|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$441.76 |
| Max. Negotiated Rate |
$1,398.54 |
| Rate for Payer: Aetna Commercial |
$934.90
|
| Rate for Payer: Aetna Medicare |
$725.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.90
|
| Rate for Payer: BCBS Complete |
$463.85
|
| Rate for Payer: BCBS MAPPO |
$697.69
|
| Rate for Payer: BCN Commercial |
$1,146.36
|
| Rate for Payer: BCN Medicare Advantage |
$697.69
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Cash Price |
$1,172.80
|
| Rate for Payer: Cofinity Commercial |
$1,004.67
|
| Rate for Payer: Cofinity Commercial |
$934.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.57
|
| Rate for Payer: Meridian Medicaid |
$463.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$767.46
|
| Rate for Payer: Nomi Health Commercial |
$837.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,099.50
|
| Rate for Payer: PACE SWMI |
$697.69
|
| Rate for Payer: PHP Commercial |
$976.77
|
| Rate for Payer: PHP Medicare Advantage |
$697.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,049.21
|
| Rate for Payer: Priority Health Medicare |
$697.69
|
| Rate for Payer: Priority Health SBD |
$1,049.21
|
| Rate for Payer: Priority Health Tiered Network |
$1,049.21
|
| Rate for Payer: Railroad Medicare Medicare |
$697.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.54
|
| Rate for Payer: UHC Core |
$1,398.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$697.69
|
| Rate for Payer: UHC Exchange |
$1,398.54
|
| Rate for Payer: UHC Medicaid |
$441.76
|
| Rate for Payer: UHCCP Medicaid |
$441.76
|
| Rate for Payer: UMR Bronson Commercial |
$674.36
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$1,261.07 |
| Rate for Payer: Aetna Commercial |
$840.31
|
| Rate for Payer: Aetna Medicare |
$652.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$903.02
|
| Rate for Payer: BCBS Complete |
$417.77
|
| Rate for Payer: BCBS MAPPO |
$627.10
|
| Rate for Payer: BCN Commercial |
$1,040.78
|
| Rate for Payer: BCN Medicare Advantage |
$627.10
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$840.31
|
| Rate for Payer: Cofinity Commercial |
$903.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.46
|
| Rate for Payer: Meridian Medicaid |
$417.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$689.81
|
| Rate for Payer: Nomi Health Commercial |
$752.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.00
|
| Rate for Payer: PACE SWMI |
$627.10
|
| Rate for Payer: PHP Commercial |
$877.94
|
| Rate for Payer: PHP Medicare Advantage |
$627.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$952.58
|
| Rate for Payer: Priority Health Medicare |
$627.10
|
| Rate for Payer: Priority Health SBD |
$952.58
|
| Rate for Payer: Priority Health Tiered Network |
$952.58
|
| Rate for Payer: Railroad Medicare Medicare |
$627.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,261.07
|
| Rate for Payer: UHC Core |
$1,261.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$627.10
|
| Rate for Payer: UHC Exchange |
$1,261.07
|
| Rate for Payer: UHC Medicaid |
$397.88
|
| Rate for Payer: UHCCP Medicaid |
$397.88
|
| Rate for Payer: UMR Bronson Commercial |
$616.40
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$633.00 |
| Rate for Payer: Aetna Commercial |
$328.42
|
| Rate for Payer: Aetna Medicare |
$254.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.93
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS MAPPO |
$245.09
|
| Rate for Payer: BCN Commercial |
$414.82
|
| Rate for Payer: BCN Medicare Advantage |
$245.09
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$328.42
|
| Rate for Payer: Cofinity Commercial |
$352.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.34
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$269.60
|
| Rate for Payer: Nomi Health Commercial |
$294.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$633.00
|
| Rate for Payer: PACE SWMI |
$245.09
|
| Rate for Payer: PHP Commercial |
$343.13
|
| Rate for Payer: PHP Medicare Advantage |
$245.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$379.67
|
| Rate for Payer: Priority Health Medicare |
$245.09
|
| Rate for Payer: Priority Health SBD |
$379.67
|
| Rate for Payer: Priority Health Tiered Network |
$379.67
|
| Rate for Payer: Railroad Medicare Medicare |
$245.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.53
|
| Rate for Payer: UHC Core |
$483.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.09
|
| Rate for Payer: UHC Exchange |
$483.53
|
| Rate for Payer: UHC Medicaid |
$159.11
|
| Rate for Payer: UHCCP Medicaid |
$159.11
|
| Rate for Payer: UMR Bronson Commercial |
