|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Aetna Commercial |
$16.95
|
| Rate for Payer: Aetna Medicare |
$13.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.22
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$12.65
|
| Rate for Payer: BCN Commercial |
$17.28
|
| Rate for Payer: BCN Medicare Advantage |
$12.65
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.65
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Healthscope Commercial |
$20.24
|
| Rate for Payer: Mclaren Medicaid |
$8.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.28
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Nomi Health Commercial |
$15.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: PACE SWMI |
$12.65
|
| Rate for Payer: PHP Medicare Advantage |
$12.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.05
|
| Rate for Payer: Priority Health Medicare |
$12.65
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$20.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC Core |
$25.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.65
|
| Rate for Payer: UHC Exchange |
$25.32
|
| Rate for Payer: UHC Medicaid |
$8.09
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
|
|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$231.11 |
| Max. Negotiated Rate |
$941.25 |
| Rate for Payer: Aetna Commercial |
$482.21
|
| Rate for Payer: Aetna Medicare |
$374.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.20
|
| Rate for Payer: BCBS Complete |
$242.67
|
| Rate for Payer: BCBS MAPPO |
$359.86
|
| Rate for Payer: BCN Commercial |
$620.98
|
| Rate for Payer: BCN Medicare Advantage |
$359.86
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cofinity Commercial |
$518.20
|
| Rate for Payer: Cofinity Commercial |
$482.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.86
|
| Rate for Payer: Healthscope Commercial |
$665.74
|
| Rate for Payer: Healthscope Commercial |
$575.78
|
| Rate for Payer: Mclaren Medicaid |
$231.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.85
|
| Rate for Payer: Meridian Medicaid |
$242.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$395.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.74
|
| Rate for Payer: Nomi Health Commercial |
$431.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$941.25
|
| Rate for Payer: PACE SWMI |
$359.86
|
| Rate for Payer: PHP Medicare Advantage |
$359.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$568.36
|
| Rate for Payer: Priority Health Medicare |
$359.86
|
| Rate for Payer: Priority Health SBD |
$568.36
|
| Rate for Payer: Priority Health Tiered Network |
$568.36
|
| Rate for Payer: Railroad Medicare Medicare |
$359.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.99
|
| Rate for Payer: UHC Core |
$737.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$359.86
|
| Rate for Payer: UHC Exchange |
$737.99
|
| Rate for Payer: UHC Medicaid |
$231.11
|
| Rate for Payer: UHCCP Medicaid |
$231.11
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$321.84 |
| Max. Negotiated Rate |
$1,026.50 |
| Rate for Payer: Aetna Commercial |
$678.94
|
| Rate for Payer: Aetna Medicare |
$526.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.60
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$506.67
|
| Rate for Payer: BCN Commercial |
$842.09
|
| Rate for Payer: BCN Medicare Advantage |
$506.67
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cofinity Commercial |
$729.60
|
| Rate for Payer: Cofinity Commercial |
$678.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.67
|
| Rate for Payer: Healthscope Commercial |
$937.34
|
| Rate for Payer: Healthscope Commercial |
$810.67
|
| Rate for Payer: Mclaren Medicaid |
$321.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$532.00
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$557.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.72
|
| Rate for Payer: Nomi Health Commercial |
$608.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$824.25
|
| Rate for Payer: PACE SWMI |
$506.67
|
| Rate for Payer: PHP Medicare Advantage |
$506.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$770.73
|
| Rate for Payer: Priority Health Medicare |
$506.67
|
| Rate for Payer: Priority Health SBD |
$770.73
|
| Rate for Payer: Priority Health Tiered Network |
$770.73
|
| Rate for Payer: Railroad Medicare Medicare |
$506.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,026.50
|
| Rate for Payer: UHC Core |
$1,026.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$506.67
|
| Rate for Payer: UHC Exchange |
$1,026.50
|
| Rate for Payer: UHC Medicaid |
$321.84
|
| Rate for Payer: UHCCP Medicaid |
$321.84
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$441.76 |
| Max. Negotiated Rate |
$1,398.54 |
| Rate for Payer: Aetna Commercial |
$934.90
|
| Rate for Payer: Aetna Medicare |
$725.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.90
|
| Rate for Payer: BCBS Complete |
$463.85
|
| Rate for Payer: BCBS MAPPO |
$697.69
|
| Rate for Payer: BCN Commercial |
$1,146.36
|
