|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$1,496.03 |
| Max. Negotiated Rate |
$2,531.75 |
| Rate for Payer: Aetna Commercial |
$2,004.68
|
| Rate for Payer: Aetna Medicare |
$1,555.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,154.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,004.68
|
| Rate for Payer: BCBS Complete |
$1,558.00
|
| Rate for Payer: BCBS MAPPO |
$1,496.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,496.03
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Cofinity Commercial |
$2,154.28
|
| Rate for Payer: Cofinity Commercial |
$2,004.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,496.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,570.83
|
| Rate for Payer: Nomi Health Commercial |
$1,795.24
|
| Rate for Payer: PACE SWMI |
$1,496.03
|
| Rate for Payer: PHP Commercial |
$2,094.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,496.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.75
|
| Rate for Payer: Priority Health Medicare |
$1,496.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,496.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,496.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,791.70
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$50.71
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Commercial |
$59.16
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: UMR Bronson Commercial |
$64.86
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.85
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$50.71
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Commercial |
$59.16
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: UMR Bronson Commercial |
$64.86
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna American Axle |
$400.40
|
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$529.76
|
| Rate for Payer: Cofinity Commercial |
$431.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.00
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Commercial |
$523.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Priority Health SBD |
$388.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: UMR Bronson Commercial |
$227.92
|
| Rate for Payer: VA VA |
$3,570.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.00
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Aetna American Axle |
$400.40
|
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.40
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$529.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$431.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: PHP Commercial |
$523.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health SBD |
$388.08
|
| Rate for Payer: UMR Bronson Commercial |
$271.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.00
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$193.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.28
|
| Rate for Payer: BCBS Complete |
$246.40
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.03
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$267.88
|
| Rate for Payer: Cofinity Commercial |
$249.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.33
|
| Rate for Payer: Nomi Health Commercial |
$223.24
|
| Rate for Payer: PACE SWMI |
$186.03
|
| Rate for Payer: PHP Commercial |
$260.44
|
| Rate for Payer: PHP Medicare Advantage |
$186.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$193.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.28
|
| Rate for Payer: BCBS Complete |
$246.40
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.03
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$249.28
|
| Rate for Payer: Cofinity Commercial |
$267.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.33
|
| Rate for Payer: Nomi Health Commercial |
$223.24
|
| Rate for Payer: PACE SWMI |
$186.03
|
| Rate for Payer: PHP Commercial |
$260.44
|
| Rate for Payer: PHP Medicare Advantage |
$186.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$83.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.68
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCN Medicare Advantage |
$80.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Cofinity Commercial |
$107.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.38
|
| Rate for Payer: Nomi Health Commercial |
$96.43
|
| Rate for Payer: PACE SWMI |
$80.36
|
| Rate for Payer: PHP Commercial |
$112.50
|
| Rate for Payer: PHP Medicare Advantage |
$80.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
| Rate for Payer: UMR Bronson Commercial |
$127.88
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$102.86 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna American Axle |
$180.70
|
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$239.08
|
| Rate for Payer: Cofinity Commercial |
$194.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$250.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.50
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$236.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$175.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: UMR Bronson Commercial |
$102.86
|
| Rate for Payer: VA VA |
$1,784.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.50
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$122.32 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna American Axle |
$180.70
|
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$194.60
|
| Rate for Payer: Cofinity Commercial |
$239.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Healthscope Commercial |
$250.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: PHP Commercial |
$236.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health SBD |
$175.14
|
| Rate for Payer: UMR Bronson Commercial |
$122.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.50
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$83.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.68
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCN Medicare Advantage |
$80.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Cofinity Commercial |
$107.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.38
|
| Rate for Payer: Nomi Health Commercial |
$96.43
|
| Rate for Payer: PACE SWMI |
$80.36
|
| Rate for Payer: PHP Commercial |
$112.50
|
