|
PR CLTX PROX TIBFIB JT DISLC REQ ANES
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 27831
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$574.59 |
| Rate for Payer: Aetna Commercial |
$534.69
|
| Rate for Payer: Aetna Medicare |
$414.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.69
|
| Rate for Payer: BCBS Complete |
$304.00
|
| Rate for Payer: BCBS MAPPO |
$399.02
|
| Rate for Payer: BCN Medicare Advantage |
$399.02
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$574.59
|
| Rate for Payer: Cofinity Commercial |
$534.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.97
|
| Rate for Payer: Nomi Health Commercial |
$478.82
|
| Rate for Payer: PACE SWMI |
$399.02
|
| Rate for Payer: PHP Commercial |
$558.63
|
| Rate for Payer: PHP Medicare Advantage |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.00
|
| Rate for Payer: Priority Health Medicare |
$399.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.02
|
| Rate for Payer: UHC Medicare Advantage |
$399.02
|
| Rate for Payer: UMR Bronson Commercial |
$349.60
|
|
|
PR CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MNPJ
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 25660
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$630.68 |
| Rate for Payer: Aetna Commercial |
$586.88
|
| Rate for Payer: Aetna Medicare |
$455.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.88
|
| Rate for Payer: BCBS Complete |
$287.20
|
| Rate for Payer: BCBS MAPPO |
$437.97
|
| Rate for Payer: BCN Medicare Advantage |
$437.97
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$630.68
|
| Rate for Payer: Cofinity Commercial |
$586.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.87
|
| Rate for Payer: Nomi Health Commercial |
$525.56
|
| Rate for Payer: PACE SWMI |
$437.97
|
| Rate for Payer: PHP Commercial |
$613.16
|
| Rate for Payer: PHP Medicare Advantage |
$437.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health Medicare |
$437.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.97
|
| Rate for Payer: UHC Medicare Advantage |
$437.97
|
| Rate for Payer: UMR Bronson Commercial |
$330.28
|
|
|
PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 24640
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$158.60 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Aetna Medicare |
$77.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.10
|
| Rate for Payer: BCBS Complete |
$97.60
|
| Rate for Payer: BCBS MAPPO |
$74.70
|
| Rate for Payer: BCN Medicare Advantage |
$74.70
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Cofinity Commercial |
$100.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.44
|
| Rate for Payer: Nomi Health Commercial |
$89.64
|
| Rate for Payer: PACE SWMI |
$74.70
|
| Rate for Payer: PHP Commercial |
$104.58
|
| Rate for Payer: PHP Medicare Advantage |
$74.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.60
|
| Rate for Payer: Priority Health Medicare |
$74.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.70
|
| Rate for Payer: UHC Medicare Advantage |
$74.70
|
| Rate for Payer: UMR Bronson Commercial |
$112.24
|
|
|
PR CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 25520
|
| Min. Negotiated Rate |
$531.61 |
| Max. Negotiated Rate |
$976.95 |
| Rate for Payer: Aetna Commercial |
$712.36
|
| Rate for Payer: Aetna Medicare |
$552.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$712.36
|
| Rate for Payer: BCBS Complete |
$601.20
|
| Rate for Payer: BCBS MAPPO |
$531.61
|
| Rate for Payer: BCN Medicare Advantage |
$531.61
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cofinity Commercial |
$765.52
|
| Rate for Payer: Cofinity Commercial |
$712.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.19
|
| Rate for Payer: Nomi Health Commercial |
$637.93
|
| Rate for Payer: PACE SWMI |
$531.61
|
| Rate for Payer: PHP Commercial |
$744.25
|
| Rate for Payer: PHP Medicare Advantage |
$531.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health Medicare |
$531.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.61
|
| Rate for Payer: UHC Medicare Advantage |
$531.61
|
| Rate for Payer: UMR Bronson Commercial |
$691.38
|
|
|
PR CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 23575
|
| Min. Negotiated Rate |
$371.60 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$497.94
|
| Rate for Payer: Aetna Medicare |
$386.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.94
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$371.60