$388.24
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: Aetna Commercial |
$352.00
|
| Rate for Payer: Aetna Medicare |
$273.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.27
|
| Rate for Payer: BCBS Complete |
$177.36
|
| Rate for Payer: BCBS MAPPO |
$262.69
|
| Rate for Payer: BCN Commercial |
$446.69
|
| Rate for Payer: BCN Medicare Advantage |
$262.69
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$378.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.82
|
| Rate for Payer: Meridian Medicaid |
$177.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$288.96
|
| Rate for Payer: Nomi Health Commercial |
$315.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$687.00
|
| Rate for Payer: PACE SWMI |
$262.69
|
| Rate for Payer: PHP Commercial |
$367.77
|
| Rate for Payer: PHP Medicare Advantage |
$262.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$408.84
|
| Rate for Payer: Priority Health Medicare |
$262.69
|
| Rate for Payer: Priority Health SBD |
$408.84
|
| Rate for Payer: Priority Health Tiered Network |
$408.84
|
| Rate for Payer: Railroad Medicare Medicare |
$262.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.70
|
| Rate for Payer: UHC Core |
$530.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.69
|
| Rate for Payer: UHC Exchange |
$530.70
|
| Rate for Payer: UHC Medicaid |
$168.91
|
| Rate for Payer: UHCCP Medicaid |
$168.91
|
| Rate for Payer: UMR Bronson Commercial |
$421.36
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$587.24 |
| Max. Negotiated Rate |
$1,777.58 |
| Rate for Payer: Aetna Commercial |
$1,213.09
|
| Rate for Payer: Aetna Medicare |
$941.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,213.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,303.62
|
| Rate for Payer: BCBS Complete |
$616.60
|
| Rate for Payer: BCBS MAPPO |
$905.29
|
| Rate for Payer: BCN Commercial |
$1,526.31
|
| Rate for Payer: BCN Medicare Advantage |
$905.29
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cofinity Commercial |
$1,213.09
|
| Rate for Payer: Cofinity Commercial |
$1,303.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$950.55
|
| Rate for Payer: Meridian Medicaid |
$616.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$995.82
|
| Rate for Payer: Nomi Health Commercial |
$1,086.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.00
|
| Rate for Payer: PACE SWMI |
$905.29
|
| Rate for Payer: PHP Commercial |
$1,267.41
|
| Rate for Payer: PHP Medicare Advantage |
$905.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,631.58
|
| Rate for Payer: Priority Health Medicare |
$905.29
|
| Rate for Payer: Priority Health SBD |
$1,631.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,631.58
|
| Rate for Payer: Railroad Medicare Medicare |
$905.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,777.58
|
| Rate for Payer: UHC Core |
$1,777.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$905.29
|
| Rate for Payer: UHC Exchange |
$1,777.58
|
| Rate for Payer: UHC Medicaid |
$587.24
|
| Rate for Payer: UHCCP Medicaid |
$587.24
|
| Rate for Payer: UMR Bronson Commercial |
$829.84
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$1,140.57 |
| Rate for Payer: Aetna Commercial |
$814.72
|
| Rate for Payer: Aetna Medicare |
$632.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$875.52
|
| Rate for Payer: BCBS Complete |
$418.45
|
| Rate for Payer: BCBS MAPPO |
$608.00
|
| Rate for Payer: BCN Commercial |
$1,008.91
|
| Rate for Payer: BCN Medicare Advantage |
$608.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cofinity Commercial |
$814.72
|
| Rate for Payer: Cofinity Commercial |
$875.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$638.40
|
| Rate for Payer: Meridian Medicaid |
$418.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$668.80
|
| Rate for Payer: Nomi Health Commercial |
$729.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.00
|
| Rate for Payer: PACE SWMI |
$608.00
|
| Rate for Payer: PHP Commercial |
$851.20
|
| Rate for Payer: PHP Medicare Advantage |
$608.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,078.50
|
| Rate for Payer: Priority Health Medicare |
$608.00
|
| Rate for Payer: Priority Health SBD |
$1,078.50
|
| Rate for Payer: Priority Health Tiered Network |
$1,078.50
|
| Rate for Payer: Railroad Medicare Medicare |
$608.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,140.57
|
| Rate for Payer: UHC Core |
$1,140.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$608.00
|
| Rate for Payer: UHC Exchange |
$1,140.57
|
| Rate for Payer: UHC Medicaid |
$398.52
|
