|
PR OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 27832
|
| Min. Negotiated Rate |
$733.97 |
| Max. Negotiated Rate |
$1,197.95 |
| Rate for Payer: Aetna Commercial |
$983.52
|
| Rate for Payer: Aetna Medicare |
$763.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.92
|
| Rate for Payer: BCBS Complete |
$737.20
|
| Rate for Payer: BCBS MAPPO |
$733.97
|
| Rate for Payer: BCN Medicare Advantage |
$733.97
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cofinity Commercial |
$983.52
|
| Rate for Payer: Cofinity Commercial |
$1,056.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.67
|
| Rate for Payer: Nomi Health Commercial |
$880.76
|
| Rate for Payer: PACE SWMI |
$733.97
|
| Rate for Payer: PHP Commercial |
$1,027.56
|
| Rate for Payer: PHP Medicare Advantage |
$733.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.95
|
| Rate for Payer: Priority Health Medicare |
$733.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.97
|
| Rate for Payer: UHC Medicare Advantage |
$733.97
|
| Rate for Payer: UMR Bronson Commercial |
$847.78
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE
|
Professional
|
Both
|
$2,365.00
|
|
|
Service Code
|
HCPCS 24665
|
| Min. Negotiated Rate |
$636.16 |
| Max. Negotiated Rate |
$1,537.25 |
| Rate for Payer: Aetna Commercial |
$852.45
|
| Rate for Payer: Aetna Medicare |
$661.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.45
|
| Rate for Payer: BCBS Complete |
$946.00
|
| Rate for Payer: BCBS MAPPO |
$636.16
|
| Rate for Payer: BCN Medicare Advantage |
$636.16
|
| Rate for Payer: Cash Price |
$1,892.00
|
| Rate for Payer: Cash Price |
$1,892.00
|
| Rate for Payer: Cofinity Commercial |
$916.07
|
| Rate for Payer: Cofinity Commercial |
$852.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.97
|
| Rate for Payer: Nomi Health Commercial |
$763.39
|
| Rate for Payer: PACE SWMI |
$636.16
|
| Rate for Payer: PHP Commercial |
$890.62
|
| Rate for Payer: PHP Medicare Advantage |
$636.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.25
|
| Rate for Payer: Priority Health Medicare |
$636.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$636.16
|
| Rate for Payer: UHC Medicare Advantage |
$636.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,087.90
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC
|
Professional
|
Both
|
$2,905.00
|
|
|
Service Code
|
HCPCS 24666
|
| Min. Negotiated Rate |
$707.93 |
| Max. Negotiated Rate |
$1,888.25 |
| Rate for Payer: Aetna Commercial |
$948.63
|
| Rate for Payer: Aetna Medicare |
$736.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.42
|
| Rate for Payer: BCBS Complete |
$1,162.00
|
| Rate for Payer: BCBS MAPPO |
$707.93
|
| Rate for Payer: BCN Medicare Advantage |
$707.93
|
| Rate for Payer: Cash Price |
$2,324.00
|
| Rate for Payer: Cash Price |
$2,324.00
|
| Rate for Payer: Cofinity Commercial |
$948.63
|
| Rate for Payer: Cofinity Commercial |
$1,019.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.33
|
| Rate for Payer: Nomi Health Commercial |
$849.52
|
| Rate for Payer: PACE SWMI |
$707.93
|
| Rate for Payer: PHP Commercial |
$991.10
|
| Rate for Payer: PHP Medicare Advantage |
$707.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,888.25
|
| Rate for Payer: Priority Health Medicare |
$707.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.93
|
| Rate for Payer: UHC Medicare Advantage |
$707.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.30
|
|
|
PR OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES
|
Professional
|
Both
|
$1,984.00
|
|
|
Service Code
|
HCPCS 25670
|
| Min. Negotiated Rate |
$586.97 |
| Max. Negotiated Rate |
$1,289.60 |
| Rate for Payer: Aetna Commercial |
$786.54
|
| Rate for Payer: Aetna Medicare |
$610.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.54
|
| Rate for Payer: BCBS Complete |
$793.60
|
| Rate for Payer: BCBS MAPPO |
$586.97
|
| Rate for Payer: BCN Medicare Advantage |
$586.97
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cofinity Commercial |
$845.24
|
| Rate for Payer: Cofinity Commercial |
$786.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.32
|
| Rate for Payer: Nomi Health Commercial |
$704.36
|
| Rate for Payer: PACE SWMI |
$586.97
|
| Rate for Payer: PHP Commercial |
$821.76
|
| Rate for Payer: PHP Medicare Advantage |
$586.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,289.60
|
| Rate for Payer: Priority Health Medicare |
$586.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.97
|
| Rate for Payer: UHC Medicare Advantage |
$586.97
|
| Rate for Payer: UMR Bronson Commercial |
$912.64
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 21811
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$826.92 |
| Rate for Payer: Aetna Commercial |
$769.50
|