|
| Rate for Payer: BCN Medicare Advantage |
$371.60
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$535.10
|
| Rate for Payer: Cofinity Commercial |
$497.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.18
|
| Rate for Payer: Nomi Health Commercial |
$445.92
|
| Rate for Payer: PACE SWMI |
$371.60
|
| Rate for Payer: PHP Commercial |
$520.24
|
| Rate for Payer: PHP Medicare Advantage |
$371.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$371.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.60
|
| Rate for Payer: UHC Medicare Advantage |
$371.60
|
| Rate for Payer: UMR Bronson Commercial |
$474.26
|
|
|
PR CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 23665
|
| Min. Negotiated Rate |
$391.58 |
| Max. Negotiated Rate |
$892.45 |
| Rate for Payer: Aetna Commercial |
$524.72
|
| Rate for Payer: Aetna Medicare |
$407.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.72
|
| Rate for Payer: BCBS Complete |
$549.20
|
| Rate for Payer: BCBS MAPPO |
$391.58
|
| Rate for Payer: BCN Medicare Advantage |
$391.58
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$563.88
|
| Rate for Payer: Cofinity Commercial |
$524.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.16
|
| Rate for Payer: Nomi Health Commercial |
$469.90
|
| Rate for Payer: PACE SWMI |
$391.58
|
| Rate for Payer: PHP Commercial |
$548.21
|
| Rate for Payer: PHP Medicare Advantage |
$391.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Medicare |
$391.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.58
|
| Rate for Payer: UHC Medicare Advantage |
$391.58
|
| Rate for Payer: UMR Bronson Commercial |
$631.58
|
|
|
PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 24535
|
| Min. Negotiated Rate |
$558.25 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$748.05
|
| Rate for Payer: Aetna Medicare |
$580.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.05
|
| Rate for Payer: BCBS Complete |
$656.00
|
| Rate for Payer: BCBS MAPPO |
$558.25
|
| Rate for Payer: BCN Medicare Advantage |
$558.25
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cofinity Commercial |
$803.88
|
| Rate for Payer: Cofinity Commercial |
$748.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.16
|
| Rate for Payer: Nomi Health Commercial |
$669.90
|
| Rate for Payer: PACE SWMI |
$558.25
|
| Rate for Payer: PHP Commercial |
$781.55
|
| Rate for Payer: PHP Medicare Advantage |
$558.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.00
|
| Rate for Payer: Priority Health Medicare |
$558.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.25
|
| Rate for Payer: UHC Medicare Advantage |
$558.25
|
| Rate for Payer: UMR Bronson Commercial |
$754.40
|
|
|
PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 24530
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$459.93
|
| Rate for Payer: Aetna Medicare |
$356.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.93
|
| Rate for Payer: BCBS Complete |
$337.60
|
| Rate for Payer: BCBS MAPPO |
$343.23
|
| Rate for Payer: BCN Medicare Advantage |
$343.23
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$494.25
|
| Rate for Payer: Cofinity Commercial |
$459.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.39
|
| Rate for Payer: Nomi Health Commercial |
$411.88
|
| Rate for Payer: PACE SWMI |
$343.23
|
| Rate for Payer: PHP Commercial |
$480.52
|
| Rate for Payer: PHP Medicare Advantage |
$343.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.60
|
| Rate for Payer: Priority Health Medicare |
$343.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.23
|
| Rate for Payer: UHC Medicare Advantage |
$343.23
|
| Rate for Payer: UMR Bronson Commercial |
$388.24
|
|
|
PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 27503
|
| Min. Negotiated Rate |
$773.72 |
| Max. Negotiated Rate |
$1,429.35 |
| Rate for Payer: Aetna Commercial |
$1,036.78
|
| Rate for Payer: Aetna Medicare |
$804.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,114.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,036.78
|
| Rate for Payer: BCBS Complete |
$879.60
|
| Rate for Payer: BCBS MAPPO |
$773.72
|
| Rate for Payer: BCN Medicare Advantage |
$773.72
|
| Rate for Payer: Cash Price |
$1,759.20
|
| Rate for Payer: Cash Price |
$1,759.20
|
| Rate for Payer: Cofinity Commercial |
$1,114.16
|
| Rate for Payer: Cofinity Commercial |
$1,036.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.41
|
| Rate for Payer: Nomi Health Commercial |