| Rate for Payer: BCN Medicare Advantage |
$697.69
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Cofinity Commercial |
$934.90
|
| Rate for Payer: Cofinity Commercial |
$1,004.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.69
|
| Rate for Payer: Healthscope Commercial |
$1,290.73
|
| Rate for Payer: Healthscope Commercial |
$1,116.30
|
| Rate for Payer: Mclaren Medicaid |
$441.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.57
|
| Rate for Payer: Meridian Medicaid |
$463.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$767.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,382.58
|
| Rate for Payer: Nomi Health Commercial |
$837.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,099.50
|
| Rate for Payer: PACE SWMI |
$697.69
|
| Rate for Payer: PHP Medicare Advantage |
$697.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,049.21
|
| Rate for Payer: Priority Health Medicare |
$697.69
|
| Rate for Payer: Priority Health SBD |
$1,049.21
|
| Rate for Payer: Priority Health Tiered Network |
$1,049.21
|
| Rate for Payer: Railroad Medicare Medicare |
$697.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.54
|
| Rate for Payer: UHC Core |
$1,398.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$697.69
|
| Rate for Payer: UHC Exchange |
$1,398.54
|
| Rate for Payer: UHC Medicaid |
$441.76
|
| Rate for Payer: UHCCP Medicaid |
$441.76
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$1,261.07 |
| Rate for Payer: Aetna Commercial |
$840.31
|
| Rate for Payer: Aetna Medicare |
$652.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$903.02
|
| Rate for Payer: BCBS Complete |
$417.77
|
| Rate for Payer: BCBS MAPPO |
$627.10
|
| Rate for Payer: BCN Commercial |
$1,040.78
|
| Rate for Payer: BCN Medicare Advantage |
$627.10
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$903.02
|
| Rate for Payer: Cofinity Commercial |
$840.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.10
|
| Rate for Payer: Healthscope Commercial |
$1,160.13
|
| Rate for Payer: Healthscope Commercial |
$1,003.36
|
| Rate for Payer: Mclaren Medicaid |
$397.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.46
|
| Rate for Payer: Meridian Medicaid |
$417.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$689.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.51
|
| Rate for Payer: Nomi Health Commercial |
$752.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.00
|
| Rate for Payer: PACE SWMI |
$627.10
|
| Rate for Payer: PHP Medicare Advantage |
$627.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$952.58
|
| Rate for Payer: Priority Health Medicare |
$627.10
|
| Rate for Payer: Priority Health SBD |
$952.58
|
| Rate for Payer: Priority Health Tiered Network |
$952.58
|
| Rate for Payer: Railroad Medicare Medicare |
$627.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,261.07
|
| Rate for Payer: UHC Core |
$1,261.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$627.10
|
| Rate for Payer: UHC Exchange |
$1,261.07
|
| Rate for Payer: UHC Medicaid |
$397.88
|
| Rate for Payer: UHCCP Medicaid |
$397.88
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$633.00 |
| Rate for Payer: Aetna Commercial |
$328.42
|
| Rate for Payer: Aetna Medicare |
$254.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.93
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS MAPPO |
$245.09
|
| Rate for Payer: BCN Commercial |
$414.82
|
| Rate for Payer: BCN Medicare Advantage |
$245.09
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$352.93
|
| Rate for Payer: Cofinity Commercial |
$328.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.09
|
| Rate for Payer: Healthscope Commercial |
$453.42
|
| Rate for Payer: Healthscope Commercial |
$392.14
|
| Rate for Payer: Mclaren Medicaid |
$159.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.34
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$269.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.51
|
| Rate for Payer: Nomi Health Commercial |
$294.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$633.00
|
| Rate for Payer: PACE SWMI |
$245.09
|
| Rate for Payer: PHP Medicare Advantage |
$245.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$379.67
|
| Rate for Payer: Priority Health Medicare |
$245.09
|
| Rate for Payer: Priority Health SBD |
$379.67
|
| Rate for Payer: Priority Health Tiered Network |
$379.67
|
| Rate for Payer: Railroad Medicare Medicare |
$245.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.53
|
| Rate for Payer: UHC Core |
$483.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.09
|
| Rate for Payer: UHC Exchange |
$483.53
|
| Rate for Payer: UHC Medicaid |
$159.11
|
| Rate for Payer: UHCCP Medicaid |
$159.11
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: Aetna Commercial |
$352.00
|
| Rate for Payer: Aetna Medicare |
$273.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.27
|
| Rate for Payer: BCBS Complete |
$177.36
|
| Rate for Payer: BCBS MAPPO |
$262.69
|
| Rate for Payer: BCN Commercial |
$446.69
|
