payer: UHC Exchange |
$1,108.54
|
| Rate for Payer: UHC Medicaid |
$385.74
|
| Rate for Payer: UHCCP Medicaid |
$385.74
|
|
|
PR ARTHRS KNEE SURG DRLG OSTEO DISS GRFG W/WO FIXJ
|
Professional
|
Both
|
$2,618.00
|
|
|
Service Code
|
HCPCS 29885
|
| Min. Negotiated Rate |
$454.33 |
| Max. Negotiated Rate |
$1,963.50 |
| Rate for Payer: Aetna Commercial |
$930.86
|
| Rate for Payer: Aetna Medicare |
$722.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$930.86
|
| Rate for Payer: BCBS Complete |
$477.05
|
| Rate for Payer: BCBS MAPPO |
$694.67
|
| Rate for Payer: BCN Commercial |
$1,156.31
|
| Rate for Payer: BCN Medicare Advantage |
$694.67
|
| Rate for Payer: Cash Price |
$2,094.40
|
| Rate for Payer: Cash Price |
$2,094.40
|
| Rate for Payer: Cofinity Commercial |
$930.86
|
| Rate for Payer: Cofinity Commercial |
$1,000.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.67
|
| Rate for Payer: Healthscope Commercial |
$1,285.14
|
| Rate for Payer: Healthscope Commercial |
$1,111.47
|
| Rate for Payer: Mclaren Medicaid |
$454.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.40
|
| Rate for Payer: Meridian Medicaid |
$477.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,341.34
|
| Rate for Payer: Nomi Health Commercial |
$833.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,963.50
|
| Rate for Payer: PACE SWMI |
$694.67
|
| Rate for Payer: PHP Medicare Advantage |
$694.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,236.07
|
| Rate for Payer: Priority Health Medicare |
$694.67
|
| Rate for Payer: Priority Health SBD |
$1,236.07
|
| Rate for Payer: Priority Health Tiered Network |
$1,236.07
|
| Rate for Payer: Railroad Medicare Medicare |
$694.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,316.01
|
| Rate for Payer: UHC Core |
$1,316.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.67
|
| Rate for Payer: UHC Exchange |
$1,316.01
|
| Rate for Payer: UHC Medicaid |
$454.33
|
| Rate for Payer: UHCCP Medicaid |
$454.33
|
|
|
PR ARTHRS KNEE SURG DRLG OSTEO DISS LES W/INT FIXJ
|
Professional
|
Both
|
$2,601.00
|
|
|
Service Code
|
HCPCS 29887
|
| Min. Negotiated Rate |
$453.05 |
| Max. Negotiated Rate |
$1,950.75 |
| Rate for Payer: Aetna Commercial |
$928.15
|
| Rate for Payer: Aetna Medicare |
$720.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.42
|
| Rate for Payer: BCBS Complete |
$475.70
|
| Rate for Payer: BCBS MAPPO |
$692.65
|
| Rate for Payer: BCN Commercial |
$1,151.83
|
| Rate for Payer: BCN Medicare Advantage |
$692.65
|
| Rate for Payer: Cash Price |
$2,080.80
|
| Rate for Payer: Cash Price |
$2,080.80
|
| Rate for Payer: Cofinity Commercial |
$997.42
|
| Rate for Payer: Cofinity Commercial |
$928.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.65
|
| Rate for Payer: Healthscope Commercial |
$1,281.40
|
| Rate for Payer: Healthscope Commercial |
$1,108.24
|
| Rate for Payer: Mclaren Medicaid |
$453.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$727.28
|
| Rate for Payer: Meridian Medicaid |
$475.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$761.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,335.98
|
| Rate for Payer: Nomi Health Commercial |
$831.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,950.75
|
| Rate for Payer: PACE SWMI |
$692.65
|
| Rate for Payer: PHP Medicare Advantage |
$692.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,231.27
|
| Rate for Payer: Priority Health Medicare |
$692.65
|
| Rate for Payer: Priority Health SBD |
$1,231.27
|
| Rate for Payer: Priority Health Tiered Network |
$1,231.27
|
| Rate for Payer: Railroad Medicare Medicare |
$692.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.91
|
| Rate for Payer: UHC Core |
$1,309.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$692.65
|
| Rate for Payer: UHC Exchange |
$1,309.91
|
| Rate for Payer: UHC Medicaid |
$453.05
|
| Rate for Payer: UHCCP Medicaid |
$453.05
|
|
|
PR ARTHRS KNEE SURG MENISCECTOMY MED&LAT W/SHAVING
|
Professional
|
Both
|
$2,667.00
|
|
|
Service Code
|
HCPCS 29880
|
| Min. Negotiated Rate |
$339.95 |
| Max. Negotiated Rate |
$2,000.25 |
| Rate for Payer: Aetna Commercial |
$694.47
|
| Rate for Payer: Aetna Medicare |
$538.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.29
|
| Rate for Payer: BCBS Complete |
$356.95
|
| Rate for Payer: BCBS MAPPO |
$518.26
|
| Rate for Payer: BCN Commercial |
$944.24
|
| Rate for Payer: BCN Medicare Advantage |
$518.26
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cofinity Commercial |
$746.29
|
| Rate for Payer: Cofinity Commercial |
$694.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.26
|
| Rate for Payer: Healthscope Commercial |
