|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$1,458.00
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$568.71 |
| Max. Negotiated Rate |
$1,603.13 |
| Rate for Payer: Aetna Commercial |
$1,125.72
|
| Rate for Payer: Aetna Medicare |
$873.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.73
|
| Rate for Payer: BCBS Complete |
$597.15
|
| Rate for Payer: BCBS MAPPO |
$840.09
|
| Rate for Payer: BCN Commercial |
$1,373.43
|
| Rate for Payer: BCN Medicare Advantage |
$840.09
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cofinity Commercial |
$1,209.73
|
| Rate for Payer: Cofinity Commercial |
$1,125.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.09
|
| Rate for Payer: Healthscope Commercial |
$1,554.17
|
| Rate for Payer: Healthscope Commercial |
$1,344.14
|
| Rate for Payer: Mclaren Medicaid |
$568.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$882.09
|
| Rate for Payer: Meridian Medicaid |
$597.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$924.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.13
|
| Rate for Payer: Nomi Health Commercial |
$1,008.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.50
|
| Rate for Payer: PACE SWMI |
$840.09
|
| Rate for Payer: PHP Medicare Advantage |
$840.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,468.17
|
| Rate for Payer: Priority Health Medicare |
$840.09
|
| Rate for Payer: Priority Health SBD |
$1,468.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,468.17
|
| Rate for Payer: Railroad Medicare Medicare |
$840.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.58
|
| Rate for Payer: UHC Core |
$1,448.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$840.09
|
| Rate for Payer: UHC Exchange |
$1,448.58
|
| Rate for Payer: UHC Medicaid |
$568.71
|
| Rate for Payer: UHCCP Medicaid |
$568.71
|
|
|
PR CLOSED TX METARSAL FRACTURE W/MANIPULATION EACH
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 28475
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Aetna Commercial |
$289.77
|
| Rate for Payer: Aetna Medicare |
$224.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.40
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS MAPPO |
$216.25
|
| Rate for Payer: BCN Commercial |
$355.56
|
| Rate for Payer: BCN Medicare Advantage |
$216.25
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cofinity Commercial |
$311.40
|
| Rate for Payer: Cofinity Commercial |
$289.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.25
|
| Rate for Payer: Healthscope Commercial |
$400.06
|
| Rate for Payer: Healthscope Commercial |
$346.00
|
| Rate for Payer: Mclaren Medicaid |
$143.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.06
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Nomi Health Commercial |
$259.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.25
|
| Rate for Payer: PACE SWMI |
$216.25
|
| Rate for Payer: PHP Medicare Advantage |
$216.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$380.08
|
| Rate for Payer: Priority Health Medicare |
$216.25
|
| Rate for Payer: Priority Health SBD |
$380.08
|
| Rate for Payer: Priority Health Tiered Network |
$380.08
|
| Rate for Payer: Railroad Medicare Medicare |
$216.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.65
|
| Rate for Payer: UHC Core |
$392.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.25
|
| Rate for Payer: UHC Exchange |
$392.65
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MNPJ
|
Professional
|
Both
|
$1,689.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$1,266.75 |
| Rate for Payer: Aetna Commercial |
$736.49
|
| Rate for Payer: Aetna Medicare |
$571.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$736.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.45
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS MAPPO |
$549.62
|
| Rate for Payer: BCN Commercial |
$909.32
|
| Rate for Payer: BCN Medicare Advantage |
$549.62
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cofinity Commercial |
$791.45
|
| Rate for Payer: Cofinity Commercial |
$736.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.62
|
| Rate for Payer: Healthscope Commercial |
$879.39
|
| Rate for Payer: Healthscope Commercial |
$1,016.80
|
| Rate for Payer: Mclaren Medicaid |
$362.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.10
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$604.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,045.67
|
| Rate for Payer: Nomi Health Commercial |
$659.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,266.75
|
| Rate for Payer: PACE SWMI |
$549.62
|
| Rate for Payer: PHP Medicare Advantage |
$549.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$972.04
|
| Rate for Payer: Priority Health Medicare |
$549.62
|
| Rate for Payer: Priority Health SBD |
$972.04
|
| Rate for Payer: Priority Health Tiered Network |
$972.04
|
| Rate for Payer: Railroad Medicare Medicare |
$549.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$964.62
|
| Rate for Payer: UHC Core |
