|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 27767
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$472.55 |
| Rate for Payer: Aetna Commercial |
$380.72
|
| Rate for Payer: Aetna Medicare |
$295.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.72
|
| Rate for Payer: BCBS Complete |
$290.80
|
| Rate for Payer: BCBS MAPPO |
$284.12
|
| Rate for Payer: BCN Medicare Advantage |
$284.12
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$409.13
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.33
|
| Rate for Payer: Nomi Health Commercial |
$340.94
|
| Rate for Payer: PACE SWMI |
$284.12
|
| Rate for Payer: PHP Commercial |
$397.77
|
| Rate for Payer: PHP Medicare Advantage |
$284.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.55
|
| Rate for Payer: Priority Health Medicare |
$284.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.12
|
| Rate for Payer: UHC Medicare Advantage |
$284.12
|
| Rate for Payer: UMR Bronson Commercial |
$334.42
|
|
|
PR CLOSED TREATMENT SESAMOID FRACTURE
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 28530
|
| Min. Negotiated Rate |
$100.07 |
| Max. Negotiated Rate |
$228.80 |
| Rate for Payer: Aetna Commercial |
$134.09
|
| Rate for Payer: Aetna Medicare |
$104.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.09
|
| Rate for Payer: BCBS Complete |
$140.80
|
| Rate for Payer: BCBS MAPPO |
$100.07
|
| Rate for Payer: BCN Medicare Advantage |
$100.07
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cofinity Commercial |
$144.10
|
| Rate for Payer: Cofinity Commercial |
$134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.07
|
| Rate for Payer: Nomi Health Commercial |
$120.08
|
| Rate for Payer: PACE SWMI |
$100.07
|
| Rate for Payer: PHP Commercial |
$140.10
|
| Rate for Payer: PHP Medicare Advantage |
$100.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.80
|
| Rate for Payer: Priority Health Medicare |
$100.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.07
|
| Rate for Payer: UHC Medicare Advantage |
$100.07
|
| Rate for Payer: UMR Bronson Commercial |
$161.92
|
|
|
PR CLOSED TREATMENT STERNUM FRACTURE
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 21820
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$208.92 |
| Rate for Payer: Aetna Commercial |
$194.41
|
| Rate for Payer: Aetna Medicare |
$150.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.41
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$145.08
|
| Rate for Payer: BCN Medicare Advantage |
$145.08
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$208.92
|
| Rate for Payer: Cofinity Commercial |
$194.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.33
|
| Rate for Payer: Nomi Health Commercial |
$174.10
|
| Rate for Payer: PACE SWMI |
$145.08
|
| Rate for Payer: PHP Commercial |
$203.11
|
| Rate for Payer: PHP Medicare Advantage |
$145.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$145.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.08
|
| Rate for Payer: UHC Medicare Advantage |
$145.08
|
| Rate for Payer: UMR Bronson Commercial |
$89.24
|
|
|
PR CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 25650
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Aetna Commercial |
$402.24
|
| Rate for Payer: Aetna Medicare |
$312.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.24
|
| Rate for Payer: BCBS Complete |
$333.20
|
| Rate for Payer: BCBS MAPPO |
$300.18
|
| Rate for Payer: BCN Medicare Advantage |
$300.18
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$432.26
|
| Rate for Payer: Cofinity Commercial |
$402.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.19
|
| Rate for Payer: Nomi Health Commercial |
$360.22
|
| Rate for Payer: PACE SWMI |
$300.18
|
| Rate for Payer: PHP Commercial |
$420.25
|
| Rate for Payer: PHP Medicare Advantage |
$300.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.45
|
| Rate for Payer: Priority Health Medicare |
$300.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.18
|
| Rate for Payer: UHC Medicare Advantage |
$300.18
|
| Rate for Payer: UMR Bronson Commercial |
$383.18
|
|
|
PR CLOSED TREAT SPINE PROCESS FX
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 22305
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Medicare |
$211.50
|
| Rate for Payer: BCBS Complete |
$169.20
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.95
|
| Rate for Payer: UMR Bronson Commercial |
$194.58
|
|
|
PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 27840
|
| Min. Negotiated Rate |
$368.40 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$506.81
|
| Rate for Payer: Aetna Medicare |
$393.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.64
|
| Rate for Payer: BCBS Complete |
$368.40
|
| Rate for Payer: BCBS MAPPO |
$378.22
|
| Rate for Payer: BCN Medicare Advantage |
$378.22
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$506.81