| Rate for Payer: BCN Medicare Advantage |
$262.69
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$378.27
|
| Rate for Payer: Cofinity Commercial |
$352.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.69
|
| Rate for Payer: Healthscope Commercial |
$485.98
|
| Rate for Payer: Healthscope Commercial |
$420.30
|
| Rate for Payer: Mclaren Medicaid |
$168.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.82
|
| Rate for Payer: Meridian Medicaid |
$177.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$288.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.83
|
| Rate for Payer: Nomi Health Commercial |
$315.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$687.00
|
| Rate for Payer: PACE SWMI |
$262.69
|
| Rate for Payer: PHP Medicare Advantage |
$262.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$408.84
|
| Rate for Payer: Priority Health Medicare |
$262.69
|
| Rate for Payer: Priority Health SBD |
$408.84
|
| Rate for Payer: Priority Health Tiered Network |
$408.84
|
| Rate for Payer: Railroad Medicare Medicare |
$262.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.70
|
| Rate for Payer: UHC Core |
$530.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.69
|
| Rate for Payer: UHC Exchange |
$530.70
|
| Rate for Payer: UHC Medicaid |
$168.91
|
| Rate for Payer: UHCCP Medicaid |
$168.91
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$587.24 |
| Max. Negotiated Rate |
$1,791.52 |
| Rate for Payer: Aetna Commercial |
$1,213.09
|
| Rate for Payer: Aetna Medicare |
$941.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,213.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,303.62
|
| Rate for Payer: BCBS Complete |
$616.60
|
| Rate for Payer: BCBS MAPPO |
$905.29
|
| Rate for Payer: BCN Commercial |
$1,526.31
|
| Rate for Payer: BCN Medicare Advantage |
$905.29
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cofinity Commercial |
$1,303.62
|
| Rate for Payer: Cofinity Commercial |
$1,213.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.29
|
| Rate for Payer: Healthscope Commercial |
$1,674.79
|
| Rate for Payer: Healthscope Commercial |
$1,448.46
|
| Rate for Payer: Mclaren Medicaid |
$587.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$950.55
|
| Rate for Payer: Meridian Medicaid |
$616.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$995.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.52
|
| Rate for Payer: Nomi Health Commercial |
$1,086.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.00
|
| Rate for Payer: PACE SWMI |
$905.29
|
| Rate for Payer: PHP Medicare Advantage |
$905.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,631.58
|
| Rate for Payer: Priority Health Medicare |
$905.29
|
| Rate for Payer: Priority Health SBD |
$1,631.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,631.58
|
| Rate for Payer: Railroad Medicare Medicare |
$905.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,777.58
|
| Rate for Payer: UHC Core |
$1,777.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$905.29
|
| Rate for Payer: UHC Exchange |
$1,777.58
|
| Rate for Payer: UHC Medicaid |
$587.24
|
| Rate for Payer: UHCCP Medicaid |
$587.24
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$1,167.55 |
| Rate for Payer: Aetna Commercial |
$814.72
|
| Rate for Payer: Aetna Medicare |
$632.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$875.52
|
| Rate for Payer: BCBS Complete |
$418.45
|
| Rate for Payer: BCBS MAPPO |
$608.00
|
| Rate for Payer: BCN Commercial |
$1,008.91
|
| Rate for Payer: BCN Medicare Advantage |
$608.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Cofinity Commercial |
$814.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.00
|
| Rate for Payer: Healthscope Commercial |
$972.80
|
| Rate for Payer: Healthscope Commercial |
$1,124.80
|
| Rate for Payer: Mclaren Medicaid |
$398.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$638.40
|
| Rate for Payer: Meridian Medicaid |
$418.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$668.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,167.55
|
| Rate for Payer: Nomi Health Commercial |
$729.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.00
|
| Rate for Payer: PACE SWMI |
$608.00
|
| Rate for Payer: PHP Medicare Advantage |
$608.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,078.50
|
| Rate for Payer: Priority Health Medicare |
$608.00
|
| Rate for Payer: Priority Health SBD |
$1,078.50
|
| Rate for Payer: Priority Health Tiered Network |
$1,078.50
|
| Rate for Payer: Railroad Medicare Medicare |
$608.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,140.57
|
| Rate for Payer: UHC Core |
$1,140.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$608.00
|
| Rate for Payer: UHC Exchange |
$1,140.57
|
| Rate for Payer: UHC Medicaid |
$398.52
|
| Rate for Payer: UHCCP Medicaid |
$398.52
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,246.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$716.96 |
| Max. Negotiated Rate |
$2,176.87 |
| Rate for Payer: Aetna Commercial |
