|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$70.99
|
| Rate for Payer: Aetna Medicare |
$55.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.29
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$90.13
|
| Rate for Payer: BCN Medicare Advantage |
$52.98
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$76.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.63
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.28
|
| Rate for Payer: Nomi Health Commercial |
$63.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: PACE SWMI |
$52.98
|
| Rate for Payer: PHP Commercial |
$74.17
|
| Rate for Payer: PHP Medicare Advantage |
$52.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$96.36
|
| Rate for Payer: Priority Health Medicare |
$52.98
|
| Rate for Payer: Priority Health SBD |
$96.36
|
| Rate for Payer: Priority Health Tiered Network |
$96.36
|
| Rate for Payer: Railroad Medicare Medicare |
$52.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.89
|
| Rate for Payer: UHC Core |
$258.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.98
|
| Rate for Payer: UHC Exchange |
$258.89
|
| Rate for Payer: UHC Medicaid |
$34.29
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
| Rate for Payer: UMR Bronson Commercial |
$213.90
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$320.25 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$84.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.47
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$80.88
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Medicare Advantage |
$80.88
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$116.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.92
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.97
|
| Rate for Payer: Nomi Health Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: PACE SWMI |
$80.88
|
| Rate for Payer: PHP Commercial |
$113.23
|
| Rate for Payer: PHP Medicare Advantage |
$80.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$152.24
|
| Rate for Payer: Priority Health Medicare |
$80.88
|
| Rate for Payer: Priority Health SBD |
$152.24
|
| Rate for Payer: Priority Health Tiered Network |
$152.24
|
| Rate for Payer: Railroad Medicare Medicare |
$80.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.95
|
| Rate for Payer: UHC Core |
$230.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.88
|
| Rate for Payer: UHC Exchange |
$230.95
|
| Rate for Payer: UHC Medicaid |
$52.19
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
| Rate for Payer: UMR Bronson Commercial |
$196.42
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$179.77 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna Commercial |
$362.60
|
| Rate for Payer: Aetna Medicare |
$281.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.66
|
| Rate for Payer: BCBS Complete |
$188.76
|
| Rate for Payer: BCBS MAPPO |
$270.60
|
| Rate for Payer: BCN Commercial |
$459.64
|
| Rate for Payer: BCN Medicare Advantage |
$270.60
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Cofinity Commercial |
$389.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.13
|
| Rate for Payer: Meridian Medicaid |
$188.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$297.66
|
| Rate for Payer: Nomi Health Commercial |
$324.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.50
|
| Rate for Payer: PACE SWMI |
$270.60
|
| Rate for Payer: PHP Commercial |
$378.84
|
| Rate for Payer: PHP Medicare Advantage |
$270.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.34
|
| Rate for Payer: Priority Health Medicare |
$270.60
|
| Rate for Payer: Priority Health SBD |
$491.34
|
| Rate for Payer: Priority Health Tiered Network |
$491.34
|
| Rate for Payer: Railroad Medicare Medicare |
$270.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.90
|
| Rate for Payer: UHC Core |
$503.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$270.60
|
| Rate for Payer: UHC Exchange |
$503.90
|
| Rate for Payer: UHC Medicaid |
$179.77
|
| Rate for Payer: UHCCP Medicaid |
$179.77
|
| Rate for Payer: UMR Bronson Commercial |
$311.88
|
|
|
PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT
|
Professional
|
Both
|
$1,368.00
|
|
|
Service Code
|
HCPCS 21421
|
| Min. Negotiated Rate |
$327.59 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Aetna Commercial |
$657.71
|
| Rate for Payer: Aetna Medicare |
$510.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.80
|
| Rate for Payer: BCBS Complete |
$343.97
|
| Rate for Payer: BCBS MAPPO |
$490.83
|
| Rate for Payer: BCN Commercial |
$825.16
|
| Rate for Payer: BCN Medicare Advantage |
$490.83
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cofinity Commercial |