|
| Rate for Payer: Cofinity Commercial |
$544.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.13
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: PACE SWMI |
$378.22
|
| Rate for Payer: PHP Commercial |
$529.51
|
| Rate for Payer: PHP Medicare Advantage |
$378.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$378.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.22
|
| Rate for Payer: UHC Medicare Advantage |
$378.22
|
| Rate for Payer: UMR Bronson Commercial |
$423.66
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 27810
|
| Min. Negotiated Rate |
$418.07 |
| Max. Negotiated Rate |
$773.50 |
| Rate for Payer: Aetna Commercial |
$560.21
|
| Rate for Payer: Aetna Medicare |
$434.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.21
|
| Rate for Payer: BCBS Complete |
$476.00
|
| Rate for Payer: BCBS MAPPO |
$418.07
|
| Rate for Payer: BCN Medicare Advantage |
$418.07
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$602.02
|
| Rate for Payer: Cofinity Commercial |
$560.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.97
|
| Rate for Payer: Nomi Health Commercial |
$501.68
|
| Rate for Payer: PACE SWMI |
$418.07
|
| Rate for Payer: PHP Commercial |
$585.30
|
| Rate for Payer: PHP Medicare Advantage |
$418.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.50
|
| Rate for Payer: Priority Health Medicare |
$418.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$418.07
|
| Rate for Payer: UHC Medicare Advantage |
$418.07
|
| Rate for Payer: UMR Bronson Commercial |
$547.40
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 27808
|
| Min. Negotiated Rate |
$298.59 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Commercial |
$400.11
|
| Rate for Payer: Aetna Medicare |
$310.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.11
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$298.59
|
| Rate for Payer: BCN Medicare Advantage |
$298.59
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$429.97
|
| Rate for Payer: Cofinity Commercial |
$400.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.52
|
| Rate for Payer: Nomi Health Commercial |
$358.31
|
| Rate for Payer: PACE SWMI |
$298.59
|
| Rate for Payer: PHP Commercial |
$418.03
|
| Rate for Payer: PHP Medicare Advantage |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$298.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.59
|
| Rate for Payer: UHC Medicare Advantage |
$298.59
|
| Rate for Payer: UMR Bronson Commercial |
$401.12
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,164.00
|
|
|
Service Code
|
HCPCS 28405
|
| Min. Negotiated Rate |
$396.78 |
| Max. Negotiated Rate |
$756.60 |
| Rate for Payer: Aetna Commercial |
$531.69
|
| Rate for Payer: Aetna Medicare |
$412.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.69
|
| Rate for Payer: BCBS Complete |
$465.60
|
| Rate for Payer: BCBS MAPPO |
$396.78
|
| Rate for Payer: BCN Medicare Advantage |
$396.78
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cofinity Commercial |
$571.36
|
| Rate for Payer: Cofinity Commercial |
$531.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.62
|
| Rate for Payer: Nomi Health Commercial |
$476.14
|
| Rate for Payer: PACE SWMI |
$396.78
|
| Rate for Payer: PHP Commercial |
$555.49
|
| Rate for Payer: PHP Medicare Advantage |
$396.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.60
|
| Rate for Payer: Priority Health Medicare |
$396.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.78
|
| Rate for Payer: UHC Medicare Advantage |
$396.78
|
| Rate for Payer: UMR Bronson Commercial |
$535.44
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 28400
|
| Min. Negotiated Rate |
$222.16 |
| Max. Negotiated Rate |
$466.70 |
| Rate for Payer: Aetna Commercial |
$297.69
|
| Rate for Payer: Aetna Medicare |
$231.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.69
|
| Rate for Payer: BCBS Complete |
$287.20
|
| Rate for Payer: BCBS MAPPO |
$222.16
|
| Rate for Payer: BCN Medicare Advantage |
$222.16
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$319.91
|
| Rate for Payer: Cofinity Commercial |
$297.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.27
|
| Rate for Payer: Nomi Health Commercial |
$266.59
|
| Rate for Payer: PACE SWMI |
$222.16
|
| Rate for Payer: PHP Commercial |
$311.02
|
| Rate for Payer: PHP Medicare Advantage |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health Medicare |
$222.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.16
|
| Rate for Payer: UHC Medicare Advantage |
$222.16
|
| Rate for Payer: UMR Bronson Commercial |
$330.28
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$626.64 |
| Rate for Payer: Aetna Commercial |
$583.13
|
| Rate for Payer: Aetna Medicare |
$452.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.13
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: BCBS MAPPO |
$435.17
|