$964.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$549.62
|
| Rate for Payer: UHC Exchange |
$964.62
|
| Rate for Payer: UHC Medicaid |
$362.10
|
| Rate for Payer: UHCCP Medicaid |
$362.10
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$70.99
|
| Rate for Payer: Aetna Medicare |
$55.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.29
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$90.13
|
| Rate for Payer: BCN Medicare Advantage |
$52.98
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$76.29
|
| Rate for Payer: Cofinity Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$98.01
|
| Rate for Payer: Healthscope Commercial |
$84.77
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.63
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.94
|
| Rate for Payer: Nomi Health Commercial |
$63.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: PACE SWMI |
$52.98
|
| Rate for Payer: PHP Medicare Advantage |
$52.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$96.36
|
| Rate for Payer: Priority Health Medicare |
$52.98
|
| Rate for Payer: Priority Health SBD |
$96.36
|
| Rate for Payer: Priority Health Tiered Network |
$96.36
|
| Rate for Payer: Railroad Medicare Medicare |
$52.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.89
|
| Rate for Payer: UHC Core |
$258.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.98
|
| Rate for Payer: UHC Exchange |
$258.89
|
| Rate for Payer: UHC Medicaid |
$34.29
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$320.25 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$84.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.47
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$80.88
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Medicare Advantage |
$80.88
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$116.47
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.88
|
| Rate for Payer: Healthscope Commercial |
$149.63
|
| Rate for Payer: Healthscope Commercial |
$129.41
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.92
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.21
|
| Rate for Payer: Nomi Health Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: PACE SWMI |
$80.88
|
| Rate for Payer: PHP Medicare Advantage |
$80.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$152.24
|
| Rate for Payer: Priority Health Medicare |
$80.88
|
| Rate for Payer: Priority Health SBD |
$152.24
|
| Rate for Payer: Priority Health Tiered Network |
$152.24
|
| Rate for Payer: Railroad Medicare Medicare |
$80.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.95
|
| Rate for Payer: UHC Core |
$230.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.88
|
| Rate for Payer: UHC Exchange |
$230.95
|
| Rate for Payer: UHC Medicaid |
$52.19
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$179.77 |
| Max. Negotiated Rate |
$526.43 |
| Rate for Payer: Aetna Commercial |
$362.60
|
| Rate for Payer: Aetna Medicare |
$281.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.66
|
| Rate for Payer: BCBS Complete |
$188.76
|
| Rate for Payer: BCBS MAPPO |
$270.60
|
| Rate for Payer: BCN Commercial |
$459.64
|
| Rate for Payer: BCN Medicare Advantage |
$270.60
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$389.66
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.60
|
| Rate for Payer: Healthscope Commercial |
$500.61
|
| Rate for Payer: Healthscope Commercial |
$432.96
|
| Rate for Payer: Mclaren Medicaid |
$179.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.13
|
| Rate for Payer: Meridian Medicaid |
$188.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$297.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$526.43
|
| Rate for Payer: Nomi Health Commercial |
$324.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.50
|
| Rate for Payer: PACE SWMI |
$270.60
|
| Rate for Payer: PHP Medicare Advantage |
$270.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.34
|
| Rate for Payer: Priority Health Medicare |
$270.60
|
| Rate for Payer: Priority Health SBD |
$491.34
|
| Rate for Payer: Priority Health Tiered Network |
$491.34
|
| Rate for Payer: Railroad Medicare Medicare |
$270.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.90
|
| Rate for Payer: UHC Core |
$503.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$270.60
|
| Rate for Payer: UHC Exchange |
$503.90
|
| Rate for Payer: UHC Medicaid |
$179.77
|
| Rate for Payer: UHCCP Medicaid |
$179.77
|
|
|
PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT
|
Professional
|
Both
|
$1,368.00
|
|
|
Service Code
|
HCPCS 21421
|
| Min. Negotiated Rate |
$327.59 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Aetna Commercial |
$657.71
|
| Rate for Payer: Aetna Medicare |
$510.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.80
|
| Rate for Payer: BCBS Complete |
$343.97
|
| Rate for Payer: BCBS MAPPO |
$490.83
|
| Rate for Payer: BCN Commercial |
$825.16
|
| Rate for Payer: BCN Medicare Advantage |
$490.83
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cofinity Commercial |
$706.80
|