$928.46
|
| Rate for Payer: PACE SWMI |
$773.72
|
| Rate for Payer: PHP Commercial |
$1,083.21
|
| Rate for Payer: PHP Medicare Advantage |
$773.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,429.35
|
| Rate for Payer: Priority Health Medicare |
$773.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.72
|
| Rate for Payer: UHC Medicare Advantage |
$773.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,011.54
|
|
|
PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 27501
|
| Min. Negotiated Rate |
$483.18 |
| Max. Negotiated Rate |
$1,024.40 |
| Rate for Payer: Aetna Commercial |
$647.46
|
| Rate for Payer: Aetna Medicare |
$502.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.46
|
| Rate for Payer: BCBS Complete |
$630.40
|
| Rate for Payer: BCBS MAPPO |
$483.18
|
| Rate for Payer: BCN Medicare Advantage |
$483.18
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cofinity Commercial |
$695.78
|
| Rate for Payer: Cofinity Commercial |
$647.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.34
|
| Rate for Payer: Nomi Health Commercial |
$579.82
|
| Rate for Payer: PACE SWMI |
$483.18
|
| Rate for Payer: PHP Commercial |
$676.45
|
| Rate for Payer: PHP Medicare Advantage |
$483.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.40
|
| Rate for Payer: Priority Health Medicare |
$483.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$483.18
|
| Rate for Payer: UHC Medicare Advantage |
$483.18
|
| Rate for Payer: UMR Bronson Commercial |
$724.96
|
|
|
PR CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 28545
|
| Min. Negotiated Rate |
$263.93 |
| Max. Negotiated Rate |
$461.50 |
| Rate for Payer: Aetna Commercial |
$353.67
|
| Rate for Payer: Aetna Medicare |
$274.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.67
|
| Rate for Payer: BCBS Complete |
$284.00
|
| Rate for Payer: BCBS MAPPO |
$263.93
|
| Rate for Payer: BCN Medicare Advantage |
$263.93
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cofinity Commercial |
$380.06
|
| Rate for Payer: Cofinity Commercial |
$353.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$277.13
|
| Rate for Payer: Nomi Health Commercial |
$316.72
|
| Rate for Payer: PACE SWMI |
$263.93
|
| Rate for Payer: PHP Commercial |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$263.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.50
|
| Rate for Payer: Priority Health Medicare |
$263.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.93
|
| Rate for Payer: UHC Medicare Advantage |
$263.93
|
| Rate for Payer: UMR Bronson Commercial |
$326.60
|
|
|
PR CLTX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Professional
|
Both
|
$843.00
|
|
|
Service Code
|
HCPCS 27530
|
| Min. Negotiated Rate |
$281.96 |
| Max. Negotiated Rate |
$547.95 |
| Rate for Payer: Aetna Commercial |
$377.83
|
| Rate for Payer: Aetna Medicare |
$293.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.83
|
| Rate for Payer: BCBS Complete |
$337.20
|
| Rate for Payer: BCBS MAPPO |
$281.96
|
| Rate for Payer: BCN Medicare Advantage |
$281.96
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cofinity Commercial |
$406.02
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.06
|
| Rate for Payer: Nomi Health Commercial |
$338.35
|
| Rate for Payer: PACE SWMI |
$281.96
|
| Rate for Payer: PHP Commercial |
$394.74
|
| Rate for Payer: PHP Medicare Advantage |
$281.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.95
|
| Rate for Payer: Priority Health Medicare |
$281.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.96
|
| Rate for Payer: UHC Medicare Advantage |
$281.96
|
| Rate for Payer: UMR Bronson Commercial |
$387.78
|
|
|
PR CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
HCPCS 27532
|
| Min. Negotiated Rate |
$454.40 |
| Max. Negotiated Rate |
$811.77 |
| Rate for Payer: Aetna Commercial |
$755.40
|
| Rate for Payer: Aetna Medicare |
$586.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$811.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.40
|
| Rate for Payer: BCBS Complete |
$454.40
|
| Rate for Payer: BCBS MAPPO |
$563.73
|
| Rate for Payer: BCN Medicare Advantage |
$563.73
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cofinity Commercial |
$811.77
|
| Rate for Payer: Cofinity Commercial |
$755.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$563.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$591.92
|
| Rate for Payer: Nomi Health Commercial |
$676.48
|
| Rate for Payer: PACE SWMI |
