|
PR ARTHRODESIS POSTERIOR CRANIOCERVICAL
|
Professional
|
Both
|
$5,337.00
|
|
|
Service Code
|
HCPCS 22590
|
| Min. Negotiated Rate |
$1,568.47 |
| Max. Negotiated Rate |
$3,469.05 |
| Rate for Payer: Aetna Commercial |
$2,101.75
|
| Rate for Payer: Aetna Medicare |
$1,631.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,258.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,101.75
|
| Rate for Payer: BCBS Complete |
$2,134.80
|
| Rate for Payer: BCBS MAPPO |
$1,568.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.47
|
| Rate for Payer: Cash Price |
$4,269.60
|
| Rate for Payer: Cash Price |
$4,269.60
|
| Rate for Payer: Cofinity Commercial |
$2,258.60
|
| Rate for Payer: Cofinity Commercial |
$2,101.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.89
|
| Rate for Payer: Nomi Health Commercial |
$1,882.16
|
| Rate for Payer: PACE SWMI |
$1,568.47
|
| Rate for Payer: PHP Commercial |
$2,195.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,469.05
|
| Rate for Payer: Priority Health Medicare |
$1,568.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,455.02
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 22632
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$820.30 |
| Rate for Payer: Aetna Commercial |
$421.23
|
| Rate for Payer: Aetna Medicare |
$326.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.23
|
| Rate for Payer: BCBS Complete |
$504.80
|
| Rate for Payer: BCBS MAPPO |
$314.35
|
| Rate for Payer: BCN Medicare Advantage |
$314.35
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cofinity Commercial |
$452.66
|
| Rate for Payer: Cofinity Commercial |
$421.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.07
|
| Rate for Payer: Nomi Health Commercial |
$377.22
|
| Rate for Payer: PACE SWMI |
$314.35
|
| Rate for Payer: PHP Commercial |
$440.09
|
| Rate for Payer: PHP Medicare Advantage |
$314.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.30
|
| Rate for Payer: Priority Health Medicare |
$314.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.35
|
| Rate for Payer: UHC Medicare Advantage |
$314.35
|
| Rate for Payer: UMR Bronson Commercial |
$580.52
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,749.00
|
|
|
Service Code
|
HCPCS 22630
|
| Min. Negotiated Rate |
$1,536.91 |
| Max. Negotiated Rate |
$4,386.85 |
| Rate for Payer: Aetna Commercial |
$2,059.46
|
| Rate for Payer: Aetna Medicare |
$1,598.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,213.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,059.46
|
| Rate for Payer: BCBS Complete |
$2,699.60
|
| Rate for Payer: BCBS MAPPO |
$1,536.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,536.91
|
| Rate for Payer: Cash Price |
$5,399.20
|
| Rate for Payer: Cash Price |
$5,399.20
|
| Rate for Payer: Cofinity Commercial |
$2,213.15
|
| Rate for Payer: Cofinity Commercial |
$2,059.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,536.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,613.76
|
| Rate for Payer: Nomi Health Commercial |
$1,844.29
|
| Rate for Payer: PACE SWMI |
$1,536.91
|
| Rate for Payer: PHP Commercial |
$2,151.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,536.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,386.85
|
| Rate for Payer: Priority Health Medicare |
$1,536.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,536.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,536.91
|
| Rate for Payer: UMR Bronson Commercial |
$3,104.54
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$3,299.00
|
|
|
Service Code
|
HCPCS 22612
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$2,216.65 |
| Rate for Payer: Aetna Commercial |
$2,062.72
|
| Rate for Payer: Aetna Medicare |
$1,600.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,216.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,062.72
|
| Rate for Payer: BCBS Complete |
$1,319.60
|
| Rate for Payer: BCBS MAPPO |
$1,539.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,539.34
|
| Rate for Payer: Cash Price |
$2,639.20
|
| Rate for Payer: Cash Price |
$2,639.20
|
| Rate for Payer: Cofinity Commercial |
$2,216.65
|
| Rate for Payer: Cofinity Commercial |
$2,062.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,539.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,616.31
|
| Rate for Payer: Nomi Health Commercial |
$1,847.21
|
| Rate for Payer: PACE SWMI |
$1,539.34
|
| Rate for Payer: PHP Commercial |
$2,155.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,539.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,144.35
|
| Rate for Payer: Priority Health Medicare |