$657.71
|
| Rate for Payer: Cofinity Commercial |
$706.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.37
|
| Rate for Payer: Meridian Medicaid |
$343.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$539.91
|
| Rate for Payer: Nomi Health Commercial |
$589.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.00
|
| Rate for Payer: PACE SWMI |
$490.83
|
| Rate for Payer: PHP Commercial |
$687.16
|
| Rate for Payer: PHP Medicare Advantage |
$490.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.06
|
| Rate for Payer: Priority Health Medicare |
$490.83
|
| Rate for Payer: Priority Health SBD |
$882.06
|
| Rate for Payer: Priority Health Tiered Network |
$882.06
|
| Rate for Payer: Railroad Medicare Medicare |
$490.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$963.93
|
| Rate for Payer: UHC Core |
$963.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.83
|
| Rate for Payer: UHC Exchange |
$963.93
|
| Rate for Payer: UHC Medicaid |
$327.59
|
| Rate for Payer: UHCCP Medicaid |
$327.59
|
| Rate for Payer: UMR Bronson Commercial |
$629.28
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$593.15 |
| Rate for Payer: Aetna Commercial |
$511.04
|
| Rate for Payer: Aetna Medicare |
$396.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.17
|
| Rate for Payer: BCBS Complete |
$266.60
|
| Rate for Payer: BCBS MAPPO |
$381.37
|
| Rate for Payer: BCN Commercial |
$533.33
|
| Rate for Payer: BCN Medicare Advantage |
$381.37
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$511.04
|
| Rate for Payer: Cofinity Commercial |
$549.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.44
|
| Rate for Payer: Meridian Medicaid |
$266.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$419.51
|
| Rate for Payer: Nomi Health Commercial |
$457.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.00
|
| Rate for Payer: PACE SWMI |
$381.37
|
| Rate for Payer: PHP Commercial |
$533.92
|
| Rate for Payer: PHP Medicare Advantage |
$381.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$570.12
|
| Rate for Payer: Priority Health Medicare |
$381.37
|
| Rate for Payer: Priority Health SBD |
$570.12
|
| Rate for Payer: Priority Health Tiered Network |
$570.12
|
| Rate for Payer: Railroad Medicare Medicare |
$381.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.15
|
| Rate for Payer: UHC Core |
$593.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$381.37
|
| Rate for Payer: UHC Exchange |
$593.15
|
| Rate for Payer: UHC Medicaid |
$253.90
|
| Rate for Payer: UHCCP Medicaid |
$253.90
|
| Rate for Payer: UMR Bronson Commercial |
$290.72
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$509.92 |
| Rate for Payer: Aetna Commercial |
$397.86
|
| Rate for Payer: Aetna Medicare |
$308.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.55
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCBS MAPPO |
$296.91
|
| Rate for Payer: BCN Commercial |
$474.58
|
| Rate for Payer: BCN Medicare Advantage |
$296.91
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cofinity Commercial |
$397.86
|
| Rate for Payer: Cofinity Commercial |
$427.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.76
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.60
|
| Rate for Payer: Nomi Health Commercial |
$356.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$503.25
|
| Rate for Payer: PACE SWMI |
$296.91
|
| Rate for Payer: PHP Commercial |
$415.67
|
| Rate for Payer: PHP Medicare Advantage |
$296.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$507.30
|
| Rate for Payer: Priority Health Medicare |
$296.91
|
| Rate for Payer: Priority Health SBD |
$507.30
|
| Rate for Payer: Priority Health Tiered Network |
$507.30
|
| Rate for Payer: Railroad Medicare Medicare |
$296.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.92
|
| Rate for Payer: UHC Core |
$509.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$296.91
|
| Rate for Payer: UHC Exchange |
$509.92
|
| Rate for Payer: UHC Medicaid |
$198.30
|
| Rate for Payer: UHCCP Medicaid |
$198.30
|
| Rate for Payer: UMR Bronson Commercial |
$308.66
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$990.00
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$568.11
|
| Rate for Payer: Aetna Medicare |
$440.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.50
|
| Rate for Payer: BCBS Complete |
$295.89
|
| Rate for Payer: BCBS MAPPO |
$423.96
|
| Rate for Payer: BCN Commercial |
$633.43
|
| Rate for Payer: BCN Medicare Advantage |
$423.96
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cofinity Commercial |
$568.11
|
| Rate for Payer: Cofinity Commercial |
$610.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.16
|
