|
PR OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 28505
|
| Min. Negotiated Rate |
$475.10 |
| Max. Negotiated Rate |
$933.40 |
| Rate for Payer: Aetna Commercial |
$636.63
|
| Rate for Payer: Aetna Medicare |
$494.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$636.63
|
| Rate for Payer: BCBS Complete |
$574.40
|
| Rate for Payer: BCBS MAPPO |
$475.10
|
| Rate for Payer: BCN Medicare Advantage |
$475.10
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$684.14
|
| Rate for Payer: Cofinity Commercial |
$636.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.86
|
| Rate for Payer: Nomi Health Commercial |
$570.12
|
| Rate for Payer: PACE SWMI |
$475.10
|
| Rate for Payer: PHP Commercial |
$665.14
|
| Rate for Payer: PHP Medicare Advantage |
$475.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health Medicare |
$475.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.10
|
| Rate for Payer: UHC Medicare Advantage |
$475.10
|
| Rate for Payer: UMR Bronson Commercial |
$660.56
|
|
|
PR OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 28525
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$554.13 |
| Rate for Payer: Aetna Commercial |
$515.65
|
| Rate for Payer: Aetna Medicare |
$400.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.65
|
| Rate for Payer: BCBS Complete |
$246.40
|
| Rate for Payer: BCBS MAPPO |
$384.81
|
| Rate for Payer: BCN Medicare Advantage |
$384.81
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$554.13
|
| Rate for Payer: Cofinity Commercial |
$515.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$404.05
|
| Rate for Payer: Nomi Health Commercial |
$461.77
|
| Rate for Payer: PACE SWMI |
$384.81
|
| Rate for Payer: PHP Commercial |
$538.73
|
| Rate for Payer: PHP Medicare Advantage |
$384.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$384.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.81
|
| Rate for Payer: UHC Medicare Advantage |
$384.81
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
|
|
PR OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT
|
Professional
|
Both
|
$1,172.00
|
|
|
Service Code
|
HCPCS 21407
|
| Min. Negotiated Rate |
$468.80 |
| Max. Negotiated Rate |
$887.07 |
| Rate for Payer: Aetna Commercial |
$825.47
|
| Rate for Payer: Aetna Medicare |
$640.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.47
|
| Rate for Payer: BCBS Complete |
$468.80
|
| Rate for Payer: BCBS MAPPO |
$616.02
|
| Rate for Payer: BCN Medicare Advantage |
$616.02
|
| Rate for Payer: Cash Price |
$937.60
|
| Rate for Payer: Cash Price |
$937.60
|
| Rate for Payer: Cofinity Commercial |
$887.07
|
| Rate for Payer: Cofinity Commercial |
$825.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.82
|
| Rate for Payer: Nomi Health Commercial |
$739.22
|
| Rate for Payer: PACE SWMI |
$616.02
|
| Rate for Payer: PHP Commercial |
$862.43
|
| Rate for Payer: PHP Medicare Advantage |
$616.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.80
|
| Rate for Payer: Priority Health Medicare |
$616.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.02
|
| Rate for Payer: UHC Medicare Advantage |
$616.02
|
| Rate for Payer: UMR Bronson Commercial |
$539.12
|
|
|
PR OPEN TX HUMERAL EPICONDYLAR FRACTURE
|
Professional
|
Both
|
$2,436.00
|
|
|
Service Code
|
HCPCS 24575
|
| Min. Negotiated Rate |
$709.52 |
| Max. Negotiated Rate |
$1,583.40 |
| Rate for Payer: Aetna Commercial |
$950.76
|
| Rate for Payer: Aetna Medicare |
$737.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$950.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,021.71
|
| Rate for Payer: BCBS Complete |
$974.40
|
| Rate for Payer: BCBS MAPPO |
$709.52
|
| Rate for Payer: BCN Medicare Advantage |
$709.52
|
| Rate for Payer: Cash Price |
$1,948.80
|
| Rate for Payer: Cash Price |
$1,948.80
|
| Rate for Payer: Cofinity Commercial |
$950.76
|
| Rate for Payer: Cofinity Commercial |
$1,021.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$745.00
|
| Rate for Payer: Nomi Health Commercial |
$851.42
|
| Rate for Payer: PACE SWMI |
$709.52
|
| Rate for Payer: PHP Commercial |
$993.33
|
| Rate for Payer: PHP Medicare Advantage |
$709.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,583.40
|
| Rate for Payer: Priority Health Medicare |
$709.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.52
|
| Rate for Payer: UHC Medicare Advantage |
$709.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,120.56
|
|
|
PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$3,045.00
|
|
|
Service Code
|
HCPCS 24545
|
| Min. Negotiated Rate |
$897.03 |
| Max. Negotiated Rate |
$1,979.25 |
| Rate for Payer: Aetna Commercial |
$1,202.02
|
| Rate for Payer: Aetna Medicare |