| Rate for Payer: UHCCP Medicaid |
$398.52
|
| Rate for Payer: UMR Bronson Commercial |
$634.80
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,246.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$716.96 |
| Max. Negotiated Rate |
$2,111.68 |
| Rate for Payer: Aetna Commercial |
$1,479.52
|
| Rate for Payer: Aetna Medicare |
$1,148.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.93
|
| Rate for Payer: BCBS Complete |
$752.81
|
| Rate for Payer: BCBS MAPPO |
$1,104.12
|
| Rate for Payer: BCN Commercial |
$1,859.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,104.12
|
| Rate for Payer: Cash Price |
$1,796.80
|
| Rate for Payer: Cash Price |
$1,796.80
|
| Rate for Payer: Cofinity Commercial |
$1,479.52
|
| Rate for Payer: Cofinity Commercial |
$1,589.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,104.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,159.33
|
| Rate for Payer: Meridian Medicaid |
$752.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,214.53
|
| Rate for Payer: Nomi Health Commercial |
$1,324.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,684.50
|
| Rate for Payer: PACE SWMI |
$1,104.12
|
| Rate for Payer: PHP Commercial |
$1,545.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,104.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$716.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,987.71
|
| Rate for Payer: Priority Health Medicare |
$1,104.12
|
| Rate for Payer: Priority Health SBD |
$1,987.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,987.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,104.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,111.68
|
| Rate for Payer: UHC Core |
$2,111.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,104.12
|
| Rate for Payer: UHC Exchange |
$2,111.68
|
| Rate for Payer: UHC Medicaid |
$716.96
|
| Rate for Payer: UHCCP Medicaid |
$716.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,033.16
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$2,028.00
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$805.99 |
| Max. Negotiated Rate |
$2,102.70 |
| Rate for Payer: Aetna Commercial |
$1,625.25
|
| Rate for Payer: Aetna Medicare |
$1,261.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,625.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,746.53
|
| Rate for Payer: BCBS Complete |
$846.29
|
| Rate for Payer: BCBS MAPPO |
$1,212.87
|
| Rate for Payer: BCN Commercial |
$1,967.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,212.87
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cofinity Commercial |
$1,625.25
|
| Rate for Payer: Cofinity Commercial |
$1,746.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,212.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.51
|
| Rate for Payer: Meridian Medicaid |
$846.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,334.16
|
| Rate for Payer: Nomi Health Commercial |
$1,455.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,521.00
|
| Rate for Payer: PACE SWMI |
$1,212.87
|
| Rate for Payer: PHP Commercial |
$1,698.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,212.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$805.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,102.70
|
| Rate for Payer: Priority Health Medicare |
$1,212.87
|
| Rate for Payer: Priority Health SBD |
$2,102.70
|
| Rate for Payer: Priority Health Tiered Network |
$2,102.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,212.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,069.49
|
| Rate for Payer: UHC Core |
$2,069.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,212.87
|
| Rate for Payer: UHC Exchange |
$2,069.49
|
| Rate for Payer: UHC Medicaid |
$805.99
|
| Rate for Payer: UHCCP Medicaid |
$805.99
|
| Rate for Payer: UMR Bronson Commercial |
$932.88
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$1,878.00
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$463.49 |
| Max. Negotiated Rate |
$1,408.50 |
| Rate for Payer: Aetna Commercial |
$951.32
|
| Rate for Payer: Aetna Medicare |
$738.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.32
|
| Rate for Payer: BCBS Complete |
$486.66
|
| Rate for Payer: BCBS MAPPO |
$709.94
|
| Rate for Payer: BCN Commercial |
$1,185.69
|
| Rate for Payer: BCN Medicare Advantage |
$709.94
|
| Rate for Payer: Cash Price |
$1,502.40
|
| Rate for Payer: Cash Price |
$1,502.40
|
| Rate for Payer: Cofinity Commercial |
$1,022.31
|
| Rate for Payer: Cofinity Commercial |
$951.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$745.44
|
| Rate for Payer: Meridian Medicaid |
$486.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$780.93