| Rate for Payer: Meridian Medicaid |
$295.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$466.36
|
| Rate for Payer: Nomi Health Commercial |
$508.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.50
|
| Rate for Payer: PACE SWMI |
$423.96
|
| Rate for Payer: PHP Commercial |
$593.54
|
| Rate for Payer: PHP Medicare Advantage |
$423.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$677.13
|
| Rate for Payer: Priority Health Medicare |
$423.96
|
| Rate for Payer: Priority Health SBD |
$677.13
|
| Rate for Payer: Priority Health Tiered Network |
$677.13
|
| Rate for Payer: Railroad Medicare Medicare |
$423.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.97
|
| Rate for Payer: UHC Core |
$688.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$423.96
|
| Rate for Payer: UHC Exchange |
$688.97
|
| Rate for Payer: UHC Medicaid |
$281.80
|
| Rate for Payer: UHCCP Medicaid |
$281.80
|
| Rate for Payer: UMR Bronson Commercial |
$455.40
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: Aetna Medicare |
$255.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.98
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$245.82
|
| Rate for Payer: BCN Commercial |
$309.05
|
| Rate for Payer: BCN Medicare Advantage |
$245.82
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$329.40
|
| Rate for Payer: Cofinity Commercial |
$353.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.11
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.40
|
| Rate for Payer: Nomi Health Commercial |
$294.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.00
|
| Rate for Payer: PACE SWMI |
$245.82
|
| Rate for Payer: PHP Commercial |
$344.15
|
| Rate for Payer: PHP Medicare Advantage |
$245.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$418.95
|
| Rate for Payer: Priority Health Medicare |
$245.82
|
| Rate for Payer: Priority Health SBD |
$418.95
|
| Rate for Payer: Priority Health Tiered Network |
$418.95
|
| Rate for Payer: Railroad Medicare Medicare |
$245.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.56
|
| Rate for Payer: UHC Core |
$414.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.82
|
| Rate for Payer: UHC Exchange |
$414.56
|
| Rate for Payer: UHC Medicaid |
$164.86
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
| Rate for Payer: UMR Bronson Commercial |
$305.44
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Aetna Commercial |
$632.56
|
| Rate for Payer: Aetna Medicare |
$490.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.77
|
| Rate for Payer: BCBS Complete |
$328.55
|
| Rate for Payer: BCBS MAPPO |
$472.06
|
| Rate for Payer: BCN Commercial |
$718.09
|
| Rate for Payer: BCN Medicare Advantage |
$472.06
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$632.56
|
| Rate for Payer: Cofinity Commercial |
$679.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.66
|
| Rate for Payer: Meridian Medicaid |
$328.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$519.27
|
| Rate for Payer: Nomi Health Commercial |
$566.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.00
|
| Rate for Payer: PACE SWMI |
$472.06
|
| Rate for Payer: PHP Commercial |
$660.88
|
| Rate for Payer: PHP Medicare Advantage |
$472.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$767.62
|
| Rate for Payer: Priority Health Medicare |
$472.06
|
| Rate for Payer: Priority Health SBD |
$767.62
|
| Rate for Payer: Priority Health Tiered Network |
$767.62
|
| Rate for Payer: Railroad Medicare Medicare |
$472.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.65
|
| Rate for Payer: UHC Core |
$793.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$472.06
|
| Rate for Payer: UHC Exchange |
$793.65
|
| Rate for Payer: UHC Medicaid |
$312.90
|
| Rate for Payer: UHCCP Medicaid |
$312.90
|
| Rate for Payer: UMR Bronson Commercial |
$601.68
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$437.58 |
| Rate for Payer: Aetna Commercial |
$348.67
|
| Rate for Payer: Aetna Medicare |
$270.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.69
|
| Rate for Payer: BCBS Complete |
$182.72
|
| Rate for Payer: BCBS MAPPO |
$260.20
|
| Rate for Payer: BCN Commercial |
$409.34
|
| Rate for Payer: BCN Medicare Advantage |
$260.20
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$348.67
|
| Rate for Payer: Cofinity Commercial |
$374.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.21
|
| Rate for Payer: Meridian Medicaid |
$182.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.22
|
| Rate for Payer: Nomi Health Commercial |
$312.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: PACE SWMI |
$260.20
|
| Rate for Payer: PHP Commercial |
$364.28
|
| Rate for Payer: PHP Medicare Advantage |
