|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 21386
|
| Min. Negotiated Rate |
$402.36 |
| Max. Negotiated Rate |
$1,134.13 |
| Rate for Payer: Aetna Commercial |
$824.96
|
| Rate for Payer: Aetna Medicare |
$640.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.52
|
| Rate for Payer: BCBS Complete |
$422.48
|
| Rate for Payer: BCBS MAPPO |
$615.64
|
| Rate for Payer: BCN Commercial |
$1,048.75
|
| Rate for Payer: BCN Medicare Advantage |
$615.64
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$824.96
|
| Rate for Payer: Cofinity Commercial |
$886.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.42
|
| Rate for Payer: Meridian Medicaid |
$422.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.20
|
| Rate for Payer: Nomi Health Commercial |
$738.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$924.00
|
| Rate for Payer: PACE SWMI |
$615.64
|
| Rate for Payer: PHP Commercial |
$861.90
|
| Rate for Payer: PHP Medicare Advantage |
$615.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,121.09
|
| Rate for Payer: Priority Health Medicare |
$615.64
|
| Rate for Payer: Priority Health SBD |
$1,121.09
|
| Rate for Payer: Priority Health Tiered Network |
$1,121.09
|
| Rate for Payer: Railroad Medicare Medicare |
$615.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.13
|
| Rate for Payer: UHC Core |
$1,134.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.64
|
| Rate for Payer: UHC Exchange |
$1,134.13
|
| Rate for Payer: UHC Medicaid |
$402.36
|
| Rate for Payer: UHCCP Medicaid |
$402.36
|
| Rate for Payer: UMR Bronson Commercial |
$566.72
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 21385
|
| Min. Negotiated Rate |
$430.05 |
| Max. Negotiated Rate |
$1,299.88 |
| Rate for Payer: Aetna Commercial |
$878.09
|
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.62
|
| Rate for Payer: BCBS Complete |
$451.55
|
| Rate for Payer: BCBS MAPPO |
$655.29
|
| Rate for Payer: BCN Commercial |
$1,106.52
|
| Rate for Payer: BCN Medicare Advantage |
$655.29
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$878.09
|
| Rate for Payer: Cofinity Commercial |
$943.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.05
|
| Rate for Payer: Meridian Medicaid |
$451.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$720.82
|
| Rate for Payer: Nomi Health Commercial |
$786.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,193.25
|
| Rate for Payer: PACE SWMI |
$655.29
|
| Rate for Payer: PHP Commercial |
$917.41
|
| Rate for Payer: PHP Medicare Advantage |
$655.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,182.83
|
| Rate for Payer: Priority Health Medicare |
$655.29
|
| 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 |
$655.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.88
|
| Rate for Payer: UHC Core |
$1,299.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$655.29
|
| Rate for Payer: UHC Exchange |
$1,299.88
|
| Rate for Payer: UHC Medicaid |
$430.05
|
| Rate for Payer: UHCCP Medicaid |
$430.05
|
| Rate for Payer: UMR Bronson Commercial |
$731.86
|
|
|
PR OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 21423
|
| Min. Negotiated Rate |
$460.29 |
| Max. Negotiated Rate |
$1,332.37 |
| Rate for Payer: Aetna Commercial |
$943.20
|
| Rate for Payer: Aetna Medicare |
$732.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,013.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.20
|
| Rate for Payer: BCBS Complete |
$483.30
|
| Rate for Payer: BCBS MAPPO |
$703.88
|
| Rate for Payer: BCN Commercial |
$1,199.14
|
| Rate for Payer: BCN Medicare Advantage |
$703.88
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cofinity Commercial |
$1,013.59
|
| Rate for Payer: Cofinity Commercial |
$943.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$739.07
|
| Rate for Payer: Meridian Medicaid |
$483.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$774.27
|
| Rate for Payer: Nomi Health Commercial |
$844.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.50
|
| Rate for Payer: PACE SWMI |
$703.88
|
| Rate for Payer: PHP Commercial |
$985.43
|
| Rate for Payer: PHP Medicare Advantage |
$703.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,281.84
|
| Rate for Payer: Priority Health Medicare |
$703.88
|
| Rate for Payer: Priority Health SBD |
$1,281.84
|
| Rate for Payer: Priority Health Tiered Network |
$1,281.84
|
| Rate for Payer: Railroad Medicare Medicare |
$703.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,332.37
|
| Rate for Payer: UHC Core |
$1,332.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.88
|
| Rate for Payer: UHC Exchange |
$1,332.37
|
| Rate for Payer: UHC Medicaid |
$460.29
|
| Rate for Payer: UHCCP Medicaid |
$460.29
|
| Rate for Payer: UMR Bronson Commercial |
$747.96
|
|
|
PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Professional
|
Both
|
$1,869.00
|
|
|
Service Code
|
HCPCS 26735
|
| Min. Negotiated Rate |
$359.97 |