| Rate for Payer: Cofinity Commercial |
$657.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.83
|
| Rate for Payer: Healthscope Commercial |
$908.04
|
| Rate for Payer: Healthscope Commercial |
$785.33
|
| Rate for Payer: Mclaren Medicaid |
$327.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.37
|
| Rate for Payer: Meridian Medicaid |
$343.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$539.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.64
|
| Rate for Payer: Nomi Health Commercial |
$589.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.00
|
| Rate for Payer: PACE SWMI |
$490.83
|
| Rate for Payer: PHP Medicare Advantage |
$490.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.06
|
| Rate for Payer: Priority Health Medicare |
$490.83
|
| Rate for Payer: Priority Health SBD |
$882.06
|
| Rate for Payer: Priority Health Tiered Network |
$882.06
|
| Rate for Payer: Railroad Medicare Medicare |
$490.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$963.93
|
| Rate for Payer: UHC Core |
$963.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.83
|
| Rate for Payer: UHC Exchange |
$963.93
|
| Rate for Payer: UHC Medicaid |
$327.59
|
| Rate for Payer: UHCCP Medicaid |
$327.59
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$705.53 |
| Rate for Payer: Aetna Commercial |
$511.04
|
| Rate for Payer: Aetna Medicare |
$396.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.17
|
| Rate for Payer: BCBS Complete |
$266.60
|
| Rate for Payer: BCBS MAPPO |
$381.37
|
| Rate for Payer: BCN Commercial |
$533.33
|
| Rate for Payer: BCN Medicare Advantage |
$381.37
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$549.17
|
| Rate for Payer: Cofinity Commercial |
$511.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.37
|
| Rate for Payer: Healthscope Commercial |
$705.53
|
| Rate for Payer: Healthscope Commercial |
$610.19
|
| Rate for Payer: Mclaren Medicaid |
$253.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.44
|
| Rate for Payer: Meridian Medicaid |
$266.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$419.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.64
|
| Rate for Payer: Nomi Health Commercial |
$457.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.00
|
| Rate for Payer: PACE SWMI |
$381.37
|
| Rate for Payer: PHP Medicare Advantage |
$381.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$570.12
|
| Rate for Payer: Priority Health Medicare |
$381.37
|
| Rate for Payer: Priority Health SBD |
$570.12
|
| Rate for Payer: Priority Health Tiered Network |
$570.12
|
| Rate for Payer: Railroad Medicare Medicare |
$381.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.15
|
| Rate for Payer: UHC Core |
$593.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$381.37
|
| Rate for Payer: UHC Exchange |
$593.15
|
| Rate for Payer: UHC Medicaid |
$253.90
|
| Rate for Payer: UHCCP Medicaid |
$253.90
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$549.28 |
| Rate for Payer: Aetna Commercial |
$397.86
|
| Rate for Payer: Aetna Medicare |
$308.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.55
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCBS MAPPO |
$296.91
|
| Rate for Payer: BCN Commercial |
$474.58
|
| Rate for Payer: BCN Medicare Advantage |
$296.91
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cofinity Commercial |
$427.55
|
| Rate for Payer: Cofinity Commercial |
$397.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.91
|
| Rate for Payer: Healthscope Commercial |
$549.28
|
| Rate for Payer: Healthscope Commercial |
$475.06
|
| Rate for Payer: Mclaren Medicaid |
$198.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.76
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.55
|
| Rate for Payer: Nomi Health Commercial |
$356.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$503.25
|
| Rate for Payer: PACE SWMI |
$296.91
|
| Rate for Payer: PHP Medicare Advantage |
$296.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$507.30
|
| Rate for Payer: Priority Health Medicare |
$296.91
|
| Rate for Payer: Priority Health SBD |
$507.30
|
| Rate for Payer: Priority Health Tiered Network |
$507.30
|
| Rate for Payer: Railroad Medicare Medicare |
$296.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.92
|
| Rate for Payer: UHC Core |
$509.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$296.91
|
| Rate for Payer: UHC Exchange |
$509.92
|
| Rate for Payer: UHC Medicaid |
$198.30
|
| Rate for Payer: UHCCP Medicaid |
$198.30
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$990.00
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$784.33 |
| Rate for Payer: Aetna Commercial |
$568.11
|
| Rate for Payer: Aetna Medicare |
$440.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.50
|
| Rate for Payer: BCBS Complete |
$295.89
|
| Rate for Payer: BCBS MAPPO |
$423.96
|
| Rate for Payer: BCN Commercial |
$633.43
|
| Rate for Payer: BCN Medicare Advantage |
$423.96
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cofinity Commercial |