| Rate for Payer: PHP Medicare Advantage |
$80.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
| Rate for Payer: UMR Bronson Commercial |
$127.88
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$16.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$16.02
|
| Rate for Payer: BCN Medicare Advantage |
$16.02
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.82
|
| Rate for Payer: Nomi Health Commercial |
$19.22
|
| Rate for Payer: PACE SWMI |
$16.02
|
| Rate for Payer: PHP Commercial |
$22.43
|
| Rate for Payer: PHP Medicare Advantage |
$16.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$16.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.02
|
| Rate for Payer: UHC Medicare Advantage |
$16.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
PR ARREST EPIPHYSEAL DISTAL FEMUR
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 27475
|
| Min. Negotiated Rate |
$641.89 |
| Max. Negotiated Rate |
$1,103.70 |
| Rate for Payer: Aetna Commercial |
$860.13
|
| Rate for Payer: Aetna Medicare |
$667.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.13
|
| Rate for Payer: BCBS Complete |
$679.20
|
| Rate for Payer: BCBS MAPPO |
$641.89
|
| Rate for Payer: BCN Medicare Advantage |
$641.89
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cofinity Commercial |
$924.32
|
| Rate for Payer: Cofinity Commercial |
$860.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.98
|
| Rate for Payer: Nomi Health Commercial |
$770.27
|
| Rate for Payer: PACE SWMI |
$641.89
|
| Rate for Payer: PHP Commercial |
$898.65
|
| Rate for Payer: PHP Medicare Advantage |
$641.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.70
|
| Rate for Payer: Priority Health Medicare |
$641.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.89
|
| Rate for Payer: UHC Medicare Advantage |
$641.89
|
| Rate for Payer: UMR Bronson Commercial |
$781.08
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
HCPCS 27732
|
| Min. Negotiated Rate |
$439.90 |
| Max. Negotiated Rate |
$989.30 |
| Rate for Payer: Aetna Commercial |
$589.47
|
| Rate for Payer: Aetna Medicare |
$457.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.47
|
| Rate for Payer: BCBS Complete |
$608.80
|
| Rate for Payer: BCBS MAPPO |
$439.90
|
| Rate for Payer: BCN Medicare Advantage |
$439.90
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cofinity Commercial |
$633.46
|
| Rate for Payer: Cofinity Commercial |
$589.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.89
|
| Rate for Payer: Nomi Health Commercial |
$527.88
|
| Rate for Payer: PACE SWMI |
$439.90
|
| Rate for Payer: PHP Commercial |
$615.86
|
| Rate for Payer: PHP Medicare Advantage |
$439.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$989.30
|
| Rate for Payer: Priority Health Medicare |
$439.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.90
|
| Rate for Payer: UHC Medicare Advantage |
$439.90
|
| Rate for Payer: UMR Bronson Commercial |
$700.12
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27730
|
| Min. Negotiated Rate |
$569.72 |
| Max. Negotiated Rate |
$929.50 |
| Rate for Payer: Aetna Commercial |
$763.42
|
| Rate for Payer: Aetna Medicare |
$592.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$820.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.42
|
| Rate for Payer: BCBS Complete |
$572.00
|
| Rate for Payer: BCBS MAPPO |
$569.72
|
| Rate for Payer: BCN Medicare Advantage |
$569.72
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$820.40
|
| Rate for Payer: Cofinity Commercial |
$763.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.21
|
| Rate for Payer: Nomi Health Commercial |
$683.66
|
| Rate for Payer: PACE SWMI |
$569.72
|
| Rate for Payer: PHP Commercial |
$797.61
|
| Rate for Payer: PHP Medicare Advantage |
$569.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.50
|
| Rate for Payer: Priority Health Medicare |
$569.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.72
|
| Rate for Payer: UHC Medicare Advantage |
$569.72
|
| Rate for Payer: UMR Bronson Commercial |
$657.80
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA
|
Professional
|
Both
|
$2,957.00
|
|
|
Service Code
|
HCPCS 27734
|
| Min. Negotiated Rate |
$637.10 |
| Max. Negotiated Rate |
$1,922.05 |
| Rate for Payer: Aetna Commercial |
$853.71
|
| Rate for Payer: Aetna Medicare |
$662.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.71
|
| Rate for Payer: BCBS Complete |
$1,182.80
|
| Rate for Payer: BCBS MAPPO |
$637.10
|
| Rate for Payer: BCN Medicare Advantage |
$637.10
|
| Rate for Payer: Cash Price |
$2,365.60
|
| Rate for Payer: Cash Price |
$2,365.60
|
| Rate for Payer: Cofinity Commercial |
$917.42
|
| Rate for Payer: Cofinity Commercial |
$853.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.96
|
| Rate for Payer: Nomi Health Commercial |
$764.52
|
| Rate for Payer: PACE SWMI |
$637.10
|
| Rate for Payer: PHP Commercial |
$891.94
|
| Rate for Payer: PHP Medicare Advantage |
$637.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,922.05
|
| Rate for Payer: Priority Health Medicare |
$637.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.10
|
| Rate for Payer: UHC Medicare Advantage |
$637.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,360.22
|
|
|
PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 27742
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,082.04 |
| Rate for Payer: Aetna Commercial |
$1,006.90
|
| Rate for Payer: Aetna Medicare |
$781.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.90
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS MAPPO |
$751.42
|
| Rate for Payer: BCN Medicare Advantage |
$751.42
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,082.04
|
| Rate for Payer: Cofinity Commercial |
$1,006.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.99
|
| Rate for Payer: Nomi Health Commercial |
$901.70
|
| Rate for Payer: PACE SWMI |
$751.42
|
| Rate for Payer: PHP Commercial |
$1,051.99
|
| Rate for Payer: PHP Medicare Advantage |
$751.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health Medicare |
$751.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.42
|
| Rate for Payer: UHC Medicare Advantage |
$751.42
|
| Rate for Payer: UMR Bronson Commercial |
$622.38
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$3,099.00