|
| Rate for Payer: Nomi Health Commercial |
$851.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,408.50
|
| Rate for Payer: PACE SWMI |
$709.94
|
| Rate for Payer: PHP Commercial |
$993.92
|
| Rate for Payer: PHP Medicare Advantage |
$709.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,267.47
|
| Rate for Payer: Priority Health Medicare |
$709.94
|
| Rate for Payer: Priority Health SBD |
$1,267.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,267.47
|
| Rate for Payer: Railroad Medicare Medicare |
$709.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,365.24
|
| Rate for Payer: UHC Core |
$1,365.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$709.94
|
| Rate for Payer: UHC Exchange |
$1,365.24
|
| Rate for Payer: UHC Medicaid |
$463.49
|
| Rate for Payer: UHCCP Medicaid |
$463.49
|
| Rate for Payer: UMR Bronson Commercial |
$863.88
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$460.29 |
| Max. Negotiated Rate |
$1,182.83 |
| Rate for Payer: Aetna Commercial |
$917.10
|
| Rate for Payer: Aetna Medicare |
$711.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.54
|
| Rate for Payer: BCBS Complete |
$483.30
|
| Rate for Payer: BCBS MAPPO |
$684.40
|
| Rate for Payer: BCN Commercial |
$1,106.52
|
| Rate for Payer: BCN Medicare Advantage |
$684.40
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cofinity Commercial |
$917.10
|
| Rate for Payer: Cofinity Commercial |
$985.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.62
|
| Rate for Payer: Meridian Medicaid |
$483.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$752.84
|
| Rate for Payer: Nomi Health Commercial |
$821.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.75
|
| Rate for Payer: PACE SWMI |
$684.40
|
| Rate for Payer: PHP Commercial |
$958.16
|
| Rate for Payer: PHP Medicare Advantage |
$684.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,182.83
|
| Rate for Payer: Priority Health Medicare |
$684.40
|
| Rate for Payer: Priority Health SBD |
$1,182.83
|
| Rate for Payer: Priority Health Tiered Network |
$1,182.83
|
| Rate for Payer: Railroad Medicare Medicare |
$684.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,093.03
|
| Rate for Payer: UHC Core |
$1,093.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$684.40
|
| Rate for Payer: UHC Exchange |
$1,093.03
|
| Rate for Payer: UHC Medicaid |
$460.29
|
| Rate for Payer: UHCCP Medicaid |
$460.29
|
| Rate for Payer: UMR Bronson Commercial |
$672.06
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,278.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$239.63 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Aetna Commercial |
$494.41
|
| Rate for Payer: Aetna Medicare |
$383.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.30
|
| Rate for Payer: BCBS Complete |
$251.61
|
| Rate for Payer: BCBS MAPPO |
$368.96
|
| Rate for Payer: BCN Commercial |
$607.04
|
| Rate for Payer: BCN Medicare Advantage |
$368.96
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cofinity Commercial |
$494.41
|
| Rate for Payer: Cofinity Commercial |
$531.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.41
|
| Rate for Payer: Meridian Medicaid |
$251.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$405.86
|
| Rate for Payer: Nomi Health Commercial |
$442.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$958.50
|
| Rate for Payer: PACE SWMI |
$368.96
|
| Rate for Payer: PHP Commercial |
$516.54
|
| Rate for Payer: PHP Medicare Advantage |
$368.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$648.90
|
| Rate for Payer: Priority Health Medicare |
$368.96
|
| Rate for Payer: Priority Health SBD |
$648.90
|
| Rate for Payer: Priority Health Tiered Network |
$648.90
|
| Rate for Payer: Railroad Medicare Medicare |
$368.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.56
|
| Rate for Payer: UHC Core |
$711.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$368.96
|
| Rate for Payer: UHC Exchange |
$711.56
|
| Rate for Payer: UHC Medicaid |
$239.63
|
| Rate for Payer: UHCCP Medicaid |
$239.63
|
| Rate for Payer: UMR Bronson Commercial |
$587.88
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$1,822.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$283.08 |
| Max. Negotiated Rate |
$1,366.50 |
| Rate for Payer: Aetna Commercial |
$590.93
|
| Rate for Payer: Aetna Medicare |
$458.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.03
|
| Rate for Payer: BCBS Complete |
$297.23
|
| Rate for Payer: BCBS MAPPO |
$440.99
|
| Rate for Payer: BCN Commercial |
$713.61
|
| Rate for Payer: BCN Medicare Advantage |