$610.50
|
| Rate for Payer: Cofinity Commercial |
$568.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.96
|
| Rate for Payer: Healthscope Commercial |
$784.33
|
| Rate for Payer: Healthscope Commercial |
$678.34
|
| Rate for Payer: Mclaren Medicaid |
$281.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.16
|
| Rate for Payer: Meridian Medicaid |
$295.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$466.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.74
|
| Rate for Payer: Nomi Health Commercial |
$508.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.50
|
| Rate for Payer: PACE SWMI |
$423.96
|
| Rate for Payer: PHP Medicare Advantage |
$423.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$677.13
|
| Rate for Payer: Priority Health Medicare |
$423.96
|
| Rate for Payer: Priority Health SBD |
$677.13
|
| Rate for Payer: Priority Health Tiered Network |
$677.13
|
| Rate for Payer: Railroad Medicare Medicare |
$423.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.97
|
| Rate for Payer: UHC Core |
$688.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$423.96
|
| Rate for Payer: UHC Exchange |
$688.97
|
| Rate for Payer: UHC Medicaid |
$281.80
|
| Rate for Payer: UHCCP Medicaid |
$281.80
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: Aetna Medicare |
$255.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.98
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$245.82
|
| Rate for Payer: BCN Commercial |
$309.05
|
| Rate for Payer: BCN Medicare Advantage |
$245.82
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$353.98
|
| Rate for Payer: Cofinity Commercial |
$329.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.82
|
| Rate for Payer: Healthscope Commercial |
$454.77
|
| Rate for Payer: Healthscope Commercial |
$393.31
|
| Rate for Payer: Mclaren Medicaid |
$164.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.11
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.17
|
| Rate for Payer: Nomi Health Commercial |
$294.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.00
|
| Rate for Payer: PACE SWMI |
$245.82
|
| Rate for Payer: PHP Medicare Advantage |
$245.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$418.95
|
| Rate for Payer: Priority Health Medicare |
$245.82
|
| Rate for Payer: Priority Health SBD |
$418.95
|
| Rate for Payer: Priority Health Tiered Network |
$418.95
|
| Rate for Payer: Railroad Medicare Medicare |
$245.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.56
|
| Rate for Payer: UHC Core |
$414.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.82
|
| Rate for Payer: UHC Exchange |
$414.56
|
| Rate for Payer: UHC Medicaid |
$164.86
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Aetna Commercial |
$632.56
|
| Rate for Payer: Aetna Medicare |
$490.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.77
|
| Rate for Payer: BCBS Complete |
$328.55
|
| Rate for Payer: BCBS MAPPO |
$472.06
|
| Rate for Payer: BCN Commercial |
$718.09
|
| Rate for Payer: BCN Medicare Advantage |
$472.06
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$679.77
|
| Rate for Payer: Cofinity Commercial |
$632.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.06
|
| Rate for Payer: Healthscope Commercial |
$873.31
|
| Rate for Payer: Healthscope Commercial |
$755.30
|
| Rate for Payer: Mclaren Medicaid |
$312.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.66
|
| Rate for Payer: Meridian Medicaid |
$328.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$519.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$824.33
|
| Rate for Payer: Nomi Health Commercial |
$566.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.00
|
| Rate for Payer: PACE SWMI |
$472.06
|
| Rate for Payer: PHP Medicare Advantage |
$472.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$767.62
|
| Rate for Payer: Priority Health Medicare |
$472.06
|
| Rate for Payer: Priority Health SBD |
$767.62
|
| Rate for Payer: Priority Health Tiered Network |
$767.62
|
| Rate for Payer: Railroad Medicare Medicare |
$472.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.65
|
| Rate for Payer: UHC Core |
$793.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$472.06
|
| Rate for Payer: UHC Exchange |
$793.65
|
| Rate for Payer: UHC Medicaid |
$312.90
|
| Rate for Payer: UHCCP Medicaid |
$312.90
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$481.37 |
| Rate for Payer: Aetna Commercial |
$348.67
|
| Rate for Payer: Aetna Medicare |
$270.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.69
|
| Rate for Payer: BCBS Complete |
$182.72
|
| Rate for Payer: BCBS MAPPO |
$260.20
|
| Rate for Payer: BCN Commercial |
$409.34
|
| Rate for Payer: BCN Medicare Advantage |
$260.20
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$374.69
|
| Rate for Payer: Cofinity Commercial |
$348.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.20
|
| Rate for Payer: Healthscope Commercial |
$481.37
|
| Rate for Payer: Healthscope Commercial |
$416.32
|
| Rate for Payer: Mclaren Medicaid |