$260.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$437.58
|
| Rate for Payer: Priority Health Medicare |
$260.20
|
| Rate for Payer: Priority Health SBD |
$437.58
|
| Rate for Payer: Priority Health Tiered Network |
$437.58
|
| Rate for Payer: Railroad Medicare Medicare |
$260.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.98
|
| Rate for Payer: UHC Core |
$432.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$260.20
|
| Rate for Payer: UHC Exchange |
$432.98
|
| Rate for Payer: UHC Medicaid |
$174.02
|
| Rate for Payer: UHCCP Medicaid |
$174.02
|
| Rate for Payer: UMR Bronson Commercial |
$213.90
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$1,471.00
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$325.04 |
| Max. Negotiated Rate |
$1,103.25 |
| Rate for Payer: Aetna Commercial |
$658.44
|
| Rate for Payer: Aetna Medicare |
$511.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.57
|
| Rate for Payer: BCBS Complete |
$341.29
|
| Rate for Payer: BCBS MAPPO |
$491.37
|
| Rate for Payer: BCN Commercial |
$721.07
|
| Rate for Payer: BCN Medicare Advantage |
$491.37
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Cofinity Commercial |
$658.44
|
| Rate for Payer: Cofinity Commercial |
$707.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.94
|
| Rate for Payer: Meridian Medicaid |
$341.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$540.51
|
| Rate for Payer: Nomi Health Commercial |
$589.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,103.25
|
| Rate for Payer: PACE SWMI |
$491.37
|
| Rate for Payer: PHP Commercial |
$687.92
|
| Rate for Payer: PHP Medicare Advantage |
$491.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$770.81
|
| Rate for Payer: Priority Health Medicare |
$491.37
|
| Rate for Payer: Priority Health SBD |
$770.81
|
| Rate for Payer: Priority Health Tiered Network |
$770.81
|
| Rate for Payer: Railroad Medicare Medicare |
$491.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.99
|
| Rate for Payer: UHC Core |
$805.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$491.37
|
| Rate for Payer: UHC Exchange |
$805.99
|
| Rate for Payer: UHC Medicaid |
$325.04
|
| Rate for Payer: UHCCP Medicaid |
$325.04
|
| Rate for Payer: UMR Bronson Commercial |
$676.66
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: Aetna Commercial |
$349.46
|
| Rate for Payer: Aetna Medicare |
$271.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.54
|
| Rate for Payer: BCBS Complete |
$183.17
|
| Rate for Payer: BCBS MAPPO |
$260.79
|
| Rate for Payer: BCN Commercial |
$324.37
|
| Rate for Payer: BCN Medicare Advantage |
$260.79
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$349.46
|
| Rate for Payer: Cofinity Commercial |
$375.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.83
|
| Rate for Payer: Meridian Medicaid |
$183.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.87
|
| Rate for Payer: Nomi Health Commercial |
$312.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: PACE SWMI |
$260.79
|
| Rate for Payer: PHP Commercial |
$365.11
|
| Rate for Payer: PHP Medicare Advantage |
$260.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.70
|
| Rate for Payer: Priority Health Medicare |
$260.79
|
| Rate for Payer: Priority Health SBD |
$439.70
|
| Rate for Payer: Priority Health Tiered Network |
$439.70
|
| Rate for Payer: Railroad Medicare Medicare |
$260.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.37
|
| Rate for Payer: UHC Core |
$436.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$260.79
|
| Rate for Payer: UHC Exchange |
$436.37
|
| Rate for Payer: UHC Medicaid |
$174.45
|
| Rate for Payer: UHCCP Medicaid |
$174.45
|
| Rate for Payer: UMR Bronson Commercial |
$338.10
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Aetna Commercial |
$322.83
|
| Rate for Payer: Aetna Medicare |
$250.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.92
|
| Rate for Payer: BCBS Complete |
$169.30
|
| Rate for Payer: BCBS MAPPO |
$240.92
|
| Rate for Payer: BCN Commercial |
$385.44
|
| Rate for Payer: BCN Medicare Advantage |
$240.92
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$322.83
|
| Rate for Payer: Cofinity Commercial |
$346.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.97
|
| Rate for Payer: Meridian Medicaid |
$169.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.01
|
| Rate for Payer: Nomi Health Commercial |
$289.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.00
|
| Rate for Payer: PACE SWMI |
$240.92
|
| Rate for Payer: PHP Commercial |
$337.29
|
| Rate for Payer: PHP Medicare Advantage |
$240.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$412.02
|