| Max. Negotiated Rate |
$1,401.75 |
| Rate for Payer: Aetna Commercial |
$732.28
|
| Rate for Payer: Aetna Medicare |
$568.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.93
|
| Rate for Payer: BCBS Complete |
$377.97
|
| Rate for Payer: BCBS MAPPO |
$546.48
|
| Rate for Payer: BCN Commercial |
$916.28
|
| Rate for Payer: BCN Medicare Advantage |
$546.48
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cofinity Commercial |
$732.28
|
| Rate for Payer: Cofinity Commercial |
$786.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.80
|
| Rate for Payer: Meridian Medicaid |
$377.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$601.13
|
| Rate for Payer: Nomi Health Commercial |
$655.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.75
|
| Rate for Payer: PACE SWMI |
$546.48
|
| Rate for Payer: PHP Commercial |
$765.07
|
| Rate for Payer: PHP Medicare Advantage |
$546.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$979.49
|
| Rate for Payer: Priority Health Medicare |
$546.48
|
| Rate for Payer: Priority Health SBD |
$979.49
|
| Rate for Payer: Priority Health Tiered Network |
$979.49
|
| Rate for Payer: Railroad Medicare Medicare |
$546.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.78
|
| Rate for Payer: UHC Core |
$1,029.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$546.48
|
| Rate for Payer: UHC Exchange |
$1,029.78
|
| Rate for Payer: UHC Medicaid |
$359.97
|
| Rate for Payer: UHCCP Medicaid |
$359.97
|
| Rate for Payer: UMR Bronson Commercial |
$859.74
|
|
|
PR OPEN TX POST PELVIC FXCTURE
|
Professional
|
Both
|
$2,438.00
|
|
|
Service Code
|
HCPCS G0415
|
| Min. Negotiated Rate |
$790.23 |
| Max. Negotiated Rate |
$2,408.18 |
| Rate for Payer: Aetna Commercial |
$1,638.32
|
| Rate for Payer: Aetna Medicare |
$1,271.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,638.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,760.59
|
| Rate for Payer: BCBS Complete |
$829.74
|
| Rate for Payer: BCBS MAPPO |
$1,222.63
|
| Rate for Payer: BCN Commercial |
$2,074.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,222.63
|
| Rate for Payer: Cash Price |
$1,950.40
|
| Rate for Payer: Cash Price |
$1,950.40
|
| Rate for Payer: Cofinity Commercial |
$1,638.32
|
| Rate for Payer: Cofinity Commercial |
$1,760.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,222.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,283.76
|
| Rate for Payer: Meridian Medicaid |
$829.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,344.89
|
| Rate for Payer: Nomi Health Commercial |
$1,467.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,828.50
|
| Rate for Payer: PACE SWMI |
$1,222.63
|
| Rate for Payer: PHP Commercial |
$1,711.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,222.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$790.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,217.14
|
| Rate for Payer: Priority Health Medicare |
$1,222.63
|
| Rate for Payer: Priority Health SBD |
$2,217.14
|
| Rate for Payer: Priority Health Tiered Network |
$2,217.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,222.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,408.18
|
| Rate for Payer: UHC Core |
$2,408.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,222.63
|
| Rate for Payer: UHC Exchange |
$2,408.18
|
| Rate for Payer: UHC Medicaid |
$790.23
|
| Rate for Payer: UHCCP Medicaid |
$790.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,121.48
|
|
|
PR OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB
|
Professional
|
Both
|
$1,898.00
|
|
|
Service Code
|
HCPCS 27832
|
| Min. Negotiated Rate |
$457.10 |
| Max. Negotiated Rate |
$1,423.50 |
| Rate for Payer: Aetna Commercial |
$935.95
|
| Rate for Payer: Aetna Medicare |
$726.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,005.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$935.95
|
| Rate for Payer: BCBS Complete |
$479.95
|
| Rate for Payer: BCBS MAPPO |
$698.47
|
| Rate for Payer: BCN Commercial |
$1,160.79
|
| Rate for Payer: BCN Medicare Advantage |
$698.47
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cofinity Commercial |
$1,005.80
|
| Rate for Payer: Cofinity Commercial |
$935.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$698.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$733.39
|
| Rate for Payer: Meridian Medicaid |
$479.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$768.32
|
| Rate for Payer: Nomi Health Commercial |
$838.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,423.50
|
| Rate for Payer: PACE SWMI |
$698.47
|
| Rate for Payer: PHP Commercial |
$977.86
|
| Rate for Payer: PHP Medicare Advantage |
$698.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,240.86
|
| Rate for Payer: Priority Health Medicare |
$698.47
|
| Rate for Payer: Priority Health SBD |
$1,240.86
|
| Rate for Payer: Priority Health Tiered Network |
$1,240.86
|
| Rate for Payer: Railroad Medicare Medicare |