$563.73
|
| Rate for Payer: PHP Commercial |
$789.22
|
| Rate for Payer: PHP Medicare Advantage |
$563.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.40
|
| Rate for Payer: Priority Health Medicare |
$563.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$563.73
|
| Rate for Payer: UHC Medicare Advantage |
$563.73
|
| Rate for Payer: UMR Bronson Commercial |
$522.56
|
|
|
PR CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$1,793.00
|
|
|
Service Code
|
HCPCS 27752
|
| Min. Negotiated Rate |
$476.72 |
| Max. Negotiated Rate |
$1,165.45 |
| Rate for Payer: Aetna Commercial |
$638.80
|
| Rate for Payer: Aetna Medicare |
$495.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.80
|
| Rate for Payer: BCBS Complete |
$717.20
|
| Rate for Payer: BCBS MAPPO |
$476.72
|
| Rate for Payer: BCN Medicare Advantage |
$476.72
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cofinity Commercial |
$686.48
|
| Rate for Payer: Cofinity Commercial |
$638.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$500.56
|
| Rate for Payer: Nomi Health Commercial |
$572.06
|
| Rate for Payer: PACE SWMI |
$476.72
|
| Rate for Payer: PHP Commercial |
$667.41
|
| Rate for Payer: PHP Medicare Advantage |
$476.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.45
|
| Rate for Payer: Priority Health Medicare |
$476.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.72
|
| Rate for Payer: UHC Medicare Advantage |
$476.72
|
| Rate for Payer: UMR Bronson Commercial |
$824.78
|
|
|
PR CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 27750
|
| Min. Negotiated Rate |
$315.19 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$422.35
|
| Rate for Payer: Aetna Medicare |
$327.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.35
|
| Rate for Payer: BCBS Complete |
$368.40
|
| Rate for Payer: BCBS MAPPO |
$315.19
|
| Rate for Payer: BCN Medicare Advantage |
$315.19
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$453.87
|
| Rate for Payer: Cofinity Commercial |
$422.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.95
|
| Rate for Payer: Nomi Health Commercial |
$378.23
|
| Rate for Payer: PACE SWMI |
$315.19
|
| Rate for Payer: PHP Commercial |
$441.27
|
| Rate for Payer: PHP Medicare Advantage |
$315.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$315.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.19
|
| Rate for Payer: UHC Medicare Advantage |
$315.19
|
| Rate for Payer: UMR Bronson Commercial |
$423.66
|
|
|
PR CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MNPJ
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 25680
|
| Min. Negotiated Rate |
$357.60 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna Commercial |
$692.07
|
| Rate for Payer: Aetna Medicare |
$537.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.07
|
| Rate for Payer: BCBS Complete |
$357.60
|
| Rate for Payer: BCBS MAPPO |
$516.47
|
| Rate for Payer: BCN Medicare Advantage |
$516.47
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cofinity Commercial |
$743.72
|
| Rate for Payer: Cofinity Commercial |
$692.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$542.29
|
| Rate for Payer: Nomi Health Commercial |
$619.76
|
| Rate for Payer: PACE SWMI |
$516.47
|
| Rate for Payer: PHP Commercial |
$723.06
|
| Rate for Payer: PHP Medicare Advantage |
$516.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.10
|
| Rate for Payer: Priority Health Medicare |
$516.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.47
|
| Rate for Payer: UHC Medicare Advantage |
$516.47
|
| Rate for Payer: UMR Bronson Commercial |
$411.24
|
|
|
PR CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Professional
|
Both
|
$1,696.00
|
|
|
Service Code
|
HCPCS 27818
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$1,102.40 |
| Rate for Payer: Aetna Commercial |
$577.55
|
| Rate for Payer: Aetna Medicare |
$448.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.55
|
| Rate for Payer: BCBS Complete |
$678.40
|
| Rate for Payer: BCBS MAPPO |
$431.01
|
| Rate for Payer: BCN Medicare Advantage |
$431.01
|
| Rate for Payer: Cash Price |
$1,356.80
|
| Rate for Payer: Cash Price |
$1,356.80
|
| Rate for Payer: Cofinity Commercial |
$620.65
|
| Rate for Payer: Cofinity Commercial |
$577.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$452.56
|
| Rate for Payer: Nomi Health Commercial |
$517.21
|
| Rate for Payer: PACE SWMI |
$431.01
|
| Rate for Payer: PHP Commercial |
$603.41