| Rate for Payer: Priority Health Medicare |
$240.92
|
| Rate for Payer: Priority Health SBD |
$412.02
|
| Rate for Payer: Priority Health Tiered Network |
$412.02
|
| Rate for Payer: Railroad Medicare Medicare |
$240.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.92
|
| Rate for Payer: UHC Core |
$410.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$240.92
|
| Rate for Payer: UHC Exchange |
$410.92
|
| Rate for Payer: UHC Medicaid |
$161.24
|
| Rate for Payer: UHCCP Medicaid |
$161.24
|
| Rate for Payer: UMR Bronson Commercial |
$290.72
|
|
|
PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 23525
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$617.21 |
| Rate for Payer: Aetna Commercial |
$471.13
|
| Rate for Payer: Aetna Medicare |
$365.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.29
|
| Rate for Payer: BCBS Complete |
$245.79
|
| Rate for Payer: BCBS MAPPO |
$351.59
|
| Rate for Payer: BCN Commercial |
$571.68
|
| Rate for Payer: BCN Medicare Advantage |
$351.59
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$471.13
|
| Rate for Payer: Cofinity Commercial |
$506.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.17
|
| Rate for Payer: Meridian Medicaid |
$245.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$386.75
|
| Rate for Payer: Nomi Health Commercial |
$421.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$604.50
|
| Rate for Payer: PACE SWMI |
$351.59
|
| Rate for Payer: PHP Commercial |
$492.23
|
| Rate for Payer: PHP Medicare Advantage |
$351.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$611.12
|
| Rate for Payer: Priority Health Medicare |
$351.59
|
| Rate for Payer: Priority Health SBD |
$611.12
|
| Rate for Payer: Priority Health Tiered Network |
$611.12
|
| Rate for Payer: Railroad Medicare Medicare |
$351.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.21
|
| Rate for Payer: UHC Core |
$617.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$351.59
|
| Rate for Payer: UHC Exchange |
$617.21
|
| Rate for Payer: UHC Medicaid |
$234.09
|
| Rate for Payer: UHCCP Medicaid |
$234.09
|
| Rate for Payer: UMR Bronson Commercial |
$370.76
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 28570
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$333.77 |
| Rate for Payer: Aetna Commercial |
$261.18
|
| Rate for Payer: Aetna Medicare |
$202.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.67
|
| Rate for Payer: BCBS Complete |
$137.32
|
| Rate for Payer: BCBS MAPPO |
$194.91
|
| Rate for Payer: BCN Commercial |
$312.23
|
| Rate for Payer: BCN Medicare Advantage |
$194.91
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$261.18
|
| Rate for Payer: Cofinity Commercial |
$280.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.66
|
| Rate for Payer: Meridian Medicaid |
$137.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.40
|
| Rate for Payer: Nomi Health Commercial |
$233.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.75
|
| Rate for Payer: PACE SWMI |
$194.91
|
| Rate for Payer: PHP Commercial |
$272.87
|
| Rate for Payer: PHP Medicare Advantage |
$194.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$333.77
|
| Rate for Payer: Priority Health Medicare |
$194.91
|
| Rate for Payer: Priority Health SBD |
$333.77
|
| Rate for Payer: Priority Health Tiered Network |
$333.77
|
| Rate for Payer: Railroad Medicare Medicare |
$194.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.41
|
| Rate for Payer: UHC Core |
$328.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.91
|
| Rate for Payer: UHC Exchange |
$328.41
|
| Rate for Payer: UHC Medicaid |
$130.78
|
| Rate for Payer: UHCCP Medicaid |
$130.78
|
| Rate for Payer: UMR Bronson Commercial |
$169.74
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$217.90 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$438.23
|
| Rate for Payer: Aetna Medicare |
$340.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.94
|
| Rate for Payer: BCBS Complete |
$228.79
|
| Rate for Payer: BCBS MAPPO |
$327.04
|
| Rate for Payer: BCN Commercial |
$531.34
|
| Rate for Payer: BCN Medicare Advantage |
$327.04
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$438.23
|
| Rate for Payer: Cofinity Commercial |
$470.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.39
|
| Rate for Payer: Meridian Medicaid |
$228.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$359.74
|
| Rate for Payer: Nomi Health Commercial |
$392.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$327.04
|
| Rate for Payer: PHP Commercial |
$457.86
|
| Rate for Payer: PHP Medicare Advantage |
$327.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$568.00
|
| Rate for Payer: Priority Health Medicare |
$327.04