$1,479.52
|
| Rate for Payer: Aetna Medicare |
$1,148.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.93
|
| Rate for Payer: BCBS Complete |
$752.81
|
| Rate for Payer: BCBS MAPPO |
$1,104.12
|
| Rate for Payer: BCN Commercial |
$1,859.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,104.12
|
| Rate for Payer: Cash Price |
$1,796.80
|
| Rate for Payer: Cash Price |
$1,796.80
|
| Rate for Payer: Cofinity Commercial |
$1,589.93
|
| Rate for Payer: Cofinity Commercial |
$1,479.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,104.12
|
| Rate for Payer: Healthscope Commercial |
$2,042.62
|
| Rate for Payer: Healthscope Commercial |
$1,766.59
|
| Rate for Payer: Mclaren Medicaid |
$716.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,159.33
|
| Rate for Payer: Meridian Medicaid |
$752.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,214.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.87
|
| Rate for Payer: Nomi Health Commercial |
$1,324.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,684.50
|
| Rate for Payer: PACE SWMI |
$1,104.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,104.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$716.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,987.71
|
| Rate for Payer: Priority Health Medicare |
$1,104.12
|
| 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 |
$1,104.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,111.68
|
| Rate for Payer: UHC Core |
$2,111.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,104.12
|
| Rate for Payer: UHC Exchange |
$2,111.68
|
| Rate for Payer: UHC Medicaid |
$716.96
|
| Rate for Payer: UHCCP Medicaid |
$716.96
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$2,028.00
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$805.99 |
| Max. Negotiated Rate |
$2,295.68 |
| Rate for Payer: Aetna Commercial |
$1,625.25
|
| Rate for Payer: Aetna Medicare |
$1,261.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,625.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,746.53
|
| Rate for Payer: BCBS Complete |
$846.29
|
| Rate for Payer: BCBS MAPPO |
$1,212.87
|
| Rate for Payer: BCN Commercial |
$1,967.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,212.87
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cofinity Commercial |
$1,746.53
|
| Rate for Payer: Cofinity Commercial |
$1,625.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,212.87
|
| Rate for Payer: Healthscope Commercial |
$2,243.81
|
| Rate for Payer: Healthscope Commercial |
$1,940.59
|
| Rate for Payer: Mclaren Medicaid |
$805.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.51
|
| Rate for Payer: Meridian Medicaid |
$846.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,334.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,295.68
|
| Rate for Payer: Nomi Health Commercial |
$1,455.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,521.00
|
| Rate for Payer: PACE SWMI |
$1,212.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,212.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$805.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,102.70
|
| Rate for Payer: Priority Health Medicare |
$1,212.87
|
| Rate for Payer: Priority Health SBD |
$2,102.70
|
| Rate for Payer: Priority Health Tiered Network |
$2,102.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,212.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,069.49
|
| Rate for Payer: UHC Core |
$2,069.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,212.87
|
| Rate for Payer: UHC Exchange |
$2,069.49
|
| Rate for Payer: UHC Medicaid |
$805.99
|
| Rate for Payer: UHCCP Medicaid |
$805.99
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$1,878.00
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$463.49 |
| Max. Negotiated Rate |
$1,408.50 |
| Rate for Payer: Aetna Commercial |
$951.32
|
| Rate for Payer: Aetna Medicare |
$738.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.32
|
| Rate for Payer: BCBS Complete |
$486.66
|
| Rate for Payer: BCBS MAPPO |
$709.94
|
| Rate for Payer: BCN Commercial |
$1,185.69
|
| Rate for Payer: BCN Medicare Advantage |
$709.94
|
| Rate for Payer: Cash Price |
$1,502.40
|
| Rate for Payer: Cash Price |
$1,502.40
|
| Rate for Payer: Cofinity Commercial |
$951.32
|
| Rate for Payer: Cofinity Commercial |
$1,022.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.94
|
| Rate for Payer: Healthscope Commercial |
$1,313.39
|
| Rate for Payer: Healthscope Commercial |
$1,135.90
|
| Rate for Payer: Mclaren Medicaid |
$463.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$745.44
|
| Rate for Payer: Meridian Medicaid |
$486.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$780.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.56
|
| Rate for Payer: Nomi Health Commercial |
$851.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,408.50
|
| Rate for Payer: PACE SWMI |
$709.94
|
| Rate for Payer: PHP Medicare Advantage |
$709.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,267.47
|