$932.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,291.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.02
|
| Rate for Payer: BCBS Complete |
$1,218.00
|
| Rate for Payer: BCBS MAPPO |
$897.03
|
| Rate for Payer: BCN Medicare Advantage |
$897.03
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cofinity Commercial |
$1,291.72
|
| Rate for Payer: Cofinity Commercial |
$1,202.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$897.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$941.88
|
| Rate for Payer: Nomi Health Commercial |
$1,076.44
|
| Rate for Payer: PACE SWMI |
$897.03
|
| Rate for Payer: PHP Commercial |
$1,255.84
|
| Rate for Payer: PHP Medicare Advantage |
$897.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,979.25
|
| Rate for Payer: Priority Health Medicare |
$897.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$897.03
|
| Rate for Payer: UHC Medicare Advantage |
$897.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,400.70
|
|
|
PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN
|
Professional
|
Both
|
$3,982.00
|
|
|
Service Code
|
HCPCS 24546
|
| Min. Negotiated Rate |
$1,001.71 |
| Max. Negotiated Rate |
$2,588.30 |
| Rate for Payer: Aetna Commercial |
$1,342.29
|
| Rate for Payer: Aetna Medicare |
$1,041.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,342.29
|
| Rate for Payer: BCBS Complete |
$1,592.80
|
| Rate for Payer: BCBS MAPPO |
$1,001.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,001.71
|
| Rate for Payer: Cash Price |
$3,185.60
|
| Rate for Payer: Cash Price |
$3,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,442.46
|
| Rate for Payer: Cofinity Commercial |
$1,342.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,001.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,051.80
|
| Rate for Payer: Nomi Health Commercial |
$1,202.05
|
| Rate for Payer: PACE SWMI |
$1,001.71
|
| Rate for Payer: PHP Commercial |
$1,402.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,001.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,588.30
|
| Rate for Payer: Priority Health Medicare |
$1,001.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,001.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,001.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,831.72
|
|
|
PR OPEN TX ILIAC SPINE UNI/BIL
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS G0412
|
| Min. Negotiated Rate |
$699.08 |
| Max. Negotiated Rate |
$1,712.10 |
| Rate for Payer: Aetna Commercial |
$936.77
|
| Rate for Payer: Aetna Medicare |
$727.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.68
|
| Rate for Payer: BCBS Complete |
$1,053.60
|
| Rate for Payer: BCBS MAPPO |
$699.08
|
| Rate for Payer: BCN Medicare Advantage |
$699.08
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Cofinity Commercial |
$936.77
|
| Rate for Payer: Cofinity Commercial |
$1,006.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$734.03
|
| Rate for Payer: Nomi Health Commercial |
$838.90
|
| Rate for Payer: PACE SWMI |
$699.08
|
| Rate for Payer: PHP Commercial |
$978.71
|
| Rate for Payer: PHP Medicare Advantage |
$699.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.10
|
| Rate for Payer: Priority Health Medicare |
$699.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.08
|
| Rate for Payer: UHC Medicare Advantage |
$699.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,211.64
|
|
|
PR OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE
|
Professional
|
Both
|
$2,749.00
|
|
|
Service Code
|
HCPCS 27540
|
| Min. Negotiated Rate |
$787.24 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,054.90
|
| Rate for Payer: Aetna Medicare |
$818.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,054.90
|
| Rate for Payer: BCBS Complete |
$1,099.60
|
| Rate for Payer: BCBS MAPPO |
$787.24
|
| Rate for Payer: BCN Medicare Advantage |
$787.24
|
| Rate for Payer: Cash Price |
$2,199.20
|
| Rate for Payer: Cash Price |
$2,199.20
|
| Rate for Payer: Cofinity Commercial |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,054.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.60
|
| Rate for Payer: Nomi Health Commercial |
$944.69
|
| Rate for Payer: PACE SWMI |
$787.24
|
| Rate for Payer: PHP Commercial |
$1,102.14
|
| Rate for Payer: PHP Medicare Advantage |
$787.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,786.85
|
| Rate for Payer: Priority Health Medicare |
$787.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.24
|
| Rate for Payer: UHC Medicare Advantage |
$787.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,264.54
|
|
|
PR OPEN TX INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26785
|
| Min. Negotiated Rate |