$958.78
|
| Rate for Payer: Healthscope Commercial |
$829.22
|
| Rate for Payer: Mclaren Medicaid |
$339.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$544.17
|
| Rate for Payer: Meridian Medicaid |
$356.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$570.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$997.15
|
| Rate for Payer: Nomi Health Commercial |
$621.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,000.25
|
| Rate for Payer: PACE SWMI |
$518.26
|
| Rate for Payer: PHP Medicare Advantage |
$518.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$918.80
|
| Rate for Payer: Priority Health Medicare |
$518.26
|
| Rate for Payer: Priority Health SBD |
$918.80
|
| Rate for Payer: Priority Health Tiered Network |
$918.80
|
| Rate for Payer: Railroad Medicare Medicare |
$518.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.18
|
| Rate for Payer: UHC Core |
$977.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$518.26
|
| Rate for Payer: UHC Exchange |
$977.18
|
| Rate for Payer: UHC Medicaid |
$339.95
|
| Rate for Payer: UHCCP Medicaid |
$339.95
|
|
|
PR ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG
|
Professional
|
Both
|
$2,467.00
|
|
|
Service Code
|
HCPCS 29881
|
| Min. Negotiated Rate |
$328.87 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Aetna Commercial |
$671.14
|
| Rate for Payer: Aetna Medicare |
$520.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.22
|
| Rate for Payer: BCBS Complete |
$345.31
|
| Rate for Payer: BCBS MAPPO |
$500.85
|
| Rate for Payer: BCN Commercial |
$910.33
|
| Rate for Payer: BCN Medicare Advantage |
$500.85
|
| Rate for Payer: Cash Price |
$1,973.60
|
| Rate for Payer: Cash Price |
$1,973.60
|
| Rate for Payer: Cofinity Commercial |
$721.22
|
| Rate for Payer: Cofinity Commercial |
$671.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.85
|
| Rate for Payer: Healthscope Commercial |
$926.57
|
| Rate for Payer: Healthscope Commercial |
$801.36
|
| Rate for Payer: Mclaren Medicaid |
$328.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.89
|
| Rate for Payer: Meridian Medicaid |
$345.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$550.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.27
|
| Rate for Payer: Nomi Health Commercial |
$601.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,850.25
|
| Rate for Payer: PACE SWMI |
$500.85
|
| Rate for Payer: PHP Medicare Advantage |
$500.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$885.80
|
| Rate for Payer: Priority Health Medicare |
$500.85
|
| Rate for Payer: Priority Health SBD |
$885.80
|
| Rate for Payer: Priority Health Tiered Network |
$885.80
|
| Rate for Payer: Railroad Medicare Medicare |
$500.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.04
|
| Rate for Payer: UHC Core |
$941.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$500.85
|
| Rate for Payer: UHC Exchange |
$941.04
|
| Rate for Payer: UHC Medicaid |
$328.87
|
| Rate for Payer: UHCCP Medicaid |
$328.87
|
|
|
PR ARTHRS KNE SURG ABRASION ARTHRP/MLT DRLG/MICROFX
|
Professional
|
Both
|
$2,601.00
|
|
|
Service Code
|
HCPCS 29879
|
| Min. Negotiated Rate |
$397.46 |
| Max. Negotiated Rate |
$1,950.75 |
| Rate for Payer: Aetna Commercial |
$814.25
|
| Rate for Payer: Aetna Medicare |
$631.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$875.02
|
| Rate for Payer: BCBS Complete |
$417.33
|
| Rate for Payer: BCBS MAPPO |
$607.65
|
| Rate for Payer: BCN Commercial |
$1,110.55
|
| Rate for Payer: BCN Medicare Advantage |
$607.65
|
| Rate for Payer: Cash Price |
$2,080.80
|
| Rate for Payer: Cash Price |
$2,080.80
|
| Rate for Payer: Cofinity Commercial |
$875.02
|
| Rate for Payer: Cofinity Commercial |
$814.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.65
|
| Rate for Payer: Healthscope Commercial |
$972.24
|
| Rate for Payer: Healthscope Commercial |
$1,124.15
|
| Rate for Payer: Mclaren Medicaid |
$397.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$638.03
|
| Rate for Payer: Meridian Medicaid |
$417.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$668.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.55
|
| Rate for Payer: Nomi Health Commercial |
$729.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,950.75
|
| Rate for Payer: PACE SWMI |
$607.65
|
| Rate for Payer: PHP Medicare Advantage |
$607.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,080.62
|
| Rate for Payer: Priority Health Medicare |
$607.65
|
| Rate for Payer: Priority Health SBD |
$1,080.62
|
| Rate for Payer: Priority Health Tiered Network |
$1,080.62
|
| Rate for Payer: Railroad Medicare Medicare |
$607.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,154.04