|
| Rate for Payer: PHP Medicare Advantage |
$431.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.40
|
| Rate for Payer: Priority Health Medicare |
$431.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$431.01
|
| Rate for Payer: UHC Medicare Advantage |
$431.01
|
| Rate for Payer: UMR Bronson Commercial |
$780.16
|
|
|
PR CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 27816
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$414.68 |
| Rate for Payer: Aetna Commercial |
$385.88
|
| Rate for Payer: Aetna Medicare |
$299.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.88
|
| Rate for Payer: BCBS Complete |
$233.60
|
| Rate for Payer: BCBS MAPPO |
$287.97
|
| Rate for Payer: BCN Medicare Advantage |
$287.97
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cofinity Commercial |
$414.68
|
| Rate for Payer: Cofinity Commercial |
$385.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.37
|
| Rate for Payer: Nomi Health Commercial |
$345.56
|
| Rate for Payer: PACE SWMI |
$287.97
|
| Rate for Payer: PHP Commercial |
$403.16
|
| Rate for Payer: PHP Medicare Advantage |
$287.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
| Rate for Payer: Priority Health Medicare |
$287.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.97
|
| Rate for Payer: UHC Medicare Advantage |
$287.97
|
| Rate for Payer: UMR Bronson Commercial |
$268.64
|
|
|
PR CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 22310
|
| Min. Negotiated Rate |
$286.97 |
| Max. Negotiated Rate |
$581.75 |
| Rate for Payer: Aetna Commercial |
$384.54
|
| Rate for Payer: Aetna Medicare |
$298.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.54
|
| Rate for Payer: BCBS Complete |
$358.00
|
| Rate for Payer: BCBS MAPPO |
$286.97
|
| Rate for Payer: BCN Medicare Advantage |
$286.97
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$413.24
|
| Rate for Payer: Cofinity Commercial |
$384.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.32
|
| Rate for Payer: Nomi Health Commercial |
$344.36
|
| Rate for Payer: PACE SWMI |
$286.97
|
| Rate for Payer: PHP Commercial |
$401.76
|
| Rate for Payer: PHP Medicare Advantage |
$286.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.75
|
| Rate for Payer: Priority Health Medicare |
$286.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.97
|
| Rate for Payer: UHC Medicare Advantage |
$286.97
|
| Rate for Payer: UMR Bronson Commercial |
$411.70
|
|
|
PR CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ
|
Professional
|
Both
|
$1,302.00
|
|
|
Service Code
|
HCPCS 22315
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$1,091.55 |
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna Medicare |
$788.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.75
|
| Rate for Payer: BCBS Complete |
$520.80
|
| Rate for Payer: BCBS MAPPO |
$758.02
|
| Rate for Payer: BCN Medicare Advantage |
$758.02
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cofinity Commercial |
$1,091.55
|
| Rate for Payer: Cofinity Commercial |
$1,015.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$795.92
|
| Rate for Payer: Nomi Health Commercial |
$909.62
|
| Rate for Payer: PACE SWMI |
$758.02
|
| Rate for Payer: PHP Commercial |
$1,061.23
|
| Rate for Payer: PHP Medicare Advantage |
$758.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.30
|
| Rate for Payer: Priority Health Medicare |
$758.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.02
|
| Rate for Payer: UHC Medicare Advantage |
$758.02
|
| Rate for Payer: UMR Bronson Commercial |
$598.92
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$2,029.00
|
|
|
Service Code
|
HCPCS 57260
|
| Min. Negotiated Rate |
$746.92 |
| Max. Negotiated Rate |
$1,318.85 |
| Rate for Payer: Aetna Commercial |
$1,000.87
|
| Rate for Payer: Aetna Medicare |
$776.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.87
|
| Rate for Payer: BCBS Complete |
$811.60
|
| Rate for Payer: BCBS MAPPO |
$746.92
|
| Rate for Payer: BCN Medicare Advantage |
$746.92
|
| Rate for Payer: Cash Price |
$1,623.20
|
| Rate for Payer: Cash Price |
$1,623.20
|
| Rate for Payer: Cofinity Commercial |
$1,075.56
|
| Rate for Payer: Cofinity Commercial |
$1,000.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.27
|
| Rate for Payer: Nomi Health Commercial |
$896.30
|
| Rate for Payer: PACE SWMI |
$746.92
|
| Rate for Payer: PHP Commercial |
$1,045.69
|
| Rate for Payer: PHP Medicare Advantage |