| Rate for Payer: Priority Health Medicare |
$709.94
|
| Rate for Payer: Priority Health SBD |
$1,267.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,267.47
|
| Rate for Payer: Railroad Medicare Medicare |
$709.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,365.24
|
| Rate for Payer: UHC Core |
$1,365.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$709.94
|
| Rate for Payer: UHC Exchange |
$1,365.24
|
| Rate for Payer: UHC Medicaid |
$463.49
|
| Rate for Payer: UHCCP Medicaid |
$463.49
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$460.29 |
| Max. Negotiated Rate |
$1,296.22 |
| Rate for Payer: Aetna Commercial |
$917.10
|
| Rate for Payer: Aetna Medicare |
$711.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.54
|
| Rate for Payer: BCBS Complete |
$483.30
|
| Rate for Payer: BCBS MAPPO |
$684.40
|
| Rate for Payer: BCN Commercial |
$1,106.52
|
| Rate for Payer: BCN Medicare Advantage |
$684.40
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cofinity Commercial |
$985.54
|
| Rate for Payer: Cofinity Commercial |
$917.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.40
|
| Rate for Payer: Healthscope Commercial |
$1,266.14
|
| Rate for Payer: Healthscope Commercial |
$1,095.04
|
| Rate for Payer: Mclaren Medicaid |
$460.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.62
|
| Rate for Payer: Meridian Medicaid |
$483.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$752.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.22
|
| Rate for Payer: Nomi Health Commercial |
$821.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.75
|
| Rate for Payer: PACE SWMI |
$684.40
|
| Rate for Payer: PHP Medicare Advantage |
$684.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,182.83
|
| Rate for Payer: Priority Health Medicare |
$684.40
|
| Rate for Payer: Priority Health SBD |
$1,182.83
|
| Rate for Payer: Priority Health Tiered Network |
$1,182.83
|
| Rate for Payer: Railroad Medicare Medicare |
$684.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,093.03
|
| Rate for Payer: UHC Core |
$1,093.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$684.40
|
| Rate for Payer: UHC Exchange |
$1,093.03
|
| Rate for Payer: UHC Medicaid |
$460.29
|
| Rate for Payer: UHCCP Medicaid |
$460.29
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,278.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$239.63 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Aetna Commercial |
$494.41
|
| Rate for Payer: Aetna Medicare |
$383.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.30
|
| Rate for Payer: BCBS Complete |
$251.61
|
| Rate for Payer: BCBS MAPPO |
$368.96
|
| Rate for Payer: BCN Commercial |
$607.04
|
| Rate for Payer: BCN Medicare Advantage |
$368.96
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cofinity Commercial |
$531.30
|
| Rate for Payer: Cofinity Commercial |
$494.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.96
|
| Rate for Payer: Healthscope Commercial |
$682.58
|
| Rate for Payer: Healthscope Commercial |
$590.34
|
| Rate for Payer: Mclaren Medicaid |
$239.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.41
|
| Rate for Payer: Meridian Medicaid |
$251.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$405.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.95
|
| Rate for Payer: Nomi Health Commercial |
$442.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$958.50
|
| Rate for Payer: PACE SWMI |
$368.96
|
| Rate for Payer: PHP Medicare Advantage |
$368.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$648.90
|
| Rate for Payer: Priority Health Medicare |
$368.96
|
| Rate for Payer: Priority Health SBD |
$648.90
|
| Rate for Payer: Priority Health Tiered Network |
$648.90
|
| Rate for Payer: Railroad Medicare Medicare |
$368.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.56
|
| Rate for Payer: UHC Core |
$711.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$368.96
|
| Rate for Payer: UHC Exchange |
$711.56
|
| Rate for Payer: UHC Medicaid |
$239.63
|
| Rate for Payer: UHCCP Medicaid |
$239.63
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$1,822.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$283.08 |
| Max. Negotiated Rate |
$1,366.50 |
| Rate for Payer: Aetna Commercial |
$590.93
|
| Rate for Payer: Aetna Medicare |
$458.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.03
|
| Rate for Payer: BCBS Complete |
$297.23
|
| Rate for Payer: BCBS MAPPO |
$440.99
|
| Rate for Payer: BCN Commercial |
$713.61
|
| Rate for Payer: BCN Medicare Advantage |
$440.99
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cofinity Commercial |
$635.03
|
| Rate for Payer: Cofinity Commercial |
$590.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.99
|
| Rate for Payer: Healthscope Commercial |
$815.83
|
| Rate for Payer: Healthscope Commercial |
$705.58
|
| Rate for Payer: Mclaren Medicaid |
$283.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.04
|
| Rate for Payer: Meridian Medicaid |
$297.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$485.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.40
