|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$580.95 |
| Max. Negotiated Rate |
$1,268.61 |
| Rate for Payer: Aetna Commercial |
$867.03
|
| Rate for Payer: Aetna Medicare |
$672.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.74
|
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: BCBS MAPPO |
$647.04
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$1,268.61
|
| Rate for Payer: BCN Medicare Advantage |
$647.04
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cofinity Commercial |
$931.74
|
| Rate for Payer: Cofinity Commercial |
$867.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.39
|
| Rate for Payer: Nomi Health Commercial |
$776.45
|
| Rate for Payer: PACE SWMI |
$647.04
|
| Rate for Payer: PHP Commercial |
$905.86
|
| Rate for Payer: PHP Medicare Advantage |
$647.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,084.89
|
| Rate for Payer: Priority Health Medicare |
$647.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,084.89
|
| Rate for Payer: Priority Health SBD |
$1,084.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.04
|
| Rate for Payer: UHC Medicare Advantage |
$647.04
|
| Rate for Payer: UMR Bronson Commercial |
$829.38
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$33.62
|
| Rate for Payer: Aetna Medicare |
$26.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.62
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS MAPPO |
$25.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: BCN Medicare Advantage |
$25.09
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Cofinity Commercial |
$33.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.34
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$30.11
|
| Rate for Payer: PACE SWMI |
$25.09
|
| Rate for Payer: PHP Commercial |
$35.13
|
| Rate for Payer: PHP Medicare Advantage |
$25.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.20
|
| Rate for Payer: Priority Health Medicare |
$25.09
|
| Rate for Payer: Priority Health Narrow Network |
$40.20
|
| Rate for Payer: Priority Health SBD |
$40.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.09
|
| Rate for Payer: UHC Medicare Advantage |
$25.09
|
| Rate for Payer: UHCCP Medicaid |
$16.83
|
| Rate for Payer: UMR Bronson Commercial |
$89.70
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.51
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS MAPPO |
$14.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: BCN Medicare Advantage |
$14.94
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$21.51
|
| Rate for Payer: Cofinity Commercial |
$20.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.69
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: PACE SWMI |
$14.94
|
| Rate for Payer: PHP Commercial |
$20.92
|
| Rate for Payer: PHP Medicare Advantage |
$14.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$14.94
|
| Rate for Payer: Priority Health Narrow Network |
$23.40
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.94
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$1,449.66 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,449.66
|
| Rate for Payer: BCN Commercial |
$12.07
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$831.54 |
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$831.54
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: Nomi Health Commercial |
$16.52
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Commercial |
$19.28
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$13.77
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$1,039.69 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.80
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$17.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.69
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Medicare Advantage |
$17.92
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.82
|
| Rate for Payer: Nomi Health Commercial |
$21.50
|
| Rate for Payer: PACE SWMI |
$17.92
|
| Rate for Payer: PHP Commercial |
$25.09
|
| Rate for Payer: PHP Medicare Advantage |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.92
|
| Rate for Payer: UHC Medicare Advantage |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna Medicare |
$13.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$13.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.00
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.36
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$16.03
|
| Rate for Payer: PACE SWMI |
$13.36
|
| Rate for Payer: PHP Commercial |
$18.70
|
| Rate for Payer: PHP Medicare Advantage |
$13.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.36
|
| Rate for Payer: UHC Medicare Advantage |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
|
|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$578.50 |
| Max. Negotiated Rate |
$2,702.06 |
| Rate for Payer: Aetna Commercial |
$2,004.68
|
| Rate for Payer: Aetna Medicare |
$1,555.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,004.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,154.28
|
| Rate for Payer: BCBS Complete |
$1,558.00
|
| Rate for Payer: BCBS MAPPO |
$1,496.03
|
| Rate for Payer: BCBS Trust/PPO |
$578.50
|
| Rate for Payer: BCN Commercial |
$2,682.84
|
| 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 HMO/PPO/Tiered Network |
$2,702.06
|
| Rate for Payer: Priority Health Medicare |
$1,496.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,702.06
|
| Rate for Payer: Priority Health SBD |
$2,702.06
|
| 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
|
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 |
$43.17 |
| Max. Negotiated Rate |
$700.00 |
| 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: BCBS Trust/PPO |
$257.75
|
| Rate for Payer: BCN Commercial |
$257.75
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| 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: UHC All Payor (Choice/PPO) |
$47.49
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$43.17
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$121.19 |
| 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 |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$121.19
|
| 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: Meridian Medicaid |
$29.30
|
| 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 Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.60
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: Priority Health Narrow Network |
$59.60
|
| Rate for Payer: Priority Health SBD |
$59.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
| 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 |
$27.90 |
| Max. Negotiated Rate |
$121.19 |
| 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 |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$121.19
|
| 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 |
$56.63
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| 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: Meridian Medicaid |
$29.30
|
| 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 Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.60
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: Priority Health Narrow Network |
$59.60
|
| Rate for Payer: Priority Health SBD |
$59.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
| Rate for Payer: UMR Bronson Commercial |
$64.86
|
|
|
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 |
$188.70 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna American Axle |
$400.40
|
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,705.55
|
| Rate for Payer: BCN Commercial |
$1,705.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Cash Price |