$746.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,318.85
|
| Rate for Payer: Priority Health Medicare |
$746.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.92
|
| Rate for Payer: UHC Medicare Advantage |
$746.92
|
| Rate for Payer: UMR Bronson Commercial |
$933.34
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
HCPCS 57265
|
| Min. Negotiated Rate |
$836.04 |
| Max. Negotiated Rate |
$1,697.80 |
| Rate for Payer: Aetna Commercial |
$1,120.29
|
| Rate for Payer: Aetna Medicare |
$869.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,120.29
|
| Rate for Payer: BCBS Complete |
$1,044.80
|
| Rate for Payer: BCBS MAPPO |
$836.04
|
| Rate for Payer: BCN Medicare Advantage |
$836.04
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Cofinity Commercial |
$1,203.90
|
| Rate for Payer: Cofinity Commercial |
$1,120.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$836.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.84
|
| Rate for Payer: Nomi Health Commercial |
$1,003.25
|
| Rate for Payer: PACE SWMI |
$836.04
|
| Rate for Payer: PHP Commercial |
$1,170.46
|
| Rate for Payer: PHP Medicare Advantage |
$836.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,697.80
|
| Rate for Payer: Priority Health Medicare |
$836.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$836.04
|
| Rate for Payer: UHC Medicare Advantage |
$836.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,201.52
|
|
|
PR CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 36598
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$256.75 |
| Rate for Payer: Aetna Commercial |
$44.61
|
| Rate for Payer: Aetna Medicare |
$34.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.61
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$33.29
|
| Rate for Payer: BCN Medicare Advantage |
$33.29
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Commercial |
$44.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.95
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: PACE SWMI |
$33.29
|
| Rate for Payer: PHP Commercial |
$46.61
|
| Rate for Payer: PHP Medicare Advantage |
$33.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health Medicare |
$33.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.29
|
| Rate for Payer: UHC Medicare Advantage |
$33.29
|
| Rate for Payer: UMR Bronson Commercial |
$181.70
|
|
|
PR COCCYGECTOMY PRIMARY
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 27080
|
| Min. Negotiated Rate |
$492.76 |
| Max. Negotiated Rate |
$1,268.15 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$512.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.30
|
| Rate for Payer: BCBS Complete |
$780.40
|
| Rate for Payer: BCBS MAPPO |
$492.76
|
| Rate for Payer: BCN Medicare Advantage |
$492.76
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$709.57
|
| Rate for Payer: Cofinity Commercial |
$660.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$492.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$517.40
|
| Rate for Payer: Nomi Health Commercial |
$591.31
|
| Rate for Payer: PACE SWMI |
$492.76
|
| Rate for Payer: PHP Commercial |
$689.86
|
| Rate for Payer: PHP Medicare Advantage |
$492.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health Medicare |
$492.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$492.76
|
| Rate for Payer: UHC Medicare Advantage |
$492.76
|
| Rate for Payer: UMR Bronson Commercial |
$897.46
|
|
|
PR COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY
|
Professional
|
Both
|
$4,226.00
|
|
|
Service Code
|
HCPCS 69930
|
| Min. Negotiated Rate |
$1,144.86 |
| Max. Negotiated Rate |
$2,746.90 |
| Rate for Payer: Aetna Commercial |
$1,534.11
|
| Rate for Payer: Aetna Medicare |
$1,190.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.11
|
| Rate for Payer: BCBS Complete |
$1,690.40
|
| Rate for Payer: BCBS MAPPO |
$1,144.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.86
|
| Rate for Payer: Cash Price |
$3,380.80
|
| Rate for Payer: Cash Price |
$3,380.80
|
| Rate for Payer: Cofinity Commercial |
$1,648.60
|
| Rate for Payer: Cofinity Commercial |
$1,534.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,202.10
|
| Rate for Payer: Nomi Health Commercial |
$1,373.83
|
| Rate for Payer: PACE SWMI |
$1,144.86
|
| Rate for Payer: PHP Commercial |
$1,602.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,746.90
|
| Rate for Payer: Priority Health Medicare |
$1,144.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,943.96
|
|