|
| Rate for Payer: Nomi Health Commercial |
$529.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,366.50
|
| Rate for Payer: PACE SWMI |
$440.99
|
| Rate for Payer: PHP Medicare Advantage |
$440.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$762.83
|
| Rate for Payer: Priority Health Medicare |
$440.99
|
| Rate for Payer: Priority Health SBD |
$762.83
|
| Rate for Payer: Priority Health Tiered Network |
$762.83
|
| Rate for Payer: Railroad Medicare Medicare |
$440.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.26
|
| Rate for Payer: UHC Core |
$857.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$440.99
|
| Rate for Payer: UHC Exchange |
$857.26
|
| Rate for Payer: UHC Medicaid |
$283.08
|
| Rate for Payer: UHCCP Medicaid |
$283.08
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,308.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$482.87 |
| Max. Negotiated Rate |
$1,731.00 |
| Rate for Payer: Aetna Commercial |
$1,001.44
|
| Rate for Payer: Aetna Medicare |
$777.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.17
|
| Rate for Payer: BCBS Complete |
$507.01
|
| Rate for Payer: BCBS MAPPO |
$747.34
|
| Rate for Payer: BCN Commercial |
$1,239.47
|
| Rate for Payer: BCN Medicare Advantage |
$747.34
|
| Rate for Payer: Cash Price |
$1,846.40
|
| Rate for Payer: Cash Price |
$1,846.40
|
| Rate for Payer: Cofinity Commercial |
$1,076.17
|
| Rate for Payer: Cofinity Commercial |
$1,001.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.34
|
| Rate for Payer: Healthscope Commercial |
$1,382.58
|
| Rate for Payer: Healthscope Commercial |
$1,195.74
|
| Rate for Payer: Mclaren Medicaid |
$482.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.71
|
| Rate for Payer: Meridian Medicaid |
$507.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$822.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,447.07
|
| Rate for Payer: Nomi Health Commercial |
$896.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,731.00
|
| Rate for Payer: PACE SWMI |
$747.34
|
| Rate for Payer: PHP Medicare Advantage |
$747.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,324.96
|
| Rate for Payer: Priority Health Medicare |
$747.34
|
| Rate for Payer: Priority Health SBD |
$1,324.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,324.96
|
| Rate for Payer: Railroad Medicare Medicare |
$747.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,478.62
|
| Rate for Payer: UHC Core |
$1,478.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$747.34
|
| Rate for Payer: UHC Exchange |
$1,478.62
|
| Rate for Payer: UHC Medicaid |
$482.87
|
| Rate for Payer: UHCCP Medicaid |
$482.87
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$330.36 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Aetna Commercial |
$679.69
|
| Rate for Payer: Aetna Medicare |
$527.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.41
|
| Rate for Payer: BCBS Complete |
$346.88
|
| Rate for Payer: BCBS MAPPO |
$507.23
|
| Rate for Payer: BCN Commercial |
$822.16
|
| Rate for Payer: BCN Medicare Advantage |
$507.23
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cofinity Commercial |
$730.41
|
| Rate for Payer: Cofinity Commercial |
$679.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$507.23
|
| Rate for Payer: Healthscope Commercial |
$938.38
|
| Rate for Payer: Healthscope Commercial |
$811.57
|
| Rate for Payer: Mclaren Medicaid |
$330.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$532.59
|
| Rate for Payer: Meridian Medicaid |
$346.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$557.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.34
|
| Rate for Payer: Nomi Health Commercial |
$608.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,270.50
|
| Rate for Payer: PACE SWMI |
$507.23
|
| Rate for Payer: PHP Medicare Advantage |
$507.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$878.87
|
| Rate for Payer: Priority Health Medicare |
$507.23
|
| Rate for Payer: Priority Health SBD |
$878.87
|
| Rate for Payer: Priority Health Tiered Network |
$878.87
|
| Rate for Payer: Railroad Medicare Medicare |
$507.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$963.68
|
| Rate for Payer: UHC Core |
$963.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$507.23
|
| Rate for Payer: UHC Exchange |
$963.68
|
| Rate for Payer: UHC Medicaid |
$330.36
|
| Rate for Payer: UHCCP Medicaid |
$330.36
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Aetna Commercial |
$545.41
|
| Rate for Payer: Aetna Medicare |
$423.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.11
|
| Rate for Payer: BCBS Complete |
$280.01
|
| Rate for Payer: BCBS MAPPO |
$407.02
|
| Rate for Payer: BCN Commercial |
$666.30
|
| Rate for Payer: BCN Medicare Advantage |
$407.02
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$586.11
|
| Rate for Payer: Cofinity Commercial |
$545.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.02
|
| Rate for Payer: Healthscope Commercial |