$440.99
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cofinity Commercial |
$590.93
|
| Rate for Payer: Cofinity Commercial |
$635.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.04
|
| Rate for Payer: Meridian Medicaid |
$297.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$485.09
|
| Rate for Payer: Nomi Health Commercial |
$529.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,366.50
|
| Rate for Payer: PACE SWMI |
$440.99
|
| Rate for Payer: PHP Commercial |
$617.39
|
| Rate for Payer: PHP Medicare Advantage |
$440.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$762.83
|
| Rate for Payer: Priority Health Medicare |
$440.99
|
| Rate for Payer: Priority Health SBD |
$762.83
|
| Rate for Payer: Priority Health Tiered Network |
$762.83
|
| Rate for Payer: Railroad Medicare Medicare |
$440.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.26
|
| Rate for Payer: UHC Core |
$857.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$440.99
|
| Rate for Payer: UHC Exchange |
$857.26
|
| Rate for Payer: UHC Medicaid |
$283.08
|
| Rate for Payer: UHCCP Medicaid |
$283.08
|
| Rate for Payer: UMR Bronson Commercial |
$838.12
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,308.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$482.87 |
| Max. Negotiated Rate |
$1,731.00 |
| Rate for Payer: Aetna Commercial |
$1,001.44
|
| Rate for Payer: Aetna Medicare |
$777.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.17
|
| Rate for Payer: BCBS Complete |
$507.01
|
| Rate for Payer: BCBS MAPPO |
$747.34
|
| Rate for Payer: BCN Commercial |
$1,239.47
|
| Rate for Payer: BCN Medicare Advantage |
$747.34
|
| Rate for Payer: Cash Price |
$1,846.40
|
| Rate for Payer: Cash Price |
$1,846.40
|
| Rate for Payer: Cofinity Commercial |
$1,001.44
|
| Rate for Payer: Cofinity Commercial |
$1,076.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.71
|
| Rate for Payer: Meridian Medicaid |
$507.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$822.07
|
| Rate for Payer: Nomi Health Commercial |
$896.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,731.00
|
| Rate for Payer: PACE SWMI |
$747.34
|
| Rate for Payer: PHP Commercial |
$1,046.28
|
| Rate for Payer: PHP Medicare Advantage |
$747.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,324.96
|
| Rate for Payer: Priority Health Medicare |
$747.34
|
| Rate for Payer: Priority Health SBD |
$1,324.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,324.96
|
| Rate for Payer: Railroad Medicare Medicare |
$747.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,478.62
|
| Rate for Payer: UHC Core |
$1,478.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$747.34
|
| Rate for Payer: UHC Exchange |
$1,478.62
|
| Rate for Payer: UHC Medicaid |
$482.87
|
| Rate for Payer: UHCCP Medicaid |
$482.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,061.68
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$330.36 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Aetna Commercial |
$679.69
|
| Rate for Payer: Aetna Medicare |
$527.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.41
|
| Rate for Payer: BCBS Complete |
$346.88
|
| Rate for Payer: BCBS MAPPO |
$507.23
|
| Rate for Payer: BCN Commercial |
$822.16
|
| Rate for Payer: BCN Medicare Advantage |
$507.23
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cofinity Commercial |
$679.69
|
| Rate for Payer: Cofinity Commercial |
$730.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$507.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$532.59
|
| Rate for Payer: Meridian Medicaid |
$346.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$557.95
|
| Rate for Payer: Nomi Health Commercial |
$608.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,270.50
|
| Rate for Payer: PACE SWMI |
$507.23
|
| Rate for Payer: PHP Commercial |
$710.12
|
| Rate for Payer: PHP Medicare Advantage |
$507.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$878.87
|
| Rate for Payer: Priority Health Medicare |
$507.23
|
| Rate for Payer: Priority Health SBD |
$878.87
|
| Rate for Payer: Priority Health Tiered Network |
$878.87
|
| Rate for Payer: Railroad Medicare Medicare |
$507.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$963.68
|
| Rate for Payer: UHC Core |
$963.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$507.23
|
| Rate for Payer: UHC Exchange |
$963.68
|
| Rate for Payer: UHC Medicaid |
$330.36
|
| Rate for Payer: UHCCP Medicaid |
$330.36
|
| Rate for Payer: UMR Bronson Commercial |
$779.24
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Aetna Commercial |
$545.41
|