$1,539.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,539.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,539.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,517.54
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC THORACIC
|
Professional
|
Both
|
$4,286.00
|
|
|
Service Code
|
HCPCS 22610
|
| Min. Negotiated Rate |
$1,257.65 |
| Max. Negotiated Rate |
$2,785.90 |
| Rate for Payer: Aetna Commercial |
$1,685.25
|
| Rate for Payer: Aetna Medicare |
$1,307.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,685.25
|
| Rate for Payer: BCBS Complete |
$1,714.40
|
| Rate for Payer: BCBS MAPPO |
$1,257.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.65
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cofinity Commercial |
$1,811.02
|
| Rate for Payer: Cofinity Commercial |
$1,685.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,320.53
|
| Rate for Payer: Nomi Health Commercial |
$1,509.18
|
| Rate for Payer: PACE SWMI |
$1,257.65
|
| Rate for Payer: PHP Commercial |
$1,760.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.90
|
| Rate for Payer: Priority Health Medicare |
$1,257.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,257.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,257.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,971.56
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 13+ VRT SGM
|
Professional
|
Both
|
$5,067.00
|
|
|
Service Code
|
HCPCS 22804
|
| Min. Negotiated Rate |
$2,026.80 |
| Max. Negotiated Rate |
$3,388.46 |
| Rate for Payer: Aetna Commercial |
$3,153.15
|
| Rate for Payer: Aetna Medicare |
$2,447.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,388.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,153.15
|
| Rate for Payer: BCBS Complete |
$2,026.80
|
| Rate for Payer: BCBS MAPPO |
$2,353.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,353.10
|
| Rate for Payer: Cash Price |
$4,053.60
|
| Rate for Payer: Cash Price |
$4,053.60
|
| Rate for Payer: Cofinity Commercial |
$3,388.46
|
| Rate for Payer: Cofinity Commercial |
$3,153.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,353.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,470.76
|
| Rate for Payer: Nomi Health Commercial |
$2,823.72
|
| Rate for Payer: PACE SWMI |
$2,353.10
|
| Rate for Payer: PHP Commercial |
$3,294.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,353.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,293.55
|
| Rate for Payer: Priority Health Medicare |
$2,353.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,353.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,353.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,330.82
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM <6 VRT SGM
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 22800
|
| Min. Negotiated Rate |
$1,124.80 |
| Max. Negotiated Rate |
$1,919.74 |
| Rate for Payer: Aetna Commercial |
$1,786.42
|
| Rate for Payer: Aetna Medicare |
$1,386.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,919.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,786.42
|
| Rate for Payer: BCBS Complete |
$1,124.80
|
| Rate for Payer: BCBS MAPPO |
$1,333.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,333.15
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Cofinity Commercial |
$1,919.74
|
| Rate for Payer: Cofinity Commercial |
$1,786.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,333.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,399.81
|
| Rate for Payer: Nomi Health Commercial |
$1,599.78
|
| Rate for Payer: PACE SWMI |
$1,333.15
|
| Rate for Payer: PHP Commercial |
$1,866.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,333.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.80
|
| Rate for Payer: Priority Health Medicare |
$1,333.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,333.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,333.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,293.52
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SGM
|
Professional
|
Both
|
$4,380.00
|
|
|
Service Code
|
HCPCS 22802
|
| Min. Negotiated Rate |
$1,752.00 |
| Max. Negotiated Rate |
$2,949.98 |
| Rate for Payer: Aetna Commercial |
$2,745.12
|
| Rate for Payer: Aetna Medicare |
$2,130.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,949.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,745.12
|
| Rate for Payer: BCBS Complete |
$1,752.00
|
| Rate for Payer: BCBS MAPPO |
$2,048.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,048.60
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Cofinity Commercial |