$752.99
|
| Rate for Payer: Healthscope Commercial |
$651.23
|
| Rate for Payer: Mclaren Medicaid |
$266.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.37
|
| Rate for Payer: Meridian Medicaid |
$280.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$447.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.01
|
| Rate for Payer: Nomi Health Commercial |
$488.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$407.02
|
| Rate for Payer: PHP Medicare Advantage |
$407.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$712.26
|
| Rate for Payer: Priority Health Medicare |
$407.02
|
| Rate for Payer: Priority Health SBD |
$712.26
|
| Rate for Payer: Priority Health Tiered Network |
$712.26
|
| Rate for Payer: Railroad Medicare Medicare |
$407.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$778.53
|
| Rate for Payer: UHC Core |
$778.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$407.02
|
| Rate for Payer: UHC Exchange |
$778.53
|
| Rate for Payer: UHC Medicaid |
$266.68
|
| Rate for Payer: UHCCP Medicaid |
$266.68
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$423.23 |
| Max. Negotiated Rate |
$1,248.46 |
| Rate for Payer: Aetna Commercial |
$866.69
|
| Rate for Payer: Aetna Medicare |
$672.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.36
|
| Rate for Payer: BCBS Complete |
$444.39
|
| Rate for Payer: BCBS MAPPO |
$646.78
|
| Rate for Payer: BCN Commercial |
$1,074.15
|
| Rate for Payer: BCN Medicare Advantage |
$646.78
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cofinity Commercial |
$931.36
|
| Rate for Payer: Cofinity Commercial |
$866.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.78
|
| Rate for Payer: Healthscope Commercial |
$1,196.54
|
| Rate for Payer: Healthscope Commercial |
$1,034.85
|
| Rate for Payer: Mclaren Medicaid |
$423.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.12
|
| Rate for Payer: Meridian Medicaid |
$444.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$711.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.46
|
| Rate for Payer: Nomi Health Commercial |
$776.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.25
|
| Rate for Payer: PACE SWMI |
$646.78
|
| Rate for Payer: PHP Medicare Advantage |
$646.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,148.22
|
| Rate for Payer: Priority Health Medicare |
$646.78
|
| Rate for Payer: Priority Health SBD |
$1,148.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,148.22
|
| Rate for Payer: Railroad Medicare Medicare |
$646.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,222.63
|
| Rate for Payer: UHC Core |
$1,222.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$646.78
|
| Rate for Payer: UHC Exchange |
$1,222.63
|
| Rate for Payer: UHC Medicaid |
$423.23
|
| Rate for Payer: UHCCP Medicaid |
$423.23
|
|
|
PR DCMPRN PERQ NUCLEUS PULPOSUS 1/MLT LEVELS LUMBAR
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$340.37 |
| Max. Negotiated Rate |
$2,318.25 |
| Rate for Payer: Aetna Commercial |
$697.15
|
| Rate for Payer: Aetna Medicare |
$541.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.17
|
| Rate for Payer: BCBS Complete |
$357.39
|
| Rate for Payer: BCBS MAPPO |
$520.26
|
| Rate for Payer: BCN Commercial |
$903.34
|
| Rate for Payer: BCN Medicare Advantage |
$520.26
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cofinity Commercial |
$749.17
|
| Rate for Payer: Cofinity Commercial |
$697.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.26
|
| Rate for Payer: Healthscope Commercial |
$962.48
|
| Rate for Payer: Healthscope Commercial |
$832.42
|
| Rate for Payer: Mclaren Medicaid |
$340.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.27
|
| Rate for Payer: Meridian Medicaid |
$357.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$572.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$991.06
|
| Rate for Payer: Nomi Health Commercial |
$624.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,318.25
|
| Rate for Payer: PACE SWMI |
$520.26
|
| Rate for Payer: PHP Medicare Advantage |
$520.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,049.22
|
| Rate for Payer: Priority Health Medicare |
$520.26
|
| Rate for Payer: Priority Health SBD |
$1,049.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,049.22
|
| Rate for Payer: Railroad Medicare Medicare |
$520.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,017.27
|
| Rate for Payer: UHC Core |
$1,017.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$520.26
|
| Rate for Payer: UHC Exchange |
$1,017.27
|
| Rate for Payer: UHC Medicaid |
$340.37
|
| Rate for Payer: UHCCP Medicaid |
$340.37
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Aetna Commercial |
$267.76
|
| Rate for Payer: Aetna Medicare |
$207.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.74
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$199.82
|
| Rate for Payer: BCN Commercial |
$335.14
|
| Rate for Payer: BCN Medicare Advantage |
$199.82
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$287.74
|