| Rate for Payer: Aetna Medicare |
$423.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.11
|
| Rate for Payer: BCBS Complete |
$280.01
|
| Rate for Payer: BCBS MAPPO |
$407.02
|
| Rate for Payer: BCN Commercial |
$666.30
|
| Rate for Payer: BCN Medicare Advantage |
$407.02
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$545.41
|
| Rate for Payer: Cofinity Commercial |
$586.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.37
|
| Rate for Payer: Meridian Medicaid |
$280.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$447.72
|
| Rate for Payer: Nomi Health Commercial |
$488.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$407.02
|
| Rate for Payer: PHP Commercial |
$569.83
|
| Rate for Payer: PHP Medicare Advantage |
$407.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$712.26
|
| Rate for Payer: Priority Health Medicare |
$407.02
|
| Rate for Payer: Priority Health SBD |
$712.26
|
| Rate for Payer: Priority Health Tiered Network |
$712.26
|
| Rate for Payer: Railroad Medicare Medicare |
$407.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$778.53
|
| Rate for Payer: UHC Core |
$778.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$407.02
|
| Rate for Payer: UHC Exchange |
$778.53
|
| Rate for Payer: UHC Medicaid |
$266.68
|
| Rate for Payer: UHCCP Medicaid |
$266.68
|
| Rate for Payer: UMR Bronson Commercial |
$657.80
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$423.23 |
| Max. Negotiated Rate |
$1,222.63 |
| Rate for Payer: Aetna Commercial |
$866.69
|
| Rate for Payer: Aetna Medicare |
$672.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.36
|
| Rate for Payer: BCBS Complete |
$444.39
|
| Rate for Payer: BCBS MAPPO |
$646.78
|
| Rate for Payer: BCN Commercial |
$1,074.15
|
| Rate for Payer: BCN Medicare Advantage |
$646.78
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cofinity Commercial |
$866.69
|
| Rate for Payer: Cofinity Commercial |
$931.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.12
|
| Rate for Payer: Meridian Medicaid |
$444.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$711.46
|
| Rate for Payer: Nomi Health Commercial |
$776.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.25
|
| Rate for Payer: PACE SWMI |
$646.78
|
| Rate for Payer: PHP Commercial |
$905.49
|
| Rate for Payer: PHP Medicare Advantage |
$646.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,148.22
|
| Rate for Payer: Priority Health Medicare |
$646.78
|
| Rate for Payer: Priority Health SBD |
$1,148.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,148.22
|
| Rate for Payer: Railroad Medicare Medicare |
$646.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,222.63
|
| Rate for Payer: UHC Core |
$1,222.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$646.78
|
| Rate for Payer: UHC Exchange |
$1,222.63
|
| Rate for Payer: UHC Medicaid |
$423.23
|
| Rate for Payer: UHCCP Medicaid |
$423.23
|
| Rate for Payer: UMR Bronson Commercial |
$547.86
|
|
|
PR DCMPRN PERQ NUCLEUS PULPOSUS 1/MLT LEVELS LUMBAR
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$340.37 |
| Max. Negotiated Rate |
$2,318.25 |
| Rate for Payer: Aetna Commercial |
$697.15
|
| Rate for Payer: Aetna Medicare |
$541.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.17
|
| Rate for Payer: BCBS Complete |
$357.39
|
| Rate for Payer: BCBS MAPPO |
$520.26
|
| Rate for Payer: BCN Commercial |
$903.34
|
| Rate for Payer: BCN Medicare Advantage |
$520.26
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cofinity Commercial |
$697.15
|
| Rate for Payer: Cofinity Commercial |
$749.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.27
|
| Rate for Payer: Meridian Medicaid |
$357.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$572.29
|
| Rate for Payer: Nomi Health Commercial |
$624.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,318.25
|
| Rate for Payer: PACE SWMI |
$520.26
|
| Rate for Payer: PHP Commercial |
$728.36
|
| Rate for Payer: PHP Medicare Advantage |
$520.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,049.22
|
| Rate for Payer: Priority Health Medicare |
$520.26
|
| Rate for Payer: Priority Health SBD |
$1,049.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,049.22
|
| Rate for Payer: Railroad Medicare Medicare |
$520.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,017.27
|
| Rate for Payer: UHC Core |
$1,017.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$520.26
|
| Rate for Payer: UHC Exchange |
$1,017.27
|
| Rate for Payer: UHC Medicaid |
$340.37
|
| Rate for Payer: UHCCP Medicaid |
$340.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,421.86