$174.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.21
|
| Rate for Payer: Meridian Medicaid |
$182.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.26
|
| Rate for Payer: Nomi Health Commercial |
$312.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: PACE SWMI |
$260.20
|
| Rate for Payer: PHP Medicare Advantage |
$260.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$437.58
|
| Rate for Payer: Priority Health Medicare |
$260.20
|
| Rate for Payer: Priority Health SBD |
$437.58
|
| Rate for Payer: Priority Health Tiered Network |
$437.58
|
| Rate for Payer: Railroad Medicare Medicare |
$260.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.98
|
| Rate for Payer: UHC Core |
$432.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$260.20
|
| Rate for Payer: UHC Exchange |
$432.98
|
| Rate for Payer: UHC Medicaid |
$174.02
|
| Rate for Payer: UHCCP Medicaid |
$174.02
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$1,471.00
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$325.04 |
| Max. Negotiated Rate |
$1,103.25 |
| Rate for Payer: Aetna Commercial |
$658.44
|
| Rate for Payer: Aetna Medicare |
$511.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.57
|
| Rate for Payer: BCBS Complete |
$341.29
|
| Rate for Payer: BCBS MAPPO |
$491.37
|
| Rate for Payer: BCN Commercial |
$721.07
|
| Rate for Payer: BCN Medicare Advantage |
$491.37
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Cofinity Commercial |
$707.57
|
| Rate for Payer: Cofinity Commercial |
$658.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.37
|
| Rate for Payer: Healthscope Commercial |
$909.03
|
| Rate for Payer: Healthscope Commercial |
$786.19
|
| Rate for Payer: Mclaren Medicaid |
$325.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.94
|
| Rate for Payer: Meridian Medicaid |
$341.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$540.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.59
|
| Rate for Payer: Nomi Health Commercial |
$589.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,103.25
|
| Rate for Payer: PACE SWMI |
$491.37
|
| Rate for Payer: PHP Medicare Advantage |
$491.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$770.81
|
| Rate for Payer: Priority Health Medicare |
$491.37
|
| Rate for Payer: Priority Health SBD |
$770.81
|
| Rate for Payer: Priority Health Tiered Network |
$770.81
|
| Rate for Payer: Railroad Medicare Medicare |
$491.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.99
|
| Rate for Payer: UHC Core |
$805.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$491.37
|
| Rate for Payer: UHC Exchange |
$805.99
|
| Rate for Payer: UHC Medicaid |
$325.04
|
| Rate for Payer: UHCCP Medicaid |
$325.04
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: Aetna Commercial |
$349.46
|
| Rate for Payer: Aetna Medicare |
$271.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.54
|
| Rate for Payer: BCBS Complete |
$183.17
|
| Rate for Payer: BCBS MAPPO |
$260.79
|
| Rate for Payer: BCN Commercial |
$324.37
|
| Rate for Payer: BCN Medicare Advantage |
$260.79
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$375.54
|
| Rate for Payer: Cofinity Commercial |
$349.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.79
|
| Rate for Payer: Healthscope Commercial |
$482.46
|
| Rate for Payer: Healthscope Commercial |
$417.26
|
| Rate for Payer: Mclaren Medicaid |
$174.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.83
|
| Rate for Payer: Meridian Medicaid |
$183.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.09
|
| Rate for Payer: Nomi Health Commercial |
$312.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: PACE SWMI |
$260.79
|
| Rate for Payer: PHP Medicare Advantage |
$260.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.70
|
| Rate for Payer: Priority Health Medicare |
$260.79
|
| Rate for Payer: Priority Health SBD |
$439.70
|
| Rate for Payer: Priority Health Tiered Network |
$439.70
|
| Rate for Payer: Railroad Medicare Medicare |
$260.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.37
|
| Rate for Payer: UHC Core |
$436.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$260.79
|
| Rate for Payer: UHC Exchange |
$436.37
|
| Rate for Payer: UHC Medicaid |
$174.45
|
| Rate for Payer: UHCCP Medicaid |
$174.45
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Aetna Commercial |
$322.83
|
| Rate for Payer: Aetna Medicare |
$250.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.92
|
| Rate for Payer: BCBS Complete |
$169.30
|
| Rate for Payer: BCBS MAPPO |
$240.92
|
| Rate for Payer: BCN Commercial |
$385.44
|
| Rate for Payer: BCN Medicare Advantage |
$240.92
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$346.92
|
| Rate for Payer: Cofinity Commercial |
$322.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.92
|
| Rate for Payer: Healthscope Commercial |
$445.70
|
| Rate for Payer: Healthscope Commercial |
$385.47
|
| Rate for Payer: Mclaren Medicaid |
$161.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.97
|