| Rate for Payer: BCN Medicare Advantage |
$435.17
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$626.64
|
| Rate for Payer: Cofinity Commercial |
$583.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.93
|
| Rate for Payer: Nomi Health Commercial |
$522.20
|
| Rate for Payer: PACE SWMI |
$435.17
|
| Rate for Payer: PHP Commercial |
$609.24
|
| Rate for Payer: PHP Medicare Advantage |
$435.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health Medicare |
$435.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$435.17
|
| Rate for Payer: UHC Medicare Advantage |
$435.17
|
| Rate for Payer: UMR Bronson Commercial |
$347.76
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$278.62 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Aetna Commercial |
$373.35
|
| Rate for Payer: Aetna Medicare |
$289.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.35
|
| Rate for Payer: BCBS Complete |
$317.60
|
| Rate for Payer: BCBS MAPPO |
$278.62
|
| Rate for Payer: BCN Medicare Advantage |
$278.62
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$401.21
|
| Rate for Payer: Cofinity Commercial |
$373.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.55
|
| Rate for Payer: Nomi Health Commercial |
$334.34
|
| Rate for Payer: PACE SWMI |
$278.62
|
| Rate for Payer: PHP Commercial |
$390.07
|
| Rate for Payer: PHP Medicare Advantage |
$278.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.62
|
| Rate for Payer: UHC Medicare Advantage |
$278.62
|
| Rate for Payer: UMR Bronson Commercial |
$365.24
|
|
|
PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MNPJ
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 25675
|
| Min. Negotiated Rate |
$406.10 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$544.17
|
| Rate for Payer: Aetna Medicare |
$422.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.17
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$406.10
|
| Rate for Payer: BCN Medicare Advantage |
$406.10
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$584.78
|
| Rate for Payer: Cofinity Commercial |
$544.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$426.40
|
| Rate for Payer: Nomi Health Commercial |
$487.32
|
| Rate for Payer: PACE SWMI |
$406.10
|
| Rate for Payer: PHP Commercial |
$568.54
|
| Rate for Payer: PHP Medicare Advantage |
$406.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$406.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.10
|
| Rate for Payer: UHC Medicare Advantage |
$406.10
|
| Rate for Payer: UMR Bronson Commercial |
$474.26
|
|
|
PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 27268
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$708.32
|
| Rate for Payer: Aetna Medicare |
$549.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.32
|
| Rate for Payer: BCBS Complete |
$322.00
|
| Rate for Payer: BCBS MAPPO |
$528.60
|
| Rate for Payer: BCN Medicare Advantage |
$528.60
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Cofinity Commercial |
$761.18
|
| Rate for Payer: Cofinity Commercial |
$708.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.03
|
| Rate for Payer: Nomi Health Commercial |
$634.32
|
| Rate for Payer: PACE SWMI |
$528.60
|
| Rate for Payer: PHP Commercial |
$740.04
|
| Rate for Payer: PHP Medicare Advantage |
$528.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.25
|
| Rate for Payer: Priority Health Medicare |
$528.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.60
|
| Rate for Payer: UHC Medicare Advantage |
$528.60
|
| Rate for Payer: UMR Bronson Commercial |
$370.30
|
|
|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$833.30 |
| Rate for Payer: Aetna Commercial |
$624.71
|
| Rate for Payer: Aetna Medicare |
$484.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.71
|
| Rate for Payer: BCBS Complete |
$512.80
|
| Rate for Payer: BCBS MAPPO |
$466.20
|
| Rate for Payer: BCN Medicare Advantage |
$466.20
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cofinity Commercial |
$671.33
|
| Rate for Payer: Cofinity Commercial |
$624.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.51
|
| Rate for Payer: Nomi Health Commercial |
$559.44
|
| Rate for Payer: PACE SWMI |
$466.20
|
| Rate for Payer: PHP Commercial |
$652.68
|
| Rate for Payer: PHP Medicare Advantage |
$466.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.30
|
| Rate for Payer: Priority Health Medicare |
$466.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.20
|
| Rate for Payer: UHC Medicare Advantage |
$466.20
|
| Rate for Payer: UMR Bronson Commercial |
$589.72
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$884.89 |
| Rate for Payer: Aetna Commercial |
$823.44
|
| Rate for Payer: Aetna Medicare |
$639.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.44
|
| Rate for Payer: BCBS Complete |
$351.60
|
| Rate for Payer: BCBS MAPPO |
$614.51
|
| Rate for Payer: BCN Medicare Advantage |