$698.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,318.57
|
| Rate for Payer: UHC Core |
$1,318.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$698.47
|
| Rate for Payer: UHC Exchange |
$1,318.57
|
| Rate for Payer: UHC Medicaid |
$457.10
|
| Rate for Payer: UHCCP Medicaid |
$457.10
|
| Rate for Payer: UMR Bronson Commercial |
$873.08
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE
|
Professional
|
Both
|
$2,436.00
|
|
|
Service Code
|
HCPCS 24665
|
| Min. Negotiated Rate |
$396.82 |
| Max. Negotiated Rate |
$1,827.00 |
| Rate for Payer: Aetna Commercial |
$808.88
|
| Rate for Payer: Aetna Medicare |
$627.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.24
|
| Rate for Payer: BCBS Complete |
$416.66
|
| Rate for Payer: BCBS MAPPO |
$603.64
|
| Rate for Payer: BCN Commercial |
$1,010.90
|
| Rate for Payer: BCN Medicare Advantage |
$603.64
|
| Rate for Payer: Cash Price |
$1,948.80
|
| Rate for Payer: Cash Price |
$1,948.80
|
| Rate for Payer: Cofinity Commercial |
$808.88
|
| Rate for Payer: Cofinity Commercial |
$869.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.82
|
| Rate for Payer: Meridian Medicaid |
$416.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$664.00
|
| Rate for Payer: Nomi Health Commercial |
$724.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,827.00
|
| Rate for Payer: PACE SWMI |
$603.64
|
| Rate for Payer: PHP Commercial |
$845.10
|
| Rate for Payer: PHP Medicare Advantage |
$603.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,080.62
|
| Rate for Payer: Priority Health Medicare |
$603.64
|
| Rate for Payer: Priority Health SBD |
$1,080.62
|
| Rate for Payer: Priority Health Tiered Network |
$1,080.62
|
| Rate for Payer: Railroad Medicare Medicare |
$603.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,137.19
|
| Rate for Payer: UHC Core |
$1,137.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.64
|
| Rate for Payer: UHC Exchange |
$1,137.19
|
| Rate for Payer: UHC Medicaid |
$396.82
|
| Rate for Payer: UHCCP Medicaid |
$396.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,120.56
|
|
|
PR OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 25670
|
| Min. Negotiated Rate |
$369.98 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna Commercial |
$756.76
|
| Rate for Payer: Aetna Medicare |
$587.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$756.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.24
|
| Rate for Payer: BCBS Complete |
$388.48
|
| Rate for Payer: BCBS MAPPO |
$564.75
|
| Rate for Payer: BCN Commercial |
$930.23
|
| Rate for Payer: BCN Medicare Advantage |
$564.75
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$756.76
|
| Rate for Payer: Cofinity Commercial |
$813.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.99
|
| Rate for Payer: Meridian Medicaid |
$388.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$621.23
|
| Rate for Payer: Nomi Health Commercial |
$677.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,533.00
|
| Rate for Payer: PACE SWMI |
$564.75
|
| Rate for Payer: PHP Commercial |
$790.65
|
| Rate for Payer: PHP Medicare Advantage |
$564.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$994.38
|
| Rate for Payer: Priority Health Medicare |
$564.75
|
| Rate for Payer: Priority Health SBD |
$994.38
|
| Rate for Payer: Priority Health Tiered Network |
$994.38
|
| Rate for Payer: Railroad Medicare Medicare |
$564.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,058.65
|
| Rate for Payer: UHC Core |
$1,058.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$564.75
|
| Rate for Payer: UHC Exchange |
$1,058.65
|
| Rate for Payer: UHC Medicaid |
$369.98
|
| Rate for Payer: UHCCP Medicaid |
$369.98
|
| Rate for Payer: UMR Bronson Commercial |
$940.24
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 21811
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$1,060.67 |
| Rate for Payer: Aetna Commercial |
$732.58
|
| Rate for Payer: Aetna Medicare |
$568.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.25
|
| Rate for Payer: BCBS Complete |
$364.77
|
| Rate for Payer: BCBS MAPPO |
$546.70
|
| Rate for Payer: BCN Commercial |
$881.42
|
| Rate for Payer: BCN Medicare Advantage |
$546.70
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$732.58
|
| Rate for Payer: Cofinity Commercial |
$787.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.03
|
| Rate for Payer: Meridian Medicaid |
$364.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$601.37
|
| Rate for Payer: Nomi Health Commercial |
$656.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PACE SWMI |
$546.70
|
| Rate for Payer: PHP Commercial |
$765.38
|
| Rate for Payer: PHP Medicare Advantage |
$546.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$942.22
|
| Rate for Payer: Priority Health Medicare |
$546.70
|
| Rate for Payer: Priority Health SBD |
$942.22
|
| Rate for Payer: Priority Health Tiered Network |