$531.22 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$711.83
|
| Rate for Payer: Aetna Medicare |
$552.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.83
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$531.22
|
| Rate for Payer: BCN Medicare Advantage |
$531.22
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$764.96
|
| Rate for Payer: Cofinity Commercial |
$711.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.78
|
| Rate for Payer: Nomi Health Commercial |
$637.46
|
| Rate for Payer: PACE SWMI |
$531.22
|
| Rate for Payer: PHP Commercial |
$743.71
|
| Rate for Payer: PHP Medicare Advantage |
$531.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$531.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.22
|
| Rate for Payer: UHC Medicare Advantage |
$531.22
|
| Rate for Payer: UMR Bronson Commercial |
$708.40
|
|
|
PR OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 27557
|
| Min. Negotiated Rate |
$860.00 |
| Max. Negotiated Rate |
$1,448.05 |
| Rate for Payer: Aetna Commercial |
$1,347.49
|
| Rate for Payer: Aetna Medicare |
$1,045.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.49
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$1,005.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.59
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$1,448.05
|
| Rate for Payer: Cofinity Commercial |
$1,347.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,055.87
|
| Rate for Payer: Nomi Health Commercial |
$1,206.71
|
| Rate for Payer: PACE SWMI |
$1,005.59
|
| Rate for Payer: PHP Commercial |
$1,407.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$1,005.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,005.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,005.59
|
| Rate for Payer: UMR Bronson Commercial |
$989.00
|
|
|
PR OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 27556
|
| Min. Negotiated Rate |
$710.00 |
| Max. Negotiated Rate |
$1,214.96 |
| Rate for Payer: Aetna Commercial |
$1,130.58
|
| Rate for Payer: Aetna Medicare |
$877.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,130.58
|
| Rate for Payer: BCBS Complete |
$710.00
|
| Rate for Payer: BCBS MAPPO |
$843.72
|
| Rate for Payer: BCN Medicare Advantage |
$843.72
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cofinity Commercial |
$1,214.96
|
| Rate for Payer: Cofinity Commercial |
$1,130.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$843.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$885.91
|
| Rate for Payer: Nomi Health Commercial |
$1,012.46
|
| Rate for Payer: PACE SWMI |
$843.72
|
| Rate for Payer: PHP Commercial |
$1,181.21
|
| Rate for Payer: PHP Medicare Advantage |
$843.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.75
|
| Rate for Payer: Priority Health Medicare |
$843.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$843.72
|
| Rate for Payer: UHC Medicare Advantage |
$843.72
|
| Rate for Payer: UMR Bronson Commercial |
$816.50
|
|
|
PR OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION
|
Professional
|
Both
|
$5,350.00
|
|
|
Service Code
|
HCPCS 27558
|
| Min. Negotiated Rate |
$1,144.46 |
| Max. Negotiated Rate |
$3,477.50 |
| Rate for Payer: Aetna Commercial |
$1,533.58
|
| Rate for Payer: Aetna Medicare |
$1,190.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,533.58
|
| Rate for Payer: BCBS Complete |
$2,140.00
|
| Rate for Payer: BCBS MAPPO |
$1,144.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.46
|
| Rate for Payer: Cash Price |
$4,280.00
|
| Rate for Payer: Cash Price |
$4,280.00
|
| Rate for Payer: Cofinity Commercial |
$1,648.02
|
| Rate for Payer: Cofinity Commercial |
$1,533.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,201.68
|
| Rate for Payer: Nomi Health Commercial |
$1,373.35
|
| Rate for Payer: PACE SWMI |
$1,144.46
|
| Rate for Payer: PHP Commercial |
$1,602.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,477.50
|
| Rate for Payer: Priority Health Medicare |
$1,144.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,461.00
|
|
|
PR OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$3,401.00
|
|
|
Service Code
|
HCPCS 21462
|
| Min. Negotiated Rate |
$1,067.69 |
| Max. Negotiated Rate |
$2,210.65 |
| Rate for Payer: Aetna Commercial |
$1,430.70
|
| Rate for Payer: Aetna Medicare |
$1,110.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.70
|
| Rate for Payer: BCBS Complete |
$1,360.40
|
| Rate for Payer: BCBS MAPPO |
$1,067.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,067.69
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Cofinity Commercial |
$1,537.47
|
| Rate for Payer: Cofinity Commercial |
$1,430.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,067.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,121.07