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Aetna Commercial |
$267.76
|
| Rate for Payer: Aetna Medicare |
$207.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.74
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$199.82
|
| Rate for Payer: BCN Commercial |
$335.14
|
| Rate for Payer: BCN Medicare Advantage |
$199.82
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$267.76
|
| Rate for Payer: Cofinity Commercial |
$287.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.81
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.80
|
| Rate for Payer: Nomi Health Commercial |
$239.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PACE SWMI |
$199.82
|
| Rate for Payer: PHP Commercial |
$279.75
|
| Rate for Payer: PHP Medicare Advantage |
$199.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.74
|
| Rate for Payer: Priority Health Medicare |
$199.82
|
| Rate for Payer: Priority Health SBD |
$306.74
|
| Rate for Payer: Priority Health Tiered Network |
$306.74
|
| Rate for Payer: Railroad Medicare Medicare |
$199.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.18
|
| Rate for Payer: UHC Core |
$402.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.82
|
| Rate for Payer: UHC Exchange |
$402.18
|
| Rate for Payer: UHC Medicaid |
$128.23
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Aetna Commercial |
$267.76
|
| Rate for Payer: Aetna Medicare |
$207.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.74
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$199.82
|
| Rate for Payer: BCN Commercial |
$335.14
|
| Rate for Payer: BCN Medicare Advantage |
$199.82
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$267.76
|
| Rate for Payer: Cofinity Commercial |
$287.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.81
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.80
|
| Rate for Payer: Nomi Health Commercial |
$239.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PACE SWMI |
$199.82
|
| Rate for Payer: PHP Commercial |
$279.75
|
| Rate for Payer: PHP Medicare Advantage |
$199.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.74
|
| Rate for Payer: Priority Health Medicare |
$199.82
|
| Rate for Payer: Priority Health SBD |
$306.74
|
| Rate for Payer: Priority Health Tiered Network |
$306.74
|
| Rate for Payer: Railroad Medicare Medicare |
$199.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.18
|
| Rate for Payer: UHC Core |
$402.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.82
|
| Rate for Payer: UHC Exchange |
$402.18
|
| Rate for Payer: UHC Medicaid |
$128.23
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$381.48 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Aetna American Axle |
$563.55
|
| Rate for Payer: Aetna Commercial |
$736.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.55
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Advantage |
$606.90
|
| Rate for Payer: Cofinity Commercial |
$745.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.60
|
| Rate for Payer: Healthscope Commercial |
$780.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$606.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PHP Commercial |
$736.95
|
| Rate for Payer: Priority Health SBD |
$546.21
|
| Rate for Payer: UMR Bronson Commercial |
$381.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.25
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.79 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$563.55
|
| Rate for Payer: Aetna Commercial |
$736.95
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.47
|
| Rate for Payer: BCN Commercial |
$1,750.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Advantage |
$606.90
|
| Rate for Payer: Cofinity Commercial |
$745.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$780.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$606.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.25
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.95
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$736.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$546.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$320.79
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.25
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna Medicare |
$88.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.98
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS MAPPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$143.92
|
| Rate for Payer: BCN Medicare Advantage |
$85.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$114.44
|
| Rate for Payer: Cofinity Commercial |