$942.22
|
| Rate for Payer: Railroad Medicare Medicare |
$546.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,060.67
|
| Rate for Payer: UHC Core |
$1,060.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$546.70
|
| Rate for Payer: UHC Exchange |
$1,060.67
|
| Rate for Payer: UHC Medicaid |
$347.40
|
| Rate for Payer: UHCCP Medicaid |
$347.40
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 21812
|
| Min. Negotiated Rate |
$417.91 |
| Max. Negotiated Rate |
$1,362.00 |
| Rate for Payer: Aetna Commercial |
$880.80
|
| Rate for Payer: Aetna Medicare |
$683.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$880.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.53
|
| Rate for Payer: BCBS Complete |
$438.81
|
| Rate for Payer: BCBS MAPPO |
$657.31
|
| Rate for Payer: BCN Commercial |
$1,067.17
|
| Rate for Payer: BCN Medicare Advantage |
$657.31
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cofinity Commercial |
$880.80
|
| Rate for Payer: Cofinity Commercial |
$946.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.18
|
| Rate for Payer: Meridian Medicaid |
$438.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$723.04
|
| Rate for Payer: Nomi Health Commercial |
$788.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,362.00
|
| Rate for Payer: PACE SWMI |
$657.31
|
| Rate for Payer: PHP Commercial |
$920.23
|
| Rate for Payer: PHP Medicare Advantage |
$657.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$417.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,140.79
|
| Rate for Payer: Priority Health Medicare |
$657.31
|
| Rate for Payer: Priority Health SBD |
$1,140.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,140.79
|
| Rate for Payer: Railroad Medicare Medicare |
$657.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.92
|
| Rate for Payer: UHC Core |
$1,292.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$657.31
|
| Rate for Payer: UHC Exchange |
$1,292.92
|
| Rate for Payer: UHC Medicaid |
$417.91
|
| Rate for Payer: UHCCP Medicaid |
$417.91
|
| Rate for Payer: UMR Bronson Commercial |
$835.36
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS
|
Professional
|
Both
|
$2,045.00
|
|
|
Service Code
|
HCPCS 21813
|
| Min. Negotiated Rate |
$568.50 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Aetna Medicare |
$932.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,201.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,291.67
|
| Rate for Payer: BCBS Complete |
$596.92
|
| Rate for Payer: BCBS MAPPO |
$896.99
|
| Rate for Payer: BCN Commercial |
$1,462.07
|
| Rate for Payer: BCN Medicare Advantage |
$896.99
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cofinity Commercial |
$1,201.97
|
| Rate for Payer: Cofinity Commercial |
$1,291.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$896.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$941.84
|
| Rate for Payer: Meridian Medicaid |
$596.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$986.69
|
| Rate for Payer: Nomi Health Commercial |
$1,076.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,533.75
|
| Rate for Payer: PACE SWMI |
$896.99
|
| Rate for Payer: PHP Commercial |
$1,255.79
|
| Rate for Payer: PHP Medicare Advantage |
$896.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,562.91
|
| Rate for Payer: Priority Health Medicare |
$896.99
|
| Rate for Payer: Priority Health SBD |
$1,562.91
|
| Rate for Payer: Priority Health Tiered Network |
$1,562.91
|
| Rate for Payer: Railroad Medicare Medicare |
$896.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,768.50
|
| Rate for Payer: UHC Core |
$1,768.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$896.99
|
| Rate for Payer: UHC Exchange |
$1,768.50
|
| Rate for Payer: UHC Medicaid |
$568.50
|
| Rate for Payer: UHCCP Medicaid |
$568.50
|
| Rate for Payer: UMR Bronson Commercial |
$940.70
|
|
|
PR OPEN TX SCAPULAR FX W/INT FIXATION WHEN PFRMD
|
Professional
|
Both
|
$3,288.00
|
|
|
Service Code
|
HCPCS 23585
|
| Min. Negotiated Rate |
$571.05 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Aetna Commercial |
$1,176.81
|
| Rate for Payer: Aetna Medicare |
$913.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,176.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,264.64
|
| Rate for Payer: BCBS Complete |
$599.60
|
| Rate for Payer: BCBS MAPPO |
$878.22
|
| Rate for Payer: BCN Commercial |
$1,480.50
|
| Rate for Payer: BCN Medicare Advantage |
$878.22
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$1,176.81
|
| Rate for Payer: Cofinity Commercial |
$1,264.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$878.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$922.13
|
| Rate for Payer: Meridian Medicaid |
$599.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$966.04
|
| Rate for Payer: Nomi Health Commercial |
$1,053.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,466.00
|
| Rate for Payer: PACE SWMI |