| Rate for Payer: Cofinity Commercial |
$267.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.82
|
| Rate for Payer: Healthscope Commercial |
$369.67
|
| Rate for Payer: Healthscope Commercial |
$319.71
|
| Rate for Payer: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.81
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.44
|
| Rate for Payer: Nomi Health Commercial |
$239.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PACE SWMI |
$199.82
|
| Rate for Payer: PHP Medicare Advantage |
$199.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.74
|
| Rate for Payer: Priority Health Medicare |
$199.82
|
| Rate for Payer: Priority Health SBD |
$306.74
|
| Rate for Payer: Priority Health Tiered Network |
$306.74
|
| Rate for Payer: Railroad Medicare Medicare |
$199.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.18
|
| Rate for Payer: UHC Core |
$402.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.82
|
| Rate for Payer: UHC Exchange |
$402.18
|
| Rate for Payer: UHC Medicaid |
$128.23
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$546.21 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Aetna Commercial |
$736.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.55
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Advantage |
$606.90
|
| Rate for Payer: Cofinity Commercial |
$745.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.60
|
| Rate for Payer: Healthscope Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PHP Commercial |
$736.95
|
| Rate for Payer: Priority Health SBD |
$546.21
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Aetna Commercial |
$267.76
|
| Rate for Payer: Aetna Medicare |
$207.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.74
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$199.82
|
| Rate for Payer: BCN Commercial |
$335.14
|
| Rate for Payer: BCN Medicare Advantage |
$199.82
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$287.74
|
| Rate for Payer: Cofinity Commercial |
$267.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.82
|
| Rate for Payer: Healthscope Commercial |
$369.67
|
| Rate for Payer: Healthscope Commercial |
$319.71
|
| Rate for Payer: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.81
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.44
|
| Rate for Payer: Nomi Health Commercial |
$239.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PACE SWMI |
$199.82
|
| Rate for Payer: PHP Medicare Advantage |
$199.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.74
|
| Rate for Payer: Priority Health Medicare |
$199.82
|
| Rate for Payer: Priority Health SBD |
$306.74
|
| Rate for Payer: Priority Health Tiered Network |
$306.74
|
| Rate for Payer: Railroad Medicare Medicare |
$199.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.18
|
| Rate for Payer: UHC Core |
$402.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.82
|
| Rate for Payer: UHC Exchange |
$402.18
|
| Rate for Payer: UHC Medicaid |
$128.23
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$546.21 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$736.95
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.14
|
| Rate for Payer: BCN Commercial |
$1,065.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Advantage |
$606.90
|
| Rate for Payer: Cofinity Commercial |
$745.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$780.30
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.95
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$736.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$546.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna Medicare |
$88.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.98
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS MAPPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$143.92
|
| Rate for Payer: BCN Medicare Advantage |
$85.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$122.98
|
| Rate for Payer: Cofinity Commercial |
$114.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.40
|
| Rate for Payer: Healthscope Commercial |
$157.99
|
| Rate for Payer: Healthscope Commercial |
$136.64
|
| Rate for Payer: Mclaren Medicaid |
$54.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.67
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.78
|
| Rate for Payer: Nomi Health Commercial |
$102.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.50
|
| Rate for Payer: PACE SWMI |
$85.40
|
| Rate for Payer: PHP Medicare Advantage |
$85.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$131.72
|
| Rate for Payer: Priority Health Medicare |
$85.40
|
| Rate for Payer: Priority Health SBD |
$131.72
|
| Rate for Payer: Priority Health Tiered Network |
$131.72
|
| Rate for Payer: Railroad Medicare Medicare |
$85.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.79
|
| Rate for Payer: UHC Core |
$175.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$85.40
|
| Rate for Payer: UHC Exchange |
$175.79
|
| Rate for Payer: UHC Medicaid |
$54.32
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
|