| Rate for Payer: Meridian Medicaid |
$169.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.78
|
| Rate for Payer: Nomi Health Commercial |
$289.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.00
|
| Rate for Payer: PACE SWMI |
$240.92
|
| Rate for Payer: PHP Medicare Advantage |
$240.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$412.02
|
| Rate for Payer: Priority Health Medicare |
$240.92
|
| Rate for Payer: Priority Health SBD |
$412.02
|
| Rate for Payer: Priority Health Tiered Network |
$412.02
|
| Rate for Payer: Railroad Medicare Medicare |
$240.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.92
|
| Rate for Payer: UHC Core |
$410.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$240.92
|
| Rate for Payer: UHC Exchange |
$410.92
|
| Rate for Payer: UHC Medicaid |
$161.24
|
| Rate for Payer: UHCCP Medicaid |
$161.24
|
|
|
PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 23525
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$650.44 |
| Rate for Payer: Aetna Commercial |
$471.13
|
| Rate for Payer: Aetna Medicare |
$365.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.29
|
| Rate for Payer: BCBS Complete |
$245.79
|
| Rate for Payer: BCBS MAPPO |
$351.59
|
| Rate for Payer: BCN Commercial |
$571.68
|
| Rate for Payer: BCN Medicare Advantage |
$351.59
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$506.29
|
| Rate for Payer: Cofinity Commercial |
$471.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.59
|
| Rate for Payer: Healthscope Commercial |
$650.44
|
| Rate for Payer: Healthscope Commercial |
$562.54
|
| Rate for Payer: Mclaren Medicaid |
$234.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.17
|
| Rate for Payer: Meridian Medicaid |
$245.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$386.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$647.15
|
| Rate for Payer: Nomi Health Commercial |
$421.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$604.50
|
| Rate for Payer: PACE SWMI |
$351.59
|
| Rate for Payer: PHP Medicare Advantage |
$351.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$611.12
|
| Rate for Payer: Priority Health Medicare |
$351.59
|
| Rate for Payer: Priority Health SBD |
$611.12
|
| Rate for Payer: Priority Health Tiered Network |
$611.12
|
| Rate for Payer: Railroad Medicare Medicare |
$351.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.21
|
| Rate for Payer: UHC Core |
$617.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$351.59
|
| Rate for Payer: UHC Exchange |
$617.21
|
| Rate for Payer: UHC Medicaid |
$234.09
|
| Rate for Payer: UHCCP Medicaid |
$234.09
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 28570
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$360.58 |
| Rate for Payer: Aetna Commercial |
$261.18
|
| Rate for Payer: Aetna Medicare |
$202.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.67
|
| Rate for Payer: BCBS Complete |
$137.32
|
| Rate for Payer: BCBS MAPPO |
$194.91
|
| Rate for Payer: BCN Commercial |
$312.23
|
| Rate for Payer: BCN Medicare Advantage |
$194.91
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$280.67
|
| Rate for Payer: Cofinity Commercial |
$261.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.91
|
| Rate for Payer: Healthscope Commercial |
$360.58
|
| Rate for Payer: Healthscope Commercial |
$311.86
|
| Rate for Payer: Mclaren Medicaid |
$130.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.66
|
| Rate for Payer: Meridian Medicaid |
$137.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.60
|
| Rate for Payer: Nomi Health Commercial |
$233.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.75
|
| Rate for Payer: PACE SWMI |
$194.91
|
| Rate for Payer: PHP Medicare Advantage |
$194.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$333.77
|
| Rate for Payer: Priority Health Medicare |
$194.91
|
| Rate for Payer: Priority Health SBD |
$333.77
|
| Rate for Payer: Priority Health Tiered Network |
$333.77
|
| Rate for Payer: Railroad Medicare Medicare |
$194.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.41
|
| Rate for Payer: UHC Core |
$328.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.91
|
| Rate for Payer: UHC Exchange |
$328.41
|
| Rate for Payer: UHC Medicaid |
$130.78
|
| Rate for Payer: UHCCP Medicaid |
$130.78
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$217.90 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$438.23
|
| Rate for Payer: Aetna Medicare |
$340.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.94
|
| Rate for Payer: BCBS Complete |
$228.79
|
| Rate for Payer: BCBS MAPPO |
$327.04
|
| Rate for Payer: BCN Commercial |
$531.34
|
| Rate for Payer: BCN Medicare Advantage |
$327.04
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$470.94
|
| Rate for Payer: Cofinity Commercial |
$438.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.04
|
| Rate for Payer: Healthscope Commercial |
$605.02
|
| Rate for Payer: Healthscope Commercial |
$523.26
|
| Rate for Payer: Mclaren Medicaid |
$217.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.39