$878.22
|
| Rate for Payer: PHP Commercial |
$1,229.51
|
| Rate for Payer: PHP Medicare Advantage |
$878.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,582.61
|
| Rate for Payer: Priority Health Medicare |
$878.22
|
| Rate for Payer: Priority Health SBD |
$1,582.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,582.61
|
| Rate for Payer: Railroad Medicare Medicare |
$878.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,715.85
|
| Rate for Payer: UHC Core |
$1,715.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$878.22
|
| Rate for Payer: UHC Exchange |
$1,715.85
|
| Rate for Payer: UHC Medicaid |
$571.05
|
| Rate for Payer: UHCCP Medicaid |
$571.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,512.48
|
|
|
PR OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 28531
|
| Min. Negotiated Rate |
$111.40 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Aetna Commercial |
$225.52
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.35
|
| Rate for Payer: BCBS Complete |
$116.97
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCN Commercial |
$277.87
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$225.52
|
| Rate for Payer: Cofinity Commercial |
$242.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$116.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.13
|
| Rate for Payer: Nomi Health Commercial |
$201.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.50
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$235.62
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.03
|
| Rate for Payer: Priority Health Medicare |
$168.30
|
| Rate for Payer: Priority Health SBD |
$297.03
|
| Rate for Payer: Priority Health Tiered Network |
$297.03
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.77
|
| Rate for Payer: UHC Core |
$314.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.30
|
| Rate for Payer: UHC Exchange |
$314.77
|
| Rate for Payer: UHC Medicaid |
$111.40
|
| Rate for Payer: UHCCP Medicaid |
$111.40
|
| Rate for Payer: UMR Bronson Commercial |
$317.40
|
|
|
PR OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
HCPCS 23530
|
| Min. Negotiated Rate |
$350.17 |
| Max. Negotiated Rate |
$1,893.75 |
| Rate for Payer: Aetna Commercial |
$715.06
|
| Rate for Payer: Aetna Medicare |
$554.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.43
|
| Rate for Payer: BCBS Complete |
$367.68
|
| Rate for Payer: BCBS MAPPO |
$533.63
|
| Rate for Payer: BCN Commercial |
$884.91
|
| Rate for Payer: BCN Medicare Advantage |
$533.63
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cofinity Commercial |
$715.06
|
| Rate for Payer: Cofinity Commercial |
$768.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$533.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$560.31
|
| Rate for Payer: Meridian Medicaid |
$367.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$586.99
|
| Rate for Payer: Nomi Health Commercial |
$640.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,893.75
|
| Rate for Payer: PACE SWMI |
$533.63
|
| Rate for Payer: PHP Commercial |
$747.08
|
| Rate for Payer: PHP Medicare Advantage |
$533.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$945.95
|
| Rate for Payer: Priority Health Medicare |
$533.63
|
| Rate for Payer: Priority Health SBD |
$945.95
|
| Rate for Payer: Priority Health Tiered Network |
$945.95
|
| Rate for Payer: Railroad Medicare Medicare |
$533.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$998.62
|
| Rate for Payer: UHC Core |
$998.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$533.63
|
| Rate for Payer: UHC Exchange |
$998.62
|
| Rate for Payer: UHC Medicaid |
$350.17
|
| Rate for Payer: UHCCP Medicaid |
$350.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.50
|
|
|
PR OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 21825
|
| Min. Negotiated Rate |
$359.54 |
| Max. Negotiated Rate |
$949.19 |
| Rate for Payer: Aetna Commercial |
$737.32
|
| Rate for Payer: Aetna Medicare |
$572.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.35
|
| Rate for Payer: BCBS Complete |
$377.52
|
| Rate for Payer: BCBS MAPPO |
$550.24
|
| Rate for Payer: BCN Commercial |
$837.11
|
| Rate for Payer: BCN Medicare Advantage |
$550.24
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cofinity Commercial |
$737.32
|
| Rate for Payer: Cofinity Commercial |
$792.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.75
|
| Rate for Payer: Meridian Medicaid |
$377.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.26
|
| Rate for Payer: Nomi Health Commercial |
$660.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$775.50
|
| Rate for Payer: PACE SWMI |
$550.24
|
| Rate for Payer: PHP Commercial |
$770.34
|
| Rate for Payer: PHP Medicare Advantage |
$550.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$894.84
|
| Rate for Payer: Priority Health Medicare |
$550.24
|
| Rate for Payer: Priority Health SBD |
$894.84
|