|
| Rate for Payer: Priority Health SBD |
$568.00
|
| Rate for Payer: Priority Health Tiered Network |
$568.00
|
| Rate for Payer: Railroad Medicare Medicare |
$327.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.04
|
| Rate for Payer: UHC Core |
$572.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$327.04
|
| Rate for Payer: UHC Exchange |
$572.04
|
| Rate for Payer: UHC Medicaid |
$217.90
|
| Rate for Payer: UHCCP Medicaid |
$217.90
|
| Rate for Payer: UMR Bronson Commercial |
$382.72
|
|
|
PR CLOSED TX TALUS FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28435
|
| Min. Negotiated Rate |
$209.81 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare |
$328.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.56
|
| Rate for Payer: BCBS Complete |
$220.30
|
| Rate for Payer: BCBS MAPPO |
$315.67
|
| Rate for Payer: BCN Commercial |
$513.91
|
| Rate for Payer: BCN Medicare Advantage |
$315.67
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Cofinity Commercial |
$454.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.45
|
| Rate for Payer: Meridian Medicaid |
$220.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$347.24
|
| Rate for Payer: Nomi Health Commercial |
$378.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$315.67
|
| Rate for Payer: PHP Commercial |
$441.94
|
| Rate for Payer: PHP Medicare Advantage |
$315.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$549.37
|
| Rate for Payer: Priority Health Medicare |
$315.67
|
| Rate for Payer: Priority Health SBD |
$549.37
|
| Rate for Payer: Priority Health Tiered Network |
$549.37
|
| Rate for Payer: Railroad Medicare Medicare |
$315.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.43
|
| Rate for Payer: UHC Core |
$557.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$315.67
|
| Rate for Payer: UHC Exchange |
$557.43
|
| Rate for Payer: UHC Medicaid |
$209.81
|
| Rate for Payer: UHCCP Medicaid |
$209.81
|
| Rate for Payer: UMR Bronson Commercial |
$382.72
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$277.19
|
| Rate for Payer: Aetna Medicare |
$215.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.88
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$206.86
|
| Rate for Payer: BCN Commercial |
$329.66
|
| Rate for Payer: BCN Medicare Advantage |
$206.86
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$277.19
|
| Rate for Payer: Cofinity Commercial |
$297.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.20
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$227.55
|
| Rate for Payer: Nomi Health Commercial |
$248.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PACE SWMI |
$206.86
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicare Advantage |
$206.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$352.39
|
| Rate for Payer: Priority Health Medicare |
$206.86
|
| Rate for Payer: Priority Health SBD |
$352.39
|
| Rate for Payer: Priority Health Tiered Network |
$352.39
|
| Rate for Payer: Railroad Medicare Medicare |
$206.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.16
|
| Rate for Payer: UHC Core |
$360.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$206.86
|
| Rate for Payer: UHC Exchange |
$360.16
|
| Rate for Payer: UHC Medicaid |
$138.24
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
| Rate for Payer: UMR Bronson Commercial |
$318.78
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28605
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$398.76
|
| Rate for Payer: Aetna Medicare |
$309.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.52
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$297.58
|
| Rate for Payer: BCN Commercial |
$480.06
|
| Rate for Payer: BCN Medicare Advantage |
$297.58
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Cofinity Commercial |
$428.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.46
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$327.34
|
| Rate for Payer: Nomi Health Commercial |
$357.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$297.58
|
| Rate for Payer: PHP Commercial |
$416.61
|
| Rate for Payer: PHP Medicare Advantage |
$297.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$513.16
|
| Rate for Payer: Priority Health Medicare |
$297.58
|
| Rate for Payer: Priority Health SBD |
$513.16
|
| Rate for Payer: Priority Health Tiered Network |
$513.16
|
| Rate for Payer: Railroad Medicare Medicare |
$297.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.85
|
| Rate for Payer: UHC Core |
$510.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$297.58
|
| Rate for Payer: UHC Exchange |
$510.85
|
| Rate for Payer: UHC Medicaid |
$199.16