|
| Rate for Payer: Nomi Health Commercial |
$1,281.23
|
| Rate for Payer: PACE SWMI |
$1,067.69
|
| Rate for Payer: PHP Commercial |
$1,494.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,067.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,210.65
|
| Rate for Payer: Priority Health Medicare |
$1,067.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,067.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,067.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,564.46
|
|
|
PR OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION
|
Professional
|
Both
|
$4,190.00
|
|
|
Service Code
|
HCPCS 21461
|
| Min. Negotiated Rate |
$959.19 |
| Max. Negotiated Rate |
$2,723.50 |
| Rate for Payer: Aetna Commercial |
$1,285.31
|
| Rate for Payer: Aetna Medicare |
$997.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,381.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.31
|
| Rate for Payer: BCBS Complete |
$1,676.00
|
| Rate for Payer: BCBS MAPPO |
$959.19
|
| Rate for Payer: BCN Medicare Advantage |
$959.19
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cofinity Commercial |
$1,381.23
|
| Rate for Payer: Cofinity Commercial |
$1,285.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$959.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,007.15
|
| Rate for Payer: Nomi Health Commercial |
$1,151.03
|
| Rate for Payer: PACE SWMI |
$959.19
|
| Rate for Payer: PHP Commercial |
$1,342.87
|
| Rate for Payer: PHP Medicare Advantage |
$959.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,723.50
|
| Rate for Payer: Priority Health Medicare |
$959.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$959.19
|
| Rate for Payer: UHC Medicare Advantage |
$959.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,927.40
|
|
|
PR OPEN TX METACARPAL FRACTURE SINGLE EA BONE
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
HCPCS 26615
|
| Min. Negotiated Rate |
$557.20 |
| Max. Negotiated Rate |
$1,251.25 |
| Rate for Payer: Aetna Commercial |
$746.65
|
| Rate for Payer: Aetna Medicare |
$579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.65
|
| Rate for Payer: BCBS Complete |
$770.00
|
| Rate for Payer: BCBS MAPPO |
$557.20
|
| Rate for Payer: BCN Medicare Advantage |
$557.20
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cofinity Commercial |
$802.37
|
| Rate for Payer: Cofinity Commercial |
$746.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.06
|
| Rate for Payer: Nomi Health Commercial |
$668.64
|
| Rate for Payer: PACE SWMI |
$557.20
|
| Rate for Payer: PHP Commercial |
$780.08
|
| Rate for Payer: PHP Medicare Advantage |
$557.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.25
|
| Rate for Payer: Priority Health Medicare |
$557.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.20
|
| Rate for Payer: UHC Medicare Advantage |
$557.20
|
| Rate for Payer: UMR Bronson Commercial |
$885.50
|
|
|
PR OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 28645
|
| Min. Negotiated Rate |
$414.80 |
| Max. Negotiated Rate |
$674.05 |
| Rate for Payer: Aetna Commercial |
$625.02
|
| Rate for Payer: Aetna Medicare |
$485.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.02
|
| Rate for Payer: BCBS Complete |
$414.80
|
| Rate for Payer: BCBS MAPPO |
$466.43
|
| Rate for Payer: BCN Medicare Advantage |
$466.43
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cofinity Commercial |
$671.66
|
| Rate for Payer: Cofinity Commercial |
$625.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.75
|
| Rate for Payer: Nomi Health Commercial |
$559.72
|
| Rate for Payer: PACE SWMI |
$466.43
|
| Rate for Payer: PHP Commercial |
$653.00
|
| Rate for Payer: PHP Medicare Advantage |
$466.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.05
|
| Rate for Payer: Priority Health Medicare |
$466.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.43
|
| Rate for Payer: UHC Medicare Advantage |
$466.43
|
| Rate for Payer: UMR Bronson Commercial |
$477.02
|
|
|
PR OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW
|
Professional
|
Both
|
$3,444.00
|
|
|
Service Code
|
HCPCS 24635
|
| Min. Negotiated Rate |
$655.74 |
| Max. Negotiated Rate |
$2,238.60 |
| Rate for Payer: Aetna Commercial |
$878.69
|
| Rate for Payer: Aetna Medicare |
$681.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.69
|
| Rate for Payer: BCBS Complete |
$1,377.60
|
| Rate for Payer: BCBS MAPPO |
$655.74
|
| Rate for Payer: BCN Medicare Advantage |
$655.74
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cofinity Commercial |
$944.27
|
| Rate for Payer: Cofinity Commercial |
$878.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.53
|