$2,949.98
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,048.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,151.03
|
| Rate for Payer: Nomi Health Commercial |
$2,458.32
|
| Rate for Payer: PACE SWMI |
$2,048.60
|
| Rate for Payer: PHP Commercial |
$2,868.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,048.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.00
|
| Rate for Payer: Priority Health Medicare |
$2,048.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,048.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,048.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,014.80
|
|
|
PR ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 22614
|
| Min. Negotiated Rate |
$382.59 |
| Max. Negotiated Rate |
$1,218.75 |
| Rate for Payer: Aetna Commercial |
$512.67
|
| Rate for Payer: Aetna Medicare |
$397.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.67
|
| Rate for Payer: BCBS Complete |
$750.00
|
| Rate for Payer: BCBS MAPPO |
$382.59
|
| Rate for Payer: BCN Medicare Advantage |
$382.59
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cofinity Commercial |
$550.93
|
| Rate for Payer: Cofinity Commercial |
$512.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.72
|
| Rate for Payer: Nomi Health Commercial |
$459.11
|
| Rate for Payer: PACE SWMI |
$382.59
|
| Rate for Payer: PHP Commercial |
$535.63
|
| Rate for Payer: PHP Medicare Advantage |
$382.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.75
|
| Rate for Payer: Priority Health Medicare |
$382.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.59
|
| Rate for Payer: UHC Medicare Advantage |
$382.59
|
| Rate for Payer: UMR Bronson Commercial |
$862.50
|
|
|
PR ARTHRODESIS SI JOINT PERCUTANEOUS/MIN INVASIVE
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 27279
|
| Min. Negotiated Rate |
$526.40 |
| Max. Negotiated Rate |
$1,116.95 |
| Rate for Payer: Aetna Commercial |
$1,039.38
|
| Rate for Payer: Aetna Medicare |
$806.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,116.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.38
|
| Rate for Payer: BCBS Complete |
$526.40
|
| Rate for Payer: BCBS MAPPO |
$775.66
|
| Rate for Payer: BCN Medicare Advantage |
$775.66
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,116.95
|
| Rate for Payer: Cofinity Commercial |
$1,039.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.44
|
| Rate for Payer: Nomi Health Commercial |
$930.79
|
| Rate for Payer: PACE SWMI |
$775.66
|
| Rate for Payer: PHP Commercial |
$1,085.92
|
| Rate for Payer: PHP Medicare Advantage |
$775.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$855.40
|
| Rate for Payer: Priority Health Medicare |
$775.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$775.66
|
| Rate for Payer: UHC Medicare Advantage |
$775.66
|
| Rate for Payer: UMR Bronson Commercial |
$605.36
|
|
|
PR ARTHRODESIS SI JT OPN W/OBTAINING B1 GRF INSTRMJ
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 27280
|
| Min. Negotiated Rate |
$1,296.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna Commercial |
$1,784.09
|
| Rate for Payer: Aetna Medicare |
$1,384.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,784.09
|
| Rate for Payer: BCBS Complete |
$1,296.00
|
| Rate for Payer: BCBS MAPPO |
$1,331.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,331.41
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,917.23
|
| Rate for Payer: Cofinity Commercial |
$1,784.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,331.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,397.98
|
| Rate for Payer: Nomi Health Commercial |
$1,597.69
|
| Rate for Payer: PACE SWMI |
$1,331.41
|
| Rate for Payer: PHP Commercial |
$1,863.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,331.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.00
|
| Rate for Payer: Priority Health Medicare |
$1,331.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,331.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,331.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,490.40
|
|
|
PR ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 28725
|
| Min. Negotiated Rate |
$746.91 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Aetna Commercial |
$1,000.86
|
| Rate for Payer: Aetna Medicare |
$776.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.86
|
| Rate for Payer: BCBS Complete |
$1,310.40
|
| Rate for Payer: BCBS MAPPO |
$746.91
|
| Rate for Payer: BCN Medicare Advantage |
$746.91
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cofinity Commercial |
$1,075.55
|
| Rate for Payer: Cofinity Commercial |