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
| Rate for Payer: UMR Bronson Commercial |
$382.72
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$316.73 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: Aetna Medicare |
$157.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.71
|
| Rate for Payer: BCBS Complete |
$105.79
|
| Rate for Payer: BCBS MAPPO |
$151.19
|
| Rate for Payer: BCN Commercial |
$290.82
|
| Rate for Payer: BCN Medicare Advantage |
$151.19
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$202.59
|
| Rate for Payer: Cofinity Commercial |
$217.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.75
|
| Rate for Payer: Meridian Medicaid |
$105.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.31
|
| Rate for Payer: Nomi Health Commercial |
$181.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: PACE SWMI |
$151.19
|
| Rate for Payer: PHP Commercial |
$211.67
|
| Rate for Payer: PHP Medicare Advantage |
$151.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$310.87
|
| Rate for Payer: Priority Health Medicare |
$151.19
|
| Rate for Payer: Priority Health SBD |
$310.87
|
| Rate for Payer: Priority Health Tiered Network |
$310.87
|
| Rate for Payer: Railroad Medicare Medicare |
$151.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.73
|
| Rate for Payer: UHC Core |
$316.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.19
|
| Rate for Payer: UHC Exchange |
$316.73
|
| Rate for Payer: UHC Medicaid |
$100.75
|
| Rate for Payer: UHCCP Medicaid |
$100.75
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 21485
|
| Min. Negotiated Rate |
$491.82 |
| Max. Negotiated Rate |
$1,231.81 |
| Rate for Payer: Aetna Commercial |
$968.12
|
| Rate for Payer: Aetna Medicare |
$751.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.12
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS MAPPO |
$722.48
|
| Rate for Payer: BCN Commercial |
$1,152.33
|
| Rate for Payer: BCN Medicare Advantage |
$722.48
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cofinity Commercial |
$1,040.37
|
| Rate for Payer: Cofinity Commercial |
$968.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.60
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$794.73
|
| Rate for Payer: Nomi Health Commercial |
$866.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$840.75
|
| Rate for Payer: PACE SWMI |
$722.48
|
| Rate for Payer: PHP Commercial |
$1,011.47
|
| Rate for Payer: PHP Medicare Advantage |
$722.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,231.81
|
| Rate for Payer: Priority Health Medicare |
$722.48
|
| Rate for Payer: Priority Health SBD |
$1,231.81
|
| Rate for Payer: Priority Health Tiered Network |
$1,231.81
|
| Rate for Payer: Railroad Medicare Medicare |
$722.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,212.00
|
| Rate for Payer: UHC Core |
$1,212.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$722.48
|
| Rate for Payer: UHC Exchange |
$1,212.00
|
| Rate for Payer: UHC Medicaid |
$491.82
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
| Rate for Payer: UMR Bronson Commercial |
$515.66
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Aetna Commercial |
$40.74
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.78
|
| Rate for Payer: BCBS Complete |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$30.40
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$30.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$40.74
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.92
|
| Rate for Payer: Meridian Medicaid |
$20.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.44
|
| Rate for Payer: Nomi Health Commercial |
$36.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: PACE SWMI |
$30.40
|
| Rate for Payer: PHP Commercial |
$42.56
|
| Rate for Payer: PHP Medicare Advantage |
$30.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50.57
|
| Rate for Payer: Priority Health Medicare |
$30.40
|
| Rate for Payer: Priority Health SBD |
$50.57
|
| Rate for Payer: Priority Health Tiered Network |
$50.57
|
| Rate for Payer: Railroad Medicare Medicare |
$30.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.69
|
| Rate for Payer: UHC Core |
$56.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.40
|
| Rate for Payer: UHC Exchange |
$56.69
|
| Rate for Payer: UHC Medicaid |
$19.38
|
| Rate for Payer: UHCCP Medicaid |
$19.38
|
| Rate for Payer: UMR Bronson Commercial |
$67.16
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MNPJ
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 24675
|
| Min. Negotiated Rate |
$270.08 |
| Max. Negotiated Rate |
$969.75 |
| Rate for Payer: Aetna Commercial |
$546.56
|
| Rate for Payer: Aetna Medicare |