|
| Rate for Payer: Meridian Medicaid |
$228.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$359.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$602.33
|
| Rate for Payer: Nomi Health Commercial |
$392.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$327.04
|
| Rate for Payer: PHP Medicare Advantage |
$327.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$568.00
|
| Rate for Payer: Priority Health Medicare |
$327.04
|
| Rate for Payer: Priority Health SBD |
$568.00
|
| Rate for Payer: Priority Health Tiered Network |
$568.00
|
| Rate for Payer: Railroad Medicare Medicare |
$327.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.04
|
| Rate for Payer: UHC Core |
$572.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$327.04
|
| Rate for Payer: UHC Exchange |
$572.04
|
| Rate for Payer: UHC Medicaid |
$217.90
|
| Rate for Payer: UHCCP Medicaid |
$217.90
|
|
|
PR CLOSED TX TALUS FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28435
|
| Min. Negotiated Rate |
$209.81 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare |
$328.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.56
|
| Rate for Payer: BCBS Complete |
$220.30
|
| Rate for Payer: BCBS MAPPO |
$315.67
|
| Rate for Payer: BCN Commercial |
$513.91
|
| Rate for Payer: BCN Medicare Advantage |
$315.67
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$454.56
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.67
|
| Rate for Payer: Healthscope Commercial |
$583.99
|
| Rate for Payer: Healthscope Commercial |
$505.07
|
| Rate for Payer: Mclaren Medicaid |
$209.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.45
|
| Rate for Payer: Meridian Medicaid |
$220.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$347.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.81
|
| Rate for Payer: Nomi Health Commercial |
$378.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$315.67
|
| Rate for Payer: PHP Medicare Advantage |
$315.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$549.37
|
| Rate for Payer: Priority Health Medicare |
$315.67
|
| Rate for Payer: Priority Health SBD |
$549.37
|
| Rate for Payer: Priority Health Tiered Network |
$549.37
|
| Rate for Payer: Railroad Medicare Medicare |
$315.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.43
|
| Rate for Payer: UHC Core |
$557.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$315.67
|
| Rate for Payer: UHC Exchange |
$557.43
|
| Rate for Payer: UHC Medicaid |
$209.81
|
| Rate for Payer: UHCCP Medicaid |
$209.81
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$277.19
|
| Rate for Payer: Aetna Medicare |
$215.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.88
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$206.86
|
| Rate for Payer: BCN Commercial |
$329.66
|
| Rate for Payer: BCN Medicare Advantage |
$206.86
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$297.88
|
| Rate for Payer: Cofinity Commercial |
$277.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.86
|
| Rate for Payer: Healthscope Commercial |
$382.69
|
| Rate for Payer: Healthscope Commercial |
$330.98
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.20
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$227.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.87
|
| Rate for Payer: Nomi Health Commercial |
$248.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PACE SWMI |
$206.86
|
| Rate for Payer: PHP Medicare Advantage |
$206.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$352.39
|
| Rate for Payer: Priority Health Medicare |
$206.86
|
| Rate for Payer: Priority Health SBD |
$352.39
|
| Rate for Payer: Priority Health Tiered Network |
$352.39
|
| Rate for Payer: Railroad Medicare Medicare |
$206.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.16
|
| Rate for Payer: UHC Core |
$360.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$206.86
|
| Rate for Payer: UHC Exchange |
$360.16
|
| Rate for Payer: UHC Medicaid |
$138.24
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28605
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$398.76
|
| Rate for Payer: Aetna Medicare |
$309.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.52
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$297.58
|
| Rate for Payer: BCN Commercial |
$480.06
|
| Rate for Payer: BCN Medicare Advantage |
$297.58
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$428.52
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.58
|
| Rate for Payer: Healthscope Commercial |
$550.52
|
| Rate for Payer: Healthscope Commercial |
$476.13
|
| Rate for Payer: Mclaren Medicaid |
$199.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.46
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$327.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.42
|
| Rate for Payer: Nomi Health Commercial |
$357.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$297.58
|
| Rate for Payer: PHP Medicare Advantage |
$297.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$513.16