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$886.87 |
| Max. Negotiated Rate |
$2,014.35 |
| Rate for Payer: Aetna Commercial |
$1,188.41
|
| Rate for Payer: Aetna Medicare |
$922.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.41
|
| Rate for Payer: BCBS Complete |
$1,239.60
|
| Rate for Payer: BCBS MAPPO |
$886.87
|
| Rate for Payer: BCN Medicare Advantage |
$886.87
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cofinity Commercial |
$1,277.09
|
| Rate for Payer: Cofinity Commercial |
$1,188.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$931.21
|
| Rate for Payer: Nomi Health Commercial |
$1,064.24
|
| Rate for Payer: PACE SWMI |
$886.87
|
| Rate for Payer: PHP Commercial |
$1,241.62
|
| Rate for Payer: PHP Medicare Advantage |
$886.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,014.35
|
| Rate for Payer: Priority Health Medicare |
$886.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$886.87
|
| Rate for Payer: UHC Medicare Advantage |
$886.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,425.54
|
|
|
PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 36600
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna Commercial |
$18.84
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.84
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS MAPPO |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$14.06
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.76
|
| Rate for Payer: Nomi Health Commercial |
$16.87
|
| Rate for Payer: PACE SWMI |
$14.06
|
| Rate for Payer: PHP Commercial |
$19.68
|
| Rate for Payer: PHP Medicare Advantage |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Medicare |
$14.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.06
|
| Rate for Payer: UHC Medicare Advantage |
$14.06
|
| Rate for Payer: UMR Bronson Commercial |
$64.40
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$630.80 |
| Max. Negotiated Rate |
$1,454.70 |
| Rate for Payer: Aetna Commercial |
$845.27
|
| Rate for Payer: Aetna Medicare |
$656.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$908.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.27
|
| Rate for Payer: BCBS Complete |
$895.20
|
| Rate for Payer: BCBS MAPPO |
$630.80
|
| Rate for Payer: BCN Medicare Advantage |
$630.80
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cofinity Commercial |
$908.35
|
| Rate for Payer: Cofinity Commercial |
$845.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$662.34
|
| Rate for Payer: Nomi Health Commercial |
$756.96
|
| Rate for Payer: PACE SWMI |
$630.80
|
| Rate for Payer: PHP Commercial |
$883.12
|
| Rate for Payer: PHP Medicare Advantage |
$630.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,454.70
|
| Rate for Payer: Priority Health Medicare |
$630.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$630.80
|
| Rate for Payer: UHC Medicare Advantage |
$630.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,029.48
|
|
|
PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 33987
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Aetna Commercial |
$265.21
|
| Rate for Payer: Aetna Medicare |
$205.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.21
|
| Rate for Payer: BCBS Complete |
$176.80
|
| Rate for Payer: BCBS MAPPO |
$197.92
|
| Rate for Payer: BCN Medicare Advantage |
$197.92
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$265.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.82
|
| Rate for Payer: Nomi Health Commercial |
$237.50
|
| Rate for Payer: PACE SWMI |
$197.92
|
| Rate for Payer: PHP Commercial |
$277.09
|
| Rate for Payer: PHP Medicare Advantage |
$197.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health Medicare |
$197.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.92
|
| Rate for Payer: UHC Medicare Advantage |
$197.92
|
| Rate for Payer: UMR Bronson Commercial |
$203.32
|
|
|
PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$4,416.00
|
|
|
Service Code
|
HCPCS 22551
|
| Min. Negotiated Rate |
$1,666.04 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,232.49
|
| Rate for Payer: Aetna Medicare |
$1,732.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,399.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,232.49
|
| Rate for Payer: BCBS Complete |
$1,766.40
|
| Rate for Payer: BCBS MAPPO |
$1,666.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.04
|
| Rate for Payer: Cash Price |
$3,532.80
|
| Rate for Payer: Cash Price |
$3,532.80
|
| Rate for Payer: Cofinity Commercial |
$2,399.10
|
| Rate for Payer: Cofinity Commercial |
$2,232.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,749.34
|
| Rate for Payer: Nomi Health Commercial |
$1,999.25
|
| Rate for Payer: PACE SWMI |
$1,666.04
|
| Rate for Payer: PHP Commercial |
$2,332.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,870.40
|
| Rate for Payer: Priority Health Medicare |
$1,666.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,031.36
|
|
|
PR ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2
|
Professional
|
Both
|
$4,916.00
|
|
|
Service Code
|
HCPCS 22554
|
| Min. Negotiated Rate |
$1,235.93 |
| Max. Negotiated Rate |
$3,195.40 |
| Rate for Payer: Aetna Commercial |
$1,656.15
|
| Rate for Payer: Aetna Medicare |
$1,285.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,779.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,656.15
|
| Rate for Payer: BCBS Complete |
$1,966.40
|
| Rate for Payer: BCBS MAPPO |
$1,235.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,235.93
|
| Rate for Payer: Cash Price |
$3,932.80
|
| Rate for Payer: Cash Price |
$3,932.80
|
| Rate for Payer: Cofinity Commercial |
$1,779.74
|
| Rate for Payer: Cofinity Commercial |
$1,656.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,235.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,297.73
|
| Rate for Payer: Nomi Health Commercial |
$1,483.12
|
| Rate for Payer: PACE SWMI |
$1,235.93
|
| Rate for Payer: PHP Commercial |
$1,730.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,235.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,195.40
|
| Rate for Payer: Priority Health Medicare |
$1,235.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,235.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,235.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,261.36
|
|