| Rate for Payer: Nomi Health Commercial |
$786.89
|
| Rate for Payer: PACE SWMI |
$655.74
|
| Rate for Payer: PHP Commercial |
$918.04
|
| Rate for Payer: PHP Medicare Advantage |
$655.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,238.60
|
| Rate for Payer: Priority Health Medicare |
$655.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$655.74
|
| Rate for Payer: UHC Medicare Advantage |
$655.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,584.24
|
|
|
PR OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 21330
|
| Min. Negotiated Rate |
$499.02 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$668.69
|
| Rate for Payer: Aetna Medicare |
$518.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$718.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$668.69
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$499.02
|
| Rate for Payer: BCN Medicare Advantage |
$499.02
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$718.59
|
| Rate for Payer: Cofinity Commercial |
$668.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$598.82
|
| Rate for Payer: PACE SWMI |
$499.02
|
| Rate for Payer: PHP Commercial |
$698.63
|
| Rate for Payer: PHP Medicare Advantage |
$499.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$499.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$499.02
|
| Rate for Payer: UHC Medicare Advantage |
$499.02
|
| Rate for Payer: UMR Bronson Commercial |
$761.30
|
|
|
PR OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION
|
Professional
|
Both
|
$1,476.00
|
|
|
Service Code
|
HCPCS 21336
|
| Min. Negotiated Rate |
$590.40 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna Commercial |
$796.17
|
| Rate for Payer: Aetna Medicare |
$617.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$855.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.17
|
| Rate for Payer: BCBS Complete |
$590.40
|
| Rate for Payer: BCBS MAPPO |
$594.16
|
| Rate for Payer: BCN Medicare Advantage |
$594.16
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cofinity Commercial |
$855.59
|
| Rate for Payer: Cofinity Commercial |
$796.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.87
|
| Rate for Payer: Nomi Health Commercial |
$712.99
|
| Rate for Payer: PACE SWMI |
$594.16
|
| Rate for Payer: PHP Commercial |
$831.82
|
| Rate for Payer: PHP Medicare Advantage |
$594.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.40
|
| Rate for Payer: Priority Health Medicare |
$594.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$594.16
|
| Rate for Payer: UHC Medicare Advantage |
$594.16
|
| Rate for Payer: UMR Bronson Commercial |
$678.96
|
|
|
PR OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 21338
|
| Min. Negotiated Rate |
$626.45 |
| Max. Negotiated Rate |
$1,218.10 |
| Rate for Payer: Aetna Commercial |
$839.44
|
| Rate for Payer: Aetna Medicare |
$651.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$902.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.44
|
| Rate for Payer: BCBS Complete |
$749.60
|
| Rate for Payer: BCBS MAPPO |
$626.45
|
| Rate for Payer: BCN Medicare Advantage |
$626.45
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$902.09
|
| Rate for Payer: Cofinity Commercial |
$839.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$657.77
|
| Rate for Payer: Nomi Health Commercial |
$751.74
|
| Rate for Payer: PACE SWMI |
$626.45
|
| Rate for Payer: PHP Commercial |
$877.03
|
| Rate for Payer: PHP Medicare Advantage |
$626.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health Medicare |
$626.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.45
|
| Rate for Payer: UHC Medicare Advantage |
$626.45
|
| Rate for Payer: UMR Bronson Commercial |
$862.04
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 21386
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$954.68 |
| Rate for Payer: Aetna Commercial |
$888.38
|
| Rate for Payer: Aetna Medicare |
$689.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.38
|
| Rate for Payer: BCBS Complete |
$478.40
|
| Rate for Payer: BCBS MAPPO |
$662.97
|
| Rate for Payer: BCN Medicare Advantage |
$662.97
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cofinity Commercial |
$954.68
|
| Rate for Payer: Cofinity Commercial |
$888.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.12
|
| Rate for Payer: Nomi Health Commercial |
$795.56
|
| Rate for Payer: PACE SWMI |
$662.97
|
| Rate for Payer: PHP Commercial |
$928.16
|
| Rate for Payer: PHP Medicare Advantage |
$662.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.40
|
| Rate for Payer: Priority Health Medicare |
$662.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.97
|
| Rate for Payer: UHC Medicare Advantage |
$662.97
|