$1,000.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.26
|
| Rate for Payer: Nomi Health Commercial |
$896.29
|
| Rate for Payer: PACE SWMI |
$746.91
|
| Rate for Payer: PHP Commercial |
$1,045.67
|
| Rate for Payer: PHP Medicare Advantage |
$746.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health Medicare |
$746.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.91
|
| Rate for Payer: UHC Medicare Advantage |
$746.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,506.96
|
|
|
PR ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 27282
|
| Min. Negotiated Rate |
$601.20 |
| Max. Negotiated Rate |
$1,194.54 |
| Rate for Payer: Aetna Commercial |
$1,111.58
|
| Rate for Payer: Aetna Medicare |
$862.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,194.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,111.58
|
| Rate for Payer: BCBS Complete |
$601.20
|
| Rate for Payer: BCBS MAPPO |
$829.54
|
| Rate for Payer: BCN Medicare Advantage |
$829.54
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cofinity Commercial |
$1,194.54
|
| Rate for Payer: Cofinity Commercial |
$1,111.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$829.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$871.02
|
| Rate for Payer: Nomi Health Commercial |
$995.45
|
| Rate for Payer: PACE SWMI |
$829.54
|
| Rate for Payer: PHP Commercial |
$1,161.36
|
| Rate for Payer: PHP Medicare Advantage |
$829.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health Medicare |
$829.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$829.54
|
| Rate for Payer: UHC Medicare Advantage |
$829.54
|
| Rate for Payer: UMR Bronson Commercial |
$691.38
|
|
|
PR ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27871
|
| Min. Negotiated Rate |
$663.31 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$888.84
|
| Rate for Payer: Aetna Medicare |
$689.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.84
|
| Rate for Payer: BCBS Complete |
$1,202.00
|
| Rate for Payer: BCBS MAPPO |
$663.31
|
| Rate for Payer: BCN Medicare Advantage |
$663.31
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$955.17
|
| Rate for Payer: Cofinity Commercial |
$888.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.48
|
| Rate for Payer: Nomi Health Commercial |
$795.97
|
| Rate for Payer: PACE SWMI |
$663.31
|
| Rate for Payer: PHP Commercial |
$928.63
|
| Rate for Payer: PHP Medicare Advantage |
$663.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health Medicare |
$663.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$663.31
|
| Rate for Payer: UHC Medicare Advantage |
$663.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,382.30
|
|
|
PR ARTHRODESIS TRIPLE
|
Professional
|
Both
|
$4,084.00
|
|
|
Service Code
|
HCPCS 28715
|
| Min. Negotiated Rate |
$903.64 |
| Max. Negotiated Rate |
$2,654.60 |
| Rate for Payer: Aetna Commercial |
$1,210.88
|
| Rate for Payer: Aetna Medicare |
$939.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,301.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,210.88
|
| Rate for Payer: BCBS Complete |
$1,633.60
|
| Rate for Payer: BCBS MAPPO |
$903.64
|
| Rate for Payer: BCN Medicare Advantage |
$903.64
|
| Rate for Payer: Cash Price |
$3,267.20
|
| Rate for Payer: Cash Price |
$3,267.20
|
| Rate for Payer: Cofinity Commercial |
$1,301.24
|
| Rate for Payer: Cofinity Commercial |
$1,210.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.82
|
| Rate for Payer: Nomi Health Commercial |
$1,084.37
|
| Rate for Payer: PACE SWMI |
$903.64
|
| Rate for Payer: PHP Commercial |
$1,265.10
|
| Rate for Payer: PHP Medicare Advantage |
$903.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,654.60
|
| Rate for Payer: Priority Health Medicare |
$903.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$903.64
|
| Rate for Payer: UHC Medicare Advantage |
$903.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,878.64
|
|
|
PR ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 25800
|
| Min. Negotiated Rate |
$707.23 |
| Max. Negotiated Rate |
$1,598.35 |
| Rate for Payer: Aetna Commercial |
$947.69
|
| Rate for Payer: Aetna Medicare |
$735.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,018.41
|
| Rate for Payer: BCBS Complete |
$983.60
|
| Rate for Payer: BCBS MAPPO |
$707.23
|
| Rate for Payer: BCN Medicare Advantage |
$707.23
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cofinity Commercial |
$947.69
|
| Rate for Payer: Cofinity Commercial |
$1,018.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$742.59
|
| Rate for Payer: Nomi Health Commercial |
$848.68
|