$492.80
|
| 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 |
$3,586.95
|
| 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 |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Commercial |
$523.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Priority Health SBD |
$388.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.57
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$188.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: UMR Bronson Commercial |
$227.92
|
| Rate for Payer: VA VA |
$3,586.95
|
| 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 |
$123.33 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$193.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.88
|
| Rate for Payer: BCBS Complete |
$129.50
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCBS Trust/PPO |
$383.40
|
| Rate for Payer: BCN Commercial |
$455.45
|
| 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: Meridian Medicaid |
$129.50
|
| 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 Choice Medicaid |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.88
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: Priority Health Narrow Network |
$261.88
|
| Rate for Payer: Priority Health SBD |
$261.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
| Rate for Payer: UHCCP Medicaid |
$123.33
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
|
|
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
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$123.33 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$193.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.88
|
| Rate for Payer: BCBS Complete |
$129.50
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCBS Trust/PPO |
$383.40
|
| Rate for Payer: BCN Commercial |
$455.45
|
| 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: Meridian Medicaid |
$129.50
|
| 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 Choice Medicaid |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.88
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: Priority Health Narrow Network |
$261.88
|
| Rate for Payer: Priority Health SBD |
$261.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
| Rate for Payer: UHCCP Medicaid |
$123.33
|
| 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
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$83.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.72
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: BCN Commercial |
$224.79
|
| 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 |
$107.68
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| 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: Meridian Medicaid |
$56.36
|
| 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 Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.88
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: Priority Health Narrow Network |
$112.88
|
| Rate for Payer: Priority Health SBD |
$112.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
| 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 |
$80.83 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$180.70
|
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,067.93
|
| Rate for Payer: BCN Commercial |
$2,067.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$222.40
|
| 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 |
$1,792.24
|
| 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 |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$236.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$175.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.91
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$80.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$102.86
|
| Rate for Payer: VA VA |
$1,792.24
|
| 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
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$83.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.72
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: BCN Commercial |
$224.79
|
| 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 |
$107.68
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| 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: Meridian Medicaid |
$56.36
|
| 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 Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.88
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: Priority Health Narrow Network |
$112.88
|
| Rate for Payer: Priority Health SBD |
$112.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
| 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 |
$10.65 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$16.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.07
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS MAPPO |
$16.02
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$35.19
|
| 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 |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| 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: Meridian Medicaid |
$11.18
|
| 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 Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.57
|
| Rate for Payer: Priority Health Medicare |
$16.02
|
| Rate for Payer: Priority Health Narrow Network |
$22.57
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.02
|
| Rate for Payer: UHC Medicare Advantage |
$16.02
|
| Rate for Payer: UHCCP Medicaid |
$10.65
|
| 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 |
$434.31 |
| 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) |
$860.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.32
|
| Rate for Payer: BCBS Complete |
$456.03
|
| Rate for Payer: BCBS MAPPO |
$641.89
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Commercial |
$978.82
|
| 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 |
$860.13
|
| Rate for Payer: Cofinity Commercial |
$924.32
|
| 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: Meridian Medicaid |
$456.03
|
| 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 Choice Medicaid |
$434.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.91
|
| Rate for Payer: Priority Health Medicare |
$641.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.91
|
| Rate for Payer: Priority Health SBD |
$1,028.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.89
|
| Rate for Payer: UHC Medicare Advantage |
$641.89
|
| Rate for Payer: UHCCP Medicaid |
$434.31
|
| 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 |
$299.69 |
| 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) |
$589.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.46
|
| Rate for Payer: BCBS Complete |
$314.67
|
| Rate for Payer: BCBS MAPPO |
$439.90
|
| Rate for Payer: BCBS Trust/PPO |
$512.98
|
| Rate for Payer: BCN Commercial |
$673.40
|
| 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 |
$589.47
|
| Rate for Payer: Cofinity Commercial |
$633.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.90
|
| Rate for Payer: Meridian Medicaid |
$314.67
|
| 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 Choice Medicaid |
$299.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$989.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$709.36
|
| Rate for Payer: Priority Health Medicare |
$439.90
|
| Rate for Payer: Priority Health Narrow Network |
$709.36
|
| Rate for Payer: Priority Health SBD |
$709.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.90
|
| Rate for Payer: UHC Medicare Advantage |
$439.90
|
| Rate for Payer: UHCCP Medicaid |
$299.69
|
| Rate for Payer: UMR Bronson Commercial |
$700.12
|
|