| Rate for Payer: UMR Bronson Commercial |
$550.16
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 21385
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,004.25 |
| Rate for Payer: Aetna Commercial |
$934.18
|
| Rate for Payer: Aetna Medicare |
$725.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.90
|
| Rate for Payer: BCBS Complete |
$618.00
|
| Rate for Payer: BCBS MAPPO |
$697.15
|
| Rate for Payer: BCN Medicare Advantage |
$697.15
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cofinity Commercial |
$934.18
|
| Rate for Payer: Cofinity Commercial |
$1,003.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.01
|
| Rate for Payer: Nomi Health Commercial |
$836.58
|
| Rate for Payer: PACE SWMI |
$697.15
|
| Rate for Payer: PHP Commercial |
$976.01
|
| Rate for Payer: PHP Medicare Advantage |
$697.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.25
|
| Rate for Payer: Priority Health Medicare |
$697.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.15
|
| Rate for Payer: UHC Medicare Advantage |
$697.15
|
| Rate for Payer: UMR Bronson Commercial |
$710.70
|
|
|
PR OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
HCPCS 21423
|
| Min. Negotiated Rate |
$631.60 |
| Max. Negotiated Rate |
$1,090.94 |
| Rate for Payer: Aetna Commercial |
$1,015.18
|
| Rate for Payer: Aetna Medicare |
$787.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,090.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.18
|
| Rate for Payer: BCBS Complete |
$631.60
|
| Rate for Payer: BCBS MAPPO |
$757.60
|
| Rate for Payer: BCN Medicare Advantage |
$757.60
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Cofinity Commercial |
$1,090.94
|
| Rate for Payer: Cofinity Commercial |
$1,015.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$757.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$795.48
|
| Rate for Payer: Nomi Health Commercial |
$909.12
|
| Rate for Payer: PACE SWMI |
$757.60
|
| Rate for Payer: PHP Commercial |
$1,060.64
|
| Rate for Payer: PHP Medicare Advantage |
$757.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.35
|
| Rate for Payer: Priority Health Medicare |
$757.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$757.60
|
| Rate for Payer: UHC Medicare Advantage |
$757.60
|
| Rate for Payer: UMR Bronson Commercial |
$726.34
|
|
|
PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Professional
|
Both
|
$1,815.00
|
|
|
Service Code
|
HCPCS 26735
|
| Min. Negotiated Rate |
$575.52 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Aetna Commercial |
$771.20
|
| Rate for Payer: Aetna Medicare |
$598.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.20
|
| Rate for Payer: BCBS Complete |
$726.00
|
| Rate for Payer: BCBS MAPPO |
$575.52
|
| Rate for Payer: BCN Medicare Advantage |
$575.52
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cofinity Commercial |
$828.75
|
| Rate for Payer: Cofinity Commercial |
$771.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.30
|
| Rate for Payer: Nomi Health Commercial |
$690.62
|
| Rate for Payer: PACE SWMI |
$575.52
|
| Rate for Payer: PHP Commercial |
$805.73
|
| Rate for Payer: PHP Medicare Advantage |
$575.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.75
|
| Rate for Payer: Priority Health Medicare |
$575.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.52
|
| Rate for Payer: UHC Medicare Advantage |
$575.52
|
| Rate for Payer: UMR Bronson Commercial |
$834.90
|
|
|
PR OPEN TX POST PELVIC FXCTURE
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS G0415
|
| Min. Negotiated Rate |
$946.80 |
| Max. Negotiated Rate |
$1,908.55 |
| Rate for Payer: Aetna Commercial |
$1,776.01
|
| Rate for Payer: Aetna Medicare |
$1,378.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,908.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,776.01
|
| Rate for Payer: BCBS Complete |
$946.80
|
| Rate for Payer: BCBS MAPPO |
$1,325.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,325.38
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cofinity Commercial |
$1,908.55
|
| Rate for Payer: Cofinity Commercial |
$1,776.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,325.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,391.65
|
| Rate for Payer: Nomi Health Commercial |
$1,590.46
|
| Rate for Payer: PACE SWMI |
$1,325.38
|
| Rate for Payer: PHP Commercial |
$1,855.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,325.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.55
|
| Rate for Payer: Priority Health Medicare |
$1,325.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,325.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,325.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,088.82
|
|