| Rate for Payer: PACE SWMI |
$707.23
|
| Rate for Payer: PHP Commercial |
$990.12
|
| Rate for Payer: PHP Medicare Advantage |
$707.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.35
|
| Rate for Payer: Priority Health Medicare |
$707.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.23
|
| Rate for Payer: UHC Medicare Advantage |
$707.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,131.14
|
|
|
PR ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 25820
|
| Min. Negotiated Rate |
$621.74 |
| Max. Negotiated Rate |
$1,844.05 |
| Rate for Payer: Aetna Commercial |
$833.13
|
| Rate for Payer: Aetna Medicare |
$646.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.13
|
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: BCBS MAPPO |
$621.74
|
| Rate for Payer: BCN Medicare Advantage |
$621.74
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Cofinity Commercial |
$895.31
|
| Rate for Payer: Cofinity Commercial |
$833.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.83
|
| Rate for Payer: Nomi Health Commercial |
$746.09
|
| Rate for Payer: PACE SWMI |
$621.74
|
| Rate for Payer: PHP Commercial |
$870.44
|
| Rate for Payer: PHP Medicare Advantage |
$621.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.05
|
| Rate for Payer: Priority Health Medicare |
$621.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.74
|
| Rate for Payer: UHC Medicare Advantage |
$621.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,305.02
|
|
|
PR ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$3,412.00
|
|
|
Service Code
|
HCPCS 25810
|
| Min. Negotiated Rate |
$838.11 |
| Max. Negotiated Rate |
$2,217.80 |
| Rate for Payer: Aetna Commercial |
$1,123.07
|
| Rate for Payer: Aetna Medicare |
$871.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,123.07
|
| Rate for Payer: BCBS Complete |
$1,364.80
|
| Rate for Payer: BCBS MAPPO |
$838.11
|
| Rate for Payer: BCN Medicare Advantage |
$838.11
|
| Rate for Payer: Cash Price |
$2,729.60
|
| Rate for Payer: Cash Price |
$2,729.60
|
| Rate for Payer: Cofinity Commercial |
$1,206.88
|
| Rate for Payer: Cofinity Commercial |
$1,123.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$880.02
|
| Rate for Payer: Nomi Health Commercial |
$1,005.73
|
| Rate for Payer: PACE SWMI |
$838.11
|
| Rate for Payer: PHP Commercial |
$1,173.35
|
| Rate for Payer: PHP Medicare Advantage |
$838.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,217.80
|
| Rate for Payer: Priority Health Medicare |
$838.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$838.11
|
| Rate for Payer: UHC Medicare Advantage |
$838.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,569.52
|
|
|
PR ARTHRODESIS WRIST WITH AUTOGRAFT
|
Professional
|
Both
|
$14,088.00
|
|
|
Service Code
|
HCPCS 25825
|
| Min. Negotiated Rate |
$759.51 |
| Max. Negotiated Rate |
$9,157.20 |
| Rate for Payer: Aetna Commercial |
$1,017.74
|
| Rate for Payer: Aetna Medicare |
$789.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,093.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,017.74
|
| Rate for Payer: BCBS Complete |
$5,635.20
|
| Rate for Payer: BCBS MAPPO |
$759.51
|
| Rate for Payer: BCN Medicare Advantage |
$759.51
|
| Rate for Payer: Cash Price |
$11,270.40
|
| Rate for Payer: Cash Price |
$11,270.40
|
| Rate for Payer: Cofinity Commercial |
$1,093.69
|
| Rate for Payer: Cofinity Commercial |
$1,017.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.49
|
| Rate for Payer: Nomi Health Commercial |
$911.41
|
| Rate for Payer: PACE SWMI |
$759.51
|
| Rate for Payer: PHP Commercial |
$1,063.31
|
| Rate for Payer: PHP Medicare Advantage |
$759.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,157.20
|
| Rate for Payer: Priority Health Medicare |
$759.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.51
|
| Rate for Payer: UHC Medicare Advantage |
$759.51
|
| Rate for Payer: UMR Bronson Commercial |
$6,480.48
|
|
|
PR ARTHRODESIS WRIST W/SLIDING GRAFT
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25805
|
| Min. Negotiated Rate |
$819.00 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna Commercial |
$1,097.46
|
| Rate for Payer: Aetna Medicare |
$851.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,179.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,097.46
|
| Rate for Payer: BCBS Complete |
$1,190.00
|
| Rate for Payer: BCBS MAPPO |
$819.00
|
| Rate for Payer: BCN Medicare Advantage |
$819.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,179.36
|
| Rate for Payer: Cofinity Commercial |
$1,097.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$859.95
|