|
| Rate for Payer: Priority Health Medicare |
$297.58
|
| Rate for Payer: Priority Health SBD |
$513.16
|
| Rate for Payer: Priority Health Tiered Network |
$513.16
|
| Rate for Payer: Railroad Medicare Medicare |
$297.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.85
|
| Rate for Payer: UHC Core |
$510.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$297.58
|
| Rate for Payer: UHC Exchange |
$510.85
|
| Rate for Payer: UHC Medicaid |
$199.16
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$327.55 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: Aetna Medicare |
$157.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.71
|
| Rate for Payer: BCBS Complete |
$105.79
|
| Rate for Payer: BCBS MAPPO |
$151.19
|
| Rate for Payer: BCN Commercial |
$290.82
|
| Rate for Payer: BCN Medicare Advantage |
$151.19
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$217.71
|
| Rate for Payer: Cofinity Commercial |
$202.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.19
|
| Rate for Payer: Healthscope Commercial |
$279.70
|
| Rate for Payer: Healthscope Commercial |
$241.90
|
| Rate for Payer: Mclaren Medicaid |
$100.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.75
|
| Rate for Payer: Meridian Medicaid |
$105.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.55
|
| Rate for Payer: Nomi Health Commercial |
$181.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: PACE SWMI |
$151.19
|
| Rate for Payer: PHP Medicare Advantage |
$151.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$310.87
|
| Rate for Payer: Priority Health Medicare |
$151.19
|
| Rate for Payer: Priority Health SBD |
$310.87
|
| Rate for Payer: Priority Health Tiered Network |
$310.87
|
| Rate for Payer: Railroad Medicare Medicare |
$151.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.73
|
| Rate for Payer: UHC Core |
$316.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.19
|
| Rate for Payer: UHC Exchange |
$316.73
|
| Rate for Payer: UHC Medicaid |
$100.75
|
| Rate for Payer: UHCCP Medicaid |
$100.75
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 21485
|
| Min. Negotiated Rate |
$491.82 |
| Max. Negotiated Rate |
$1,356.48 |
| Rate for Payer: Aetna Commercial |
$968.12
|
| Rate for Payer: Aetna Medicare |
$751.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.12
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS MAPPO |
$722.48
|
| Rate for Payer: BCN Commercial |
$1,152.33
|
| Rate for Payer: BCN Medicare Advantage |
$722.48
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cofinity Commercial |
$968.12
|
| Rate for Payer: Cofinity Commercial |
$1,040.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.48
|
| Rate for Payer: Healthscope Commercial |
$1,336.59
|
| Rate for Payer: Healthscope Commercial |
$1,155.97
|
| Rate for Payer: Mclaren Medicaid |
$491.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.60
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$794.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,356.48
|
| Rate for Payer: Nomi Health Commercial |
$866.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$840.75
|
| Rate for Payer: PACE SWMI |
$722.48
|
| Rate for Payer: PHP Medicare Advantage |
$722.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,231.81
|
| Rate for Payer: Priority Health Medicare |
$722.48
|
| Rate for Payer: Priority Health SBD |
$1,231.81
|
| Rate for Payer: Priority Health Tiered Network |
$1,231.81
|
| Rate for Payer: Railroad Medicare Medicare |
$722.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,212.00
|
| Rate for Payer: UHC Core |
$1,212.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$722.48
|
| Rate for Payer: UHC Exchange |
$1,212.00
|
| Rate for Payer: UHC Medicaid |
$491.82
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.78
|
| Rate for Payer: BCBS Complete |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$30.40
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$30.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Cofinity Commercial |
$40.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$48.64
|
| Rate for Payer: Mclaren Medicaid |
$19.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.92
|
| Rate for Payer: Meridian Medicaid |
$20.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.20
|
| Rate for Payer: Nomi Health Commercial |
$36.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: PACE SWMI |
$30.40
|
| Rate for Payer: PHP Medicare Advantage |
$30.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50.57
|
| Rate for Payer: Priority Health Medicare |
$30.40
|
| Rate for Payer: Priority Health SBD |
$50.57
|
| Rate for Payer: Priority Health Tiered Network |
$50.57
|
| Rate for Payer: Railroad Medicare Medicare |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.69
|
| Rate for Payer: UHC Core |
$56.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.40
|
| Rate for Payer: UHC Exchange |
$56.69
|
| Rate for Payer: UHC Medicaid |
$19.38
|
| Rate for Payer: UHCCP Medicaid |
$19.38
|
|