|
| Rate for Payer: UHC Core |
$1,154.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$607.65
|
| Rate for Payer: UHC Exchange |
$1,154.04
|
| Rate for Payer: UHC Medicaid |
$397.46
|
| Rate for Payer: UHCCP Medicaid |
$397.46
|
|
|
PR ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY
|
Professional
|
Both
|
$2,467.00
|
|
|
Service Code
|
HCPCS 29904
|
| Min. Negotiated Rate |
$384.04 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Priority Health SBD |
$1,048.69
|
| Rate for Payer: Aetna Commercial |
$786.79
|
| Rate for Payer: Aetna Medicare |
$610.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.51
|
| Rate for Payer: BCBS Complete |
$403.24
|
| Rate for Payer: BCBS MAPPO |
$587.16
|
| Rate for Payer: BCN Commercial |
$981.02
|
| Rate for Payer: BCN Medicare Advantage |
$587.16
|
| Rate for Payer: Cash Price |
$1,973.60
|
| Rate for Payer: Cash Price |
$1,973.60
|
| Rate for Payer: Cofinity Commercial |
$845.51
|
| Rate for Payer: Cofinity Commercial |
$786.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.16
|
| Rate for Payer: Healthscope Commercial |
$939.46
|
| Rate for Payer: Healthscope Commercial |
$1,086.25
|
| Rate for Payer: Mclaren Medicaid |
$384.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.52
|
| Rate for Payer: Meridian Medicaid |
$403.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$645.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,135.28
|
| Rate for Payer: Nomi Health Commercial |
$704.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,850.25
|
| Rate for Payer: PACE SWMI |
$587.16
|
| Rate for Payer: PHP Medicare Advantage |
$587.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,048.69
|
| Rate for Payer: Priority Health Medicare |
$587.16
|
| Rate for Payer: Priority Health Tiered Network |
$1,048.69
|
| Rate for Payer: Railroad Medicare Medicare |
$587.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,111.16
|
| Rate for Payer: UHC Core |
$1,111.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$587.16
|
| Rate for Payer: UHC Exchange |
$1,111.16
|
| Rate for Payer: UHC Medicaid |
$384.04
|
| Rate for Payer: UHCCP Medicaid |
$384.04
|
|
|
PR ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 29846
|
| Min. Negotiated Rate |
$311.19 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna Commercial |
$635.66
|
| Rate for Payer: Aetna Medicare |
$493.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.09
|
| Rate for Payer: BCBS Complete |
$326.75
|
| Rate for Payer: BCBS MAPPO |
$474.37
|
| Rate for Payer: BCN Commercial |
$802.25
|
| Rate for Payer: BCN Medicare Advantage |
$474.37
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cofinity Commercial |
$683.09
|
| Rate for Payer: Cofinity Commercial |
$635.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.37
|
| Rate for Payer: Healthscope Commercial |
$877.58
|
| Rate for Payer: Healthscope Commercial |
$758.99
|
| Rate for Payer: Mclaren Medicaid |
$311.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.09
|
| Rate for Payer: Meridian Medicaid |
$326.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$521.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.82
|
| Rate for Payer: Nomi Health Commercial |
$569.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.00
|
| Rate for Payer: PACE SWMI |
$474.37
|
| Rate for Payer: PHP Medicare Advantage |
$474.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$857.58
|
| Rate for Payer: Priority Health Medicare |
$474.37
|
| Rate for Payer: Priority Health SBD |
$857.58
|
| Rate for Payer: Priority Health Tiered Network |
$857.58
|
| Rate for Payer: Railroad Medicare Medicare |
$474.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$908.65
|
| Rate for Payer: UHC Core |
$908.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$474.37
|
| Rate for Payer: UHC Exchange |
$908.65
|
| Rate for Payer: UHC Medicaid |
$311.19
|
| Rate for Payer: UHCCP Medicaid |
$311.19
|
|
|
PR ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 23044
|
| Min. Negotiated Rate |
$346.34 |
| Max. Negotiated Rate |
$1,011.67 |
| Rate for Payer: Aetna Commercial |
$709.10
|
| Rate for Payer: Aetna Medicare |
$550.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.02
|
| Rate for Payer: BCBS Complete |
$363.66
|
| Rate for Payer: BCBS MAPPO |
$529.18
|
| Rate for Payer: BCN Commercial |
$857.02
|
| Rate for Payer: BCN Medicare Advantage |
$529.18
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cofinity Commercial |
$762.02
|
| Rate for Payer: Cofinity Commercial |
$709.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.18
|
| Rate for Payer: Healthscope Commercial |