| Rate for Payer: Priority Health Tiered Network |
$894.84
|
| Rate for Payer: Railroad Medicare Medicare |
$550.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$949.19
|
| Rate for Payer: UHC Core |
$949.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.24
|
| Rate for Payer: UHC Exchange |
$949.19
|
| Rate for Payer: UHC Medicaid |
$359.54
|
| Rate for Payer: UHCCP Medicaid |
$359.54
|
| Rate for Payer: UMR Bronson Commercial |
$475.64
|
|
|
PR OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 28465
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$1,213.50 |
| Rate for Payer: Aetna Commercial |
$804.58
|
| Rate for Payer: Aetna Medicare |
$624.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.62
|
| Rate for Payer: BCBS Complete |
$414.88
|
| Rate for Payer: BCBS MAPPO |
$600.43
|
| Rate for Payer: BCN Commercial |
$980.03
|
| Rate for Payer: BCN Medicare Advantage |
$600.43
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cofinity Commercial |
$804.58
|
| Rate for Payer: Cofinity Commercial |
$864.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.45
|
| Rate for Payer: Meridian Medicaid |
$414.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$660.47
|
| Rate for Payer: Nomi Health Commercial |
$720.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,213.50
|
| Rate for Payer: PACE SWMI |
$600.43
|
| Rate for Payer: PHP Commercial |
$840.60
|
| Rate for Payer: PHP Medicare Advantage |
$600.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,047.62
|
| Rate for Payer: Priority Health Medicare |
$600.43
|
| Rate for Payer: Priority Health SBD |
$1,047.62
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.62
|
| Rate for Payer: Railroad Medicare Medicare |
$600.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.10
|
| Rate for Payer: UHC Core |
$1,098.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$600.43
|
| Rate for Payer: UHC Exchange |
$1,098.10
|
| Rate for Payer: UHC Medicaid |
$395.12
|
| Rate for Payer: UHCCP Medicaid |
$395.12
|
| Rate for Payer: UMR Bronson Commercial |
$744.28
|
|
|
PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$2,870.00
|
|
|
Service Code
|
HCPCS 27535
|
| Min. Negotiated Rate |
$519.93 |
| Max. Negotiated Rate |
$2,152.50 |
| Rate for Payer: Aetna Commercial |
$1,074.95
|
| Rate for Payer: Aetna Medicare |
$834.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.17
|
| Rate for Payer: BCBS Complete |
$545.93
|
| Rate for Payer: BCBS MAPPO |
$802.20
|
| Rate for Payer: BCN Commercial |
$1,356.50
|
| Rate for Payer: BCN Medicare Advantage |
$802.20
|
| Rate for Payer: Cash Price |
$2,296.00
|
| Rate for Payer: Cash Price |
$2,296.00
|
| Rate for Payer: Cofinity Commercial |
$1,074.95
|
| Rate for Payer: Cofinity Commercial |
$1,155.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$842.31
|
| Rate for Payer: Meridian Medicaid |
$545.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$882.42
|
| Rate for Payer: Nomi Health Commercial |
$962.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,152.50
|
| Rate for Payer: PACE SWMI |
$802.20
|
| Rate for Payer: PHP Commercial |
$1,123.08
|
| Rate for Payer: PHP Medicare Advantage |
$802.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$519.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,450.06
|
| Rate for Payer: Priority Health Medicare |
$802.20
|
| Rate for Payer: Priority Health SBD |
$1,450.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,450.06
|
| Rate for Payer: Railroad Medicare Medicare |
$802.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.01
|
| Rate for Payer: UHC Core |
$1,577.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$802.20
|
| Rate for Payer: UHC Exchange |
$1,577.01
|
| Rate for Payer: UHC Medicaid |
$519.93
|
| Rate for Payer: UHCCP Medicaid |
$519.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,320.20
|
|
|
PR OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC
|
Professional
|
Both
|
$2,171.00
|
|
|
Service Code
|
HCPCS 25685
|
| Min. Negotiated Rate |
$440.91 |
| Max. Negotiated Rate |
$1,628.25 |
| Rate for Payer: Aetna Commercial |
$904.39
|
| Rate for Payer: Aetna Medicare |
$701.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$904.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.88
|
| Rate for Payer: BCBS Complete |
$462.96
|
| Rate for Payer: BCBS MAPPO |
$674.92
|
| Rate for Payer: BCN Commercial |
$1,124.94
|
| Rate for Payer: BCN Medicare Advantage |
$674.92
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Cofinity Commercial |
$904.39
|
| Rate for Payer: Cofinity Commercial |
$971.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$674.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$708.67
|
| Rate for Payer: Meridian Medicaid |
$462.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$742.41
|
| Rate for Payer: Nomi Health Commercial |
$809.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,628.25
|