$614.51
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cofinity Commercial |
$884.89
|
| Rate for Payer: Cofinity Commercial |
$823.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.24
|
| Rate for Payer: Nomi Health Commercial |
$737.41
|
| Rate for Payer: PACE SWMI |
$614.51
|
| Rate for Payer: PHP Commercial |
$860.31
|
| Rate for Payer: PHP Medicare Advantage |
$614.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.35
|
| Rate for Payer: Priority Health Medicare |
$614.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.51
|
| Rate for Payer: UHC Medicare Advantage |
$614.51
|
| Rate for Payer: UMR Bronson Commercial |
$404.34
|
|
|
PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 27550
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$661.03 |
| Rate for Payer: Aetna Commercial |
$615.13
|
| Rate for Payer: Aetna Medicare |
$477.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.13
|
| Rate for Payer: BCBS Complete |
$338.00
|
| Rate for Payer: BCBS MAPPO |
$459.05
|
| Rate for Payer: BCN Medicare Advantage |
$459.05
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$661.03
|
| Rate for Payer: Cofinity Commercial |
$615.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.00
|
| Rate for Payer: Nomi Health Commercial |
$550.86
|
| Rate for Payer: PACE SWMI |
$459.05
|
| Rate for Payer: PHP Commercial |
$642.67
|
| Rate for Payer: PHP Medicare Advantage |
$459.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
| Rate for Payer: Priority Health Medicare |
$459.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.05
|
| Rate for Payer: UHC Medicare Advantage |
$459.05
|
| Rate for Payer: UMR Bronson Commercial |
$388.70
|
|
|
PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 25690
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$688.80 |
| Rate for Payer: Aetna Commercial |
$640.96
|
| Rate for Payer: Aetna Medicare |
$497.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$688.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.96
|
| Rate for Payer: BCBS Complete |
$336.80
|
| Rate for Payer: BCBS MAPPO |
$478.33
|
| Rate for Payer: BCN Medicare Advantage |
$478.33
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$688.80
|
| Rate for Payer: Cofinity Commercial |
$640.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$478.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.25
|
| Rate for Payer: Nomi Health Commercial |
$574.00
|
| Rate for Payer: PACE SWMI |
$478.33
|
| Rate for Payer: PHP Commercial |
$669.66
|
| Rate for Payer: PHP Medicare Advantage |
$478.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$478.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$478.33
|
| Rate for Payer: UHC Medicare Advantage |
$478.33
|
| Rate for Payer: UMR Bronson Commercial |
$387.32
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
HCPCS 21451
|
| Min. Negotiated Rate |
$482.80 |
| Max. Negotiated Rate |
$848.13 |
| Rate for Payer: Aetna Commercial |
$789.23
|
| Rate for Payer: Aetna Medicare |
$612.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.23
|
| Rate for Payer: BCBS Complete |
$482.80
|
| Rate for Payer: BCBS MAPPO |
$588.98
|
| Rate for Payer: BCN Medicare Advantage |
$588.98
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Cofinity Commercial |
$848.13
|
| Rate for Payer: Cofinity Commercial |
$789.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.43
|
| Rate for Payer: Nomi Health Commercial |
$706.78
|
| Rate for Payer: PACE SWMI |
$588.98
|
| Rate for Payer: PHP Commercial |
$824.57
|
| Rate for Payer: PHP Medicare Advantage |
$588.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.55
|
| Rate for Payer: Priority Health Medicare |
$588.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.98
|
| Rate for Payer: UHC Medicare Advantage |
$588.98
|
| Rate for Payer: UMR Bronson Commercial |
$555.22
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 21450
|
| Min. Negotiated Rate |
$439.54 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$588.98
|
| Rate for Payer: Aetna Medicare |
$457.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.98
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$439.54
|
| Rate for Payer: BCN Medicare Advantage |
$439.54
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$632.94
|
| Rate for Payer: Cofinity Commercial |
$588.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.52
|
| Rate for Payer: Nomi Health Commercial |
$527.45
|
| Rate for Payer: PACE SWMI |
$439.54
|
| Rate for Payer: PHP Commercial |
$615.36
|
| Rate for Payer: PHP Medicare Advantage |
$439.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$439.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.54
|
| Rate for Payer: UHC Medicare Advantage |
$439.54
|
| Rate for Payer: UMR Bronson Commercial |
$538.20
|
|
|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$566.40 |
| Max. Negotiated Rate |