$978.98
|
| Rate for Payer: Healthscope Commercial |
$846.69
|
| Rate for Payer: Mclaren Medicaid |
$346.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.64
|
| Rate for Payer: Meridian Medicaid |
$363.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$582.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,011.67
|
| Rate for Payer: Nomi Health Commercial |
$635.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$946.50
|
| Rate for Payer: PACE SWMI |
$529.18
|
| Rate for Payer: PHP Medicare Advantage |
$529.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$916.13
|
| Rate for Payer: Priority Health Medicare |
$529.18
|
| Rate for Payer: Priority Health SBD |
$916.13
|
| Rate for Payer: Priority Health Tiered Network |
$916.13
|
| Rate for Payer: Railroad Medicare Medicare |
$529.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.82
|
| Rate for Payer: UHC Core |
$986.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$529.18
|
| Rate for Payer: UHC Exchange |
$986.82
|
| Rate for Payer: UHC Medicaid |
$346.34
|
| Rate for Payer: UHCCP Medicaid |
$346.34
|
|
|
PR ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 23101
|
| Min. Negotiated Rate |
$282.86 |
| Max. Negotiated Rate |
$812.70 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Medicare |
$447.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.98
|
| Rate for Payer: BCBS Complete |
$297.00
|
| Rate for Payer: BCBS MAPPO |
$429.85
|
| Rate for Payer: BCN Commercial |
$704.64
|
| Rate for Payer: BCN Medicare Advantage |
$429.85
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cofinity Commercial |
$618.98
|
| Rate for Payer: Cofinity Commercial |
$576.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$429.85
|
| Rate for Payer: Healthscope Commercial |
$795.22
|
| Rate for Payer: Healthscope Commercial |
$687.76
|
| Rate for Payer: Mclaren Medicaid |
$282.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$451.34
|
| Rate for Payer: Meridian Medicaid |
$297.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$472.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$812.70
|
| Rate for Payer: Nomi Health Commercial |
$515.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.75
|
| Rate for Payer: PACE SWMI |
$429.85
|
| Rate for Payer: PHP Medicare Advantage |
$429.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$753.24
|
| Rate for Payer: Priority Health Medicare |
$429.85
|
| Rate for Payer: Priority Health SBD |
$753.24
|
| Rate for Payer: Priority Health Tiered Network |
$753.24
|
| Rate for Payer: Railroad Medicare Medicare |
$429.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.69
|
| Rate for Payer: UHC Core |
$792.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$429.85
|
| Rate for Payer: UHC Exchange |
$792.69
|
| Rate for Payer: UHC Medicaid |
$282.86
|
| Rate for Payer: UHCCP Medicaid |
$282.86
|
|
|
PR ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 27620
|
| Min. Negotiated Rate |
$277.75 |
| Max. Negotiated Rate |
$870.75 |
| Rate for Payer: Aetna Commercial |
$566.18
|
| Rate for Payer: Aetna Medicare |
$439.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.43
|
| Rate for Payer: BCBS Complete |
$291.64
|
| Rate for Payer: BCBS MAPPO |
$422.52
|
| Rate for Payer: BCN Commercial |
$686.72
|
| Rate for Payer: BCN Medicare Advantage |
$422.52
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cofinity Commercial |
$608.43
|
| Rate for Payer: Cofinity Commercial |
$566.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.52
|
| Rate for Payer: Healthscope Commercial |
$781.66
|
| Rate for Payer: Healthscope Commercial |
$676.03
|
| Rate for Payer: Mclaren Medicaid |
$277.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.65
|
| Rate for Payer: Meridian Medicaid |
$291.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$464.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$784.94
|
| Rate for Payer: Nomi Health Commercial |
$507.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.75
|
| Rate for Payer: PACE SWMI |
$422.52
|
| Rate for Payer: PHP Medicare Advantage |
$422.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$734.08
|
| Rate for Payer: Priority Health Medicare |
$422.52
|
| Rate for Payer: Priority Health SBD |
$734.08
|
| Rate for Payer: Priority Health Tiered Network |
$734.08
|
| Rate for Payer: Railroad Medicare Medicare |
$422.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$778.89
|
| Rate for Payer: UHC Core |
$778.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$422.52
|
| Rate for Payer: UHC Exchange |
$778.89
|
| Rate for Payer: UHC Medicaid |
$277.75
|
| Rate for Payer: UHCCP Medicaid |
$277.75
|
|