| Rate for Payer: PACE SWMI |
$674.92
|
| Rate for Payer: PHP Commercial |
$944.89
|
| Rate for Payer: PHP Medicare Advantage |
$674.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.53
|
| Rate for Payer: Priority Health Medicare |
$674.92
|
| Rate for Payer: Priority Health SBD |
$1,202.53
|
| Rate for Payer: Priority Health Tiered Network |
$1,202.53
|
| Rate for Payer: Railroad Medicare Medicare |
$674.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.56
|
| Rate for Payer: UHC Core |
$1,283.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$674.92
|
| Rate for Payer: UHC Exchange |
$1,283.56
|
| Rate for Payer: UHC Medicaid |
$440.91
|
| Rate for Payer: UHCCP Medicaid |
$440.91
|
| Rate for Payer: UMR Bronson Commercial |
$998.66
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP
|
Professional
|
Both
|
$4,293.00
|
|
|
Service Code
|
HCPCS 27823
|
| Min. Negotiated Rate |
$588.73 |
| Max. Negotiated Rate |
$3,219.75 |
| Rate for Payer: Aetna Commercial |
$1,203.88
|
| Rate for Payer: Aetna Medicare |
$934.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,293.72
|
| Rate for Payer: BCBS Complete |
$618.17
|
| Rate for Payer: BCBS MAPPO |
$898.42
|
| Rate for Payer: BCN Commercial |
$1,488.46
|
| Rate for Payer: BCN Medicare Advantage |
$898.42
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cofinity Commercial |
$1,203.88
|
| Rate for Payer: Cofinity Commercial |
$1,293.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.34
|
| Rate for Payer: Meridian Medicaid |
$618.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$988.26
|
| Rate for Payer: Nomi Health Commercial |
$1,078.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,219.75
|
| Rate for Payer: PACE SWMI |
$898.42
|
| Rate for Payer: PHP Commercial |
$1,257.79
|
| Rate for Payer: PHP Medicare Advantage |
$898.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$588.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,591.13
|
| Rate for Payer: Priority Health Medicare |
$898.42
|
| Rate for Payer: Priority Health SBD |
$1,591.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,591.13
|
| Rate for Payer: Railroad Medicare Medicare |
$898.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,707.04
|
| Rate for Payer: UHC Core |
$1,707.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$898.42
|
| Rate for Payer: UHC Exchange |
$1,707.04
|
| Rate for Payer: UHC Medicaid |
$588.73
|
| Rate for Payer: UHCCP Medicaid |
$588.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,974.78
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$3,643.00
|
|
|
Service Code
|
HCPCS 27822
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$2,732.25 |
| Rate for Payer: Aetna Commercial |
$1,074.21
|
| Rate for Payer: Aetna Medicare |
$833.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.38
|
| Rate for Payer: BCBS Complete |
$553.31
|
| Rate for Payer: BCBS MAPPO |
$801.65
|
| Rate for Payer: BCN Commercial |
$1,321.64
|
| Rate for Payer: BCN Medicare Advantage |
$801.65
|
| Rate for Payer: Cash Price |
$2,914.40
|
| Rate for Payer: Cash Price |
$2,914.40
|
| Rate for Payer: Cofinity Commercial |
$1,074.21
|
| Rate for Payer: Cofinity Commercial |
$1,154.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.73
|
| Rate for Payer: Meridian Medicaid |
$553.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$881.82
|
| Rate for Payer: Nomi Health Commercial |
$961.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,732.25
|
| Rate for Payer: PACE SWMI |
$801.65
|
| Rate for Payer: PHP Commercial |
$1,122.31
|
| Rate for Payer: PHP Medicare Advantage |
$801.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,412.80
|
| Rate for Payer: Priority Health Medicare |
$801.65
|
| Rate for Payer: Priority Health SBD |
$1,412.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,412.80
|
| Rate for Payer: Railroad Medicare Medicare |
$801.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,506.11
|
| Rate for Payer: UHC Core |
$1,506.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$801.65
|
| Rate for Payer: UHC Exchange |
$1,506.11
|
| Rate for Payer: UHC Medicaid |
$526.96
|
| Rate for Payer: UHCCP Medicaid |
$526.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,675.78
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 92014
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna Medicare |
$63.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.04
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$61.14
|
| Rate for Payer: BCN Commercial |
$81.01
|
| Rate for Payer: BCN Medicare Advantage |
$61.14
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$81.93
|
| Rate for Payer: Cofinity Commercial |
$88.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.20
|
| Rate for Payer: Meridian Medicaid |
$41.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.25
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: PACE SWMI |
$61.14
|