$122.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.67
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.94
|
| Rate for Payer: Nomi Health Commercial |
$102.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.50
|
| Rate for Payer: PACE SWMI |
$85.40
|
| Rate for Payer: PHP Commercial |
$119.56
|
| Rate for Payer: PHP Medicare Advantage |
$85.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$131.72
|
| Rate for Payer: Priority Health Medicare |
$85.40
|
| Rate for Payer: Priority Health SBD |
$131.72
|
| Rate for Payer: Priority Health Tiered Network |
$131.72
|
| Rate for Payer: Railroad Medicare Medicare |
$85.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.79
|
| Rate for Payer: UHC Core |
$175.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$85.40
|
| Rate for Payer: UHC Exchange |
$175.79
|
| Rate for Payer: UHC Medicaid |
$54.32
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
| Rate for Payer: UMR Bronson Commercial |
$173.88
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$285.75 |
| Rate for Payer: Aetna Commercial |
$161.58
|
| Rate for Payer: Aetna Medicare |
$125.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.64
|
| Rate for Payer: BCBS Complete |
$84.31
|
| Rate for Payer: BCBS MAPPO |
$120.58
|
| Rate for Payer: BCN Commercial |
$205.66
|
| Rate for Payer: BCN Medicare Advantage |
$120.58
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$161.58
|
| Rate for Payer: Cofinity Commercial |
$173.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.61
|
| Rate for Payer: Meridian Medicaid |
$84.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$132.64
|
| Rate for Payer: Nomi Health Commercial |
$144.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.75
|
| Rate for Payer: PACE SWMI |
$120.58
|
| Rate for Payer: PHP Commercial |
$168.81
|
| Rate for Payer: PHP Medicare Advantage |
$120.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.22
|
| Rate for Payer: Priority Health Medicare |
$120.58
|
| Rate for Payer: Priority Health SBD |
$203.22
|
| Rate for Payer: Priority Health Tiered Network |
$203.22
|
| Rate for Payer: Railroad Medicare Medicare |
$120.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.77
|
| Rate for Payer: UHC Core |
$227.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$120.58
|
| Rate for Payer: UHC Exchange |
$227.77
|
| Rate for Payer: UHC Medicaid |
$80.30
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
| Rate for Payer: UMR Bronson Commercial |
$175.26
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna Commercial |
$58.67
|
| Rate for Payer: Aetna Medicare |
$45.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.04
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS MAPPO |
$43.78
|
| Rate for Payer: BCN Commercial |
$77.69
|
| Rate for Payer: BCN Medicare Advantage |
$43.78
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Cofinity Commercial |
$63.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.97
|
| Rate for Payer: Meridian Medicaid |
$29.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.16
|
| Rate for Payer: Nomi Health Commercial |
$52.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: PACE SWMI |
$43.78
|
| Rate for Payer: PHP Commercial |
$61.29
|
| Rate for Payer: PHP Medicare Advantage |
$43.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76.76
|
| Rate for Payer: Priority Health Medicare |
$43.78
|
| Rate for Payer: Priority Health SBD |
$76.76
|
| Rate for Payer: Priority Health Tiered Network |
$76.76
|
| Rate for Payer: Railroad Medicare Medicare |
$43.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.90
|
| Rate for Payer: UHC Core |
$88.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43.78
|
| Rate for Payer: UHC Exchange |
$88.90
|
| Rate for Payer: UHC Medicaid |
$28.33
|
| Rate for Payer: UHCCP Medicaid |
$28.33
|
| Rate for Payer: UMR Bronson Commercial |
$106.26
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$216.92 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna American Axle |
$320.45
|
| Rate for Payer: Aetna Commercial |
$419.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.45
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cofinity Advantage |
$345.10
|
| Rate for Payer: Cofinity Commercial |
$423.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.40
|
| Rate for Payer: Healthscope Commercial |
$443.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.75
|
| Rate for Payer: PHP Commercial |
$419.05
|
| Rate for Payer: Priority Health SBD |
$310.59
|
| Rate for Payer: UMR Bronson Commercial |
$216.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.75
|
|