$1,208.58 |
| Rate for Payer: Aetna Commercial |
$1,124.65
|
| Rate for Payer: Aetna Medicare |
$872.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,208.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,124.65
|
| Rate for Payer: BCBS Complete |
$566.40
|
| Rate for Payer: BCBS MAPPO |
$839.29
|
| Rate for Payer: BCN Medicare Advantage |
$839.29
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cofinity Commercial |
$1,208.58
|
| Rate for Payer: Cofinity Commercial |
$1,124.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$839.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$881.25
|
| Rate for Payer: Nomi Health Commercial |
$1,007.15
|
| Rate for Payer: PACE SWMI |
$839.29
|
| Rate for Payer: PHP Commercial |
$1,175.01
|
| Rate for Payer: PHP Medicare Advantage |
$839.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$920.40
|
| Rate for Payer: Priority Health Medicare |
$839.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$839.29
|
| Rate for Payer: UHC Medicare Advantage |
$839.29
|
| Rate for Payer: UMR Bronson Commercial |
$651.36
|
|
|
PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 28470
|
| Min. Negotiated Rate |
$197.69 |
| Max. Negotiated Rate |
$350.35 |
| Rate for Payer: Aetna Commercial |
$264.90
|
| Rate for Payer: Aetna Medicare |
$205.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.90
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$197.69
|
| Rate for Payer: BCN Medicare Advantage |
$197.69
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$284.67
|
| Rate for Payer: Cofinity Commercial |
$264.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.57
|
| Rate for Payer: Nomi Health Commercial |
$237.23
|
| Rate for Payer: PACE SWMI |
$197.69
|
| Rate for Payer: PHP Commercial |
$276.77
|
| Rate for Payer: PHP Medicare Advantage |
$197.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.35
|
| Rate for Payer: Priority Health Medicare |
$197.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.69
|
| Rate for Payer: UHC Medicare Advantage |
$197.69
|
| Rate for Payer: UMR Bronson Commercial |
$247.94
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$571.32 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$765.57
|
| Rate for Payer: Aetna Medicare |
$594.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.57
|
| Rate for Payer: BCBS Complete |
$656.00
|
| Rate for Payer: BCBS MAPPO |
$571.32
|
| Rate for Payer: BCN Medicare Advantage |
$571.32
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cofinity Commercial |
$822.70
|
| Rate for Payer: Cofinity Commercial |
$765.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.89
|
| Rate for Payer: Nomi Health Commercial |
$685.58
|
| Rate for Payer: PACE SWMI |
$571.32
|
| Rate for Payer: PHP Commercial |
$799.85
|
| Rate for Payer: PHP Medicare Advantage |
$571.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.00
|
| Rate for Payer: Priority Health Medicare |
$571.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.32
|
| Rate for Payer: UHC Medicare Advantage |
$571.32
|
| Rate for Payer: UMR Bronson Commercial |
$754.40
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Aetna Medicare |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.00
|
| Rate for Payer: BCBS Complete |
$180.40
|
| Rate for Payer: BCBS MAPPO |
$57.46
|
| Rate for Payer: BCN Medicare Advantage |
$57.46
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cofinity Commercial |
$82.74
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.33
|
| Rate for Payer: Nomi Health Commercial |
$68.95
|
| Rate for Payer: PACE SWMI |
$57.46
|
| Rate for Payer: PHP Commercial |
$80.44
|
| Rate for Payer: PHP Medicare Advantage |
$57.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.15
|
| Rate for Payer: Priority Health Medicare |
$57.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.46
|
| Rate for Payer: UHC Medicare Advantage |
$57.46
|
| Rate for Payer: UMR Bronson Commercial |
$207.46
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Aetna Commercial |
$121.67
|
| Rate for Payer: Aetna Medicare |
$94.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.67
|
| Rate for Payer: BCBS Complete |
$166.00
|
| Rate for Payer: BCBS MAPPO |
$90.80
|
| Rate for Payer: BCN Medicare Advantage |
$90.80
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$130.75
|
| Rate for Payer: Cofinity Commercial |
$121.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.34
|
| Rate for Payer: Nomi Health Commercial |
$108.96
|
| Rate for Payer: PACE SWMI |
$90.80
|
| Rate for Payer: PHP Commercial |
$127.12
|
| Rate for Payer: PHP Medicare Advantage |
$90.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health Medicare |
$90.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.80
|
| Rate for Payer: UHC Medicare Advantage |
$90.80
|
| Rate for Payer: UMR Bronson Commercial |
$190.90
|
|