| Rate for Payer: PHP Commercial |
$85.60
|
| Rate for Payer: PHP Medicare Advantage |
$61.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.02
|
| Rate for Payer: Priority Health Medicare |
$61.14
|
| Rate for Payer: Priority Health SBD |
$95.02
|
| Rate for Payer: Priority Health Tiered Network |
$95.02
|
| Rate for Payer: Railroad Medicare Medicare |
$61.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.91
|
| Rate for Payer: UHC Core |
$98.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.14
|
| Rate for Payer: UHC Exchange |
$98.91
|
| Rate for Payer: UHC Medicaid |
$39.62
|
| Rate for Payer: UHCCP Medicaid |
$39.62
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 92004
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$102.68
|
| Rate for Payer: Aetna Medicare |
$79.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.35
|
| Rate for Payer: BCBS Complete |
$52.11
|
| Rate for Payer: BCBS MAPPO |
$76.63
|
| Rate for Payer: BCN Commercial |
$100.26
|
| Rate for Payer: BCN Medicare Advantage |
$76.63
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$102.68
|
| Rate for Payer: Cofinity Commercial |
$110.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.46
|
| Rate for Payer: Meridian Medicaid |
$52.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.29
|
| Rate for Payer: Nomi Health Commercial |
$91.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$76.63
|
| Rate for Payer: PHP Commercial |
$107.28
|
| Rate for Payer: PHP Medicare Advantage |
$76.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$117.61
|
| Rate for Payer: Priority Health Medicare |
$76.63
|
| Rate for Payer: Priority Health SBD |
$117.61
|
| Rate for Payer: Priority Health Tiered Network |
$117.61
|
| Rate for Payer: Railroad Medicare Medicare |
$76.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.03
|
| Rate for Payer: UHC Core |
$123.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.63
|
| Rate for Payer: UHC Exchange |
$123.03
|
| Rate for Payer: UHC Medicaid |
$49.63
|
| Rate for Payer: UHCCP Medicaid |
$49.63
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 92012
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$42.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.61
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$40.70
|
| Rate for Payer: BCN Commercial |
$53.76
|
| Rate for Payer: BCN Medicare Advantage |
$40.70
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$54.54
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.73
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.77
|
| Rate for Payer: Nomi Health Commercial |
$48.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.25
|
| Rate for Payer: PACE SWMI |
$40.70
|
| Rate for Payer: PHP Commercial |
$56.98
|
| Rate for Payer: PHP Medicare Advantage |
$40.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$63.06
|
| Rate for Payer: Priority Health Medicare |
$40.70
|
| Rate for Payer: Priority Health SBD |
$63.06
|
| Rate for Payer: Priority Health Tiered Network |
$63.06
|
| Rate for Payer: Railroad Medicare Medicare |
$40.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.13
|
| Rate for Payer: UHC Core |
$65.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.70
|
| Rate for Payer: UHC Exchange |
$65.13
|
| Rate for Payer: UHC Medicaid |
$26.41
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE NEW PT
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 92002
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$49.79
|
| Rate for Payer: Aetna Medicare |
$38.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.51
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS MAPPO |
$37.16
|
| Rate for Payer: BCN Commercial |
$48.68
|
| Rate for Payer: BCN Medicare Advantage |
$37.16
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$49.79
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.02
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.88
|
| Rate for Payer: Nomi Health Commercial |
$44.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.50
|
| Rate for Payer: PACE SWMI |
$37.16
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$37.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.09
|
| Rate for Payer: Priority Health Medicare |
$37.16
|
| Rate for Payer: Priority Health SBD |
$57.09
|
| Rate for Payer: Priority Health Tiered Network |
$57.09
|
| Rate for Payer: Railroad Medicare Medicare |
$37.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.50
|
| Rate for Payer: UHC Core |
$59.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.16
|
| Rate for Payer: UHC Exchange |
$59.50
|
| Rate for Payer: UHC Medicaid |
$24.07
|
| Rate for Payer: UHCCP Medicaid |
$24.07
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE, FEMORAL NECK AND PROXIMAL FEMUR
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,356.35
|
| Rate for Payer: BCN Commercial |
$4,356.35
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