| Rate for Payer: Nomi Health Commercial |
$982.80
|
| Rate for Payer: PACE SWMI |
$819.00
|
| Rate for Payer: PHP Commercial |
$1,146.60
|
| Rate for Payer: PHP Medicare Advantage |
$819.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health Medicare |
$819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$819.00
|
| Rate for Payer: UHC Medicare Advantage |
$819.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,368.50
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$83.62 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna American Axle |
$146.90
|
| Rate for Payer: Aetna Commercial |
$192.10
|
| Rate for Payer: Aetna Medicare |
$113.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.90
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$194.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.80
|
| Rate for Payer: Healthscope Commercial |
$203.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.10
|
| Rate for Payer: PHP Commercial |
$192.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health SBD |
$142.38
|
| Rate for Payer: UMR Bronson Commercial |
$83.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.50
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$99.44 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna American Axle |
$146.90
|
| Rate for Payer: Aetna Commercial |
$192.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.90
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$194.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.80
|
| Rate for Payer: Healthscope Commercial |
$203.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.10
|
| Rate for Payer: PHP Commercial |
$192.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health SBD |
$142.38
|
| Rate for Payer: UMR Bronson Commercial |
$99.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.50
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$109.30
|
| Rate for Payer: Aetna Medicare |
$84.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.30
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS MAPPO |
$81.57
|
| Rate for Payer: BCN Medicare Advantage |
$81.57
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$117.46
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.65
|
| Rate for Payer: Nomi Health Commercial |
$97.88
|
| Rate for Payer: PACE SWMI |
$81.57
|
| Rate for Payer: PHP Commercial |
$114.20
|
| Rate for Payer: PHP Medicare Advantage |
$81.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health Medicare |
$81.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.57
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
| Rate for Payer: UMR Bronson Commercial |
$103.96
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$109.30
|
| Rate for Payer: Aetna Medicare |
$84.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.30
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS MAPPO |
$81.57
|
| Rate for Payer: BCN Medicare Advantage |
$81.57
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$117.46
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.65
|
| Rate for Payer: Nomi Health Commercial |
$97.88
|
| Rate for Payer: PACE SWMI |
$81.57
|
| Rate for Payer: PHP Commercial |
$114.20
|
| Rate for Payer: PHP Medicare Advantage |
$81.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health Medicare |
$81.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.57
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
| Rate for Payer: UMR Bronson Commercial |
$103.96
|
|
|
PR ARTHROPLASTY ANKLE
|
Professional
|
Both
|
$2,703.00
|
|
|
Service Code
|
HCPCS 27700
|
| Min. Negotiated Rate |
$687.87 |
| Max. Negotiated Rate |
$1,756.95 |
| Rate for Payer: Aetna Commercial |
$921.75
|
| Rate for Payer: Aetna Medicare |
$715.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.75
|
| Rate for Payer: BCBS Complete |
$1,081.20
|
| Rate for Payer: BCBS MAPPO |
$687.87
|
| Rate for Payer: BCN Medicare Advantage |
$687.87
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cofinity Commercial |
$990.53
|
| Rate for Payer: Cofinity Commercial |
$921.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$722.26
|
| Rate for Payer: Nomi Health Commercial |
$825.44
|
| Rate for Payer: PACE SWMI |
$687.87
|
| Rate for Payer: PHP Commercial |
$963.02
|
| Rate for Payer: PHP Medicare Advantage |
$687.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,756.95
|
| Rate for Payer: Priority Health Medicare |
$687.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.87
|
| Rate for Payer: UHC Medicare Advantage |
$687.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,243.38
|
|