$424.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.35
|
| Rate for Payer: BCBS Complete |
$283.58
|
| Rate for Payer: BCBS MAPPO |
$407.88
|
| Rate for Payer: BCN Commercial |
$649.86
|
| Rate for Payer: BCN Medicare Advantage |
$407.88
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cofinity Commercial |
$546.56
|
| Rate for Payer: Cofinity Commercial |
$587.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.27
|
| Rate for Payer: Meridian Medicaid |
$283.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$448.67
|
| Rate for Payer: Nomi Health Commercial |
$489.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.75
|
| Rate for Payer: PACE SWMI |
$407.88
|
| Rate for Payer: PHP Commercial |
$571.03
|
| Rate for Payer: PHP Medicare Advantage |
$407.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$694.68
|
| Rate for Payer: Priority Health Medicare |
$407.88
|
| Rate for Payer: Priority Health SBD |
$694.68
|
| Rate for Payer: Priority Health Tiered Network |
$694.68
|
| Rate for Payer: Railroad Medicare Medicare |
$407.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.20
|
| Rate for Payer: UHC Core |
$720.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$407.88
|
| Rate for Payer: UHC Exchange |
$720.20
|
| Rate for Payer: UHC Medicaid |
$270.08
|
| Rate for Payer: UHCCP Medicaid |
$270.08
|
| Rate for Payer: UMR Bronson Commercial |
$594.78
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MNPJ
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
HCPCS 24670
|
| Min. Negotiated Rate |
$179.56 |
| Max. Negotiated Rate |
$615.75 |
| Rate for Payer: Aetna Commercial |
$359.90
|
| Rate for Payer: Aetna Medicare |
$279.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.76
|
| Rate for Payer: BCBS Complete |
$188.54
|
| Rate for Payer: BCBS MAPPO |
$268.58
|
| Rate for Payer: BCN Commercial |
$423.28
|
| Rate for Payer: BCN Medicare Advantage |
$268.58
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Cofinity Commercial |
$359.90
|
| Rate for Payer: Cofinity Commercial |
$386.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.01
|
| Rate for Payer: Meridian Medicaid |
$188.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$295.44
|
| Rate for Payer: Nomi Health Commercial |
$322.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.75
|
| Rate for Payer: PACE SWMI |
$268.58
|
| Rate for Payer: PHP Commercial |
$376.01
|
| Rate for Payer: PHP Medicare Advantage |
$268.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$452.49
|
| Rate for Payer: Priority Health Medicare |
$268.58
|
| Rate for Payer: Priority Health SBD |
$452.49
|
| Rate for Payer: Priority Health Tiered Network |
$452.49
|
| Rate for Payer: Railroad Medicare Medicare |
$268.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.94
|
| Rate for Payer: UHC Core |
$454.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$268.58
|
| Rate for Payer: UHC Exchange |
$454.94
|
| Rate for Payer: UHC Medicaid |
$179.56
|
| Rate for Payer: UHCCP Medicaid |
$179.56
|
| Rate for Payer: UMR Bronson Commercial |
$377.66
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 25535
|
| Min. Negotiated Rate |
$289.04 |
| Max. Negotiated Rate |
$919.50 |
| Rate for Payer: Aetna Commercial |
$585.33
|
| Rate for Payer: Aetna Medicare |
$454.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.01
|
| Rate for Payer: BCBS Complete |
$303.49
|
| Rate for Payer: BCBS MAPPO |
$436.81
|
| Rate for Payer: BCN Commercial |
$711.62
|
| Rate for Payer: BCN Medicare Advantage |
$436.81
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cofinity Commercial |
$585.33
|
| Rate for Payer: Cofinity Commercial |
$629.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.65
|
| Rate for Payer: Meridian Medicaid |
$303.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$480.49
|
| Rate for Payer: Nomi Health Commercial |
$524.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$919.50
|
| Rate for Payer: PACE SWMI |
$436.81
|
| Rate for Payer: PHP Commercial |
$611.53
|
| Rate for Payer: PHP Medicare Advantage |
$436.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$760.69
|
| Rate for Payer: Priority Health Medicare |
$436.81
|
| Rate for Payer: Priority Health SBD |
$760.69
|
| Rate for Payer: Priority Health Tiered Network |
$760.69
|
| Rate for Payer: Railroad Medicare Medicare |
$436.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$783.19
|
| Rate for Payer: UHC Core |
$783.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$436.81
|
| Rate for Payer: UHC Exchange |
$783.19
|
| Rate for Payer: UHC Medicaid |
$289.04
|
| Rate for Payer: UHCCP Medicaid |
$289.04
|
| Rate for Payer: UMR Bronson Commercial |
$563.96
|
|