| Rate for Payer: Aetna Medicare |
$597.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.50
|
| Rate for Payer: BCBS Complete |
$505.20
|
| Rate for Payer: BCBS MAPPO |
$574.25
|
| Rate for Payer: BCN Medicare Advantage |
$574.25
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$826.92
|
| Rate for Payer: Cofinity Commercial |
$769.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$574.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$602.96
|
| Rate for Payer: Nomi Health Commercial |
$689.10
|
| Rate for Payer: PACE SWMI |
$574.25
|
| Rate for Payer: PHP Commercial |
$803.95
|
| Rate for Payer: PHP Medicare Advantage |
$574.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health Medicare |
$574.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$574.25
|
| Rate for Payer: UHC Medicare Advantage |
$574.25
|
| Rate for Payer: UMR Bronson Commercial |
$580.98
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
HCPCS 21812
|
| Min. Negotiated Rate |
$694.60 |
| Max. Negotiated Rate |
$1,145.95 |
| Rate for Payer: Aetna Commercial |
$930.76
|
| Rate for Payer: Aetna Medicare |
$722.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$930.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.22
|
| Rate for Payer: BCBS Complete |
$705.20
|
| Rate for Payer: BCBS MAPPO |
$694.60
|
| Rate for Payer: BCN Medicare Advantage |
$694.60
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cofinity Commercial |
$930.76
|
| Rate for Payer: Cofinity Commercial |
$1,000.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.33
|
| Rate for Payer: Nomi Health Commercial |
$833.52
|
| Rate for Payer: PACE SWMI |
$694.60
|
| Rate for Payer: PHP Commercial |
$972.44
|
| Rate for Payer: PHP Medicare Advantage |
$694.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,145.95
|
| Rate for Payer: Priority Health Medicare |
$694.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.60
|
| Rate for Payer: UHC Medicare Advantage |
$694.60
|
| Rate for Payer: UMR Bronson Commercial |
$810.98
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 21813
|
| Min. Negotiated Rate |
$794.00 |
| Max. Negotiated Rate |
$1,373.64 |
| Rate for Payer: Aetna Commercial |
$1,278.25
|
| Rate for Payer: Aetna Medicare |
$992.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,278.25
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS MAPPO |
$953.92
|
| Rate for Payer: BCN Medicare Advantage |
$953.92
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,373.64
|
| Rate for Payer: Cofinity Commercial |
$1,278.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,001.62
|
| Rate for Payer: Nomi Health Commercial |
$1,144.70
|
| Rate for Payer: PACE SWMI |
$953.92
|
| Rate for Payer: PHP Commercial |
$1,335.49
|
| Rate for Payer: PHP Medicare Advantage |
$953.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health Medicare |
$953.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$953.92
|
| Rate for Payer: UHC Medicare Advantage |
$953.92
|
| Rate for Payer: UMR Bronson Commercial |
$913.10
|
|
|
PR OPEN TX SCAPULAR FX W/INT FIXATION WHEN PFRMD
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23585
|
| Min. Negotiated Rate |
$940.60 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,260.40
|
| Rate for Payer: Aetna Medicare |
$978.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,354.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.40
|
| Rate for Payer: BCBS Complete |
$1,276.80
|
| Rate for Payer: BCBS MAPPO |
$940.60
|
| Rate for Payer: BCN Medicare Advantage |
$940.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,354.46
|
| Rate for Payer: Cofinity Commercial |
$1,260.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$940.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$987.63
|
| Rate for Payer: Nomi Health Commercial |
$1,128.72
|
| Rate for Payer: PACE SWMI |
$940.60
|
| Rate for Payer: PHP Commercial |
$1,316.84
|
| Rate for Payer: PHP Medicare Advantage |
$940.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$940.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$940.60
|
| Rate for Payer: UHC Medicare Advantage |
$940.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,468.32
|
|
|
PR OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 28531
|
| Min. Negotiated Rate |
$173.61 |
| Max. Negotiated Rate |
$435.50 |
| Rate for Payer: Aetna Commercial |
$232.64
|
| Rate for Payer: Aetna Medicare |
$180.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.64
|
| Rate for Payer: BCBS Complete |
$268.00
|
| Rate for Payer: BCBS MAPPO |
$173.61
|
| Rate for Payer: BCN Medicare Advantage |
$173.61
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Commercial |
$232.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.29
|
| Rate for Payer: Nomi Health Commercial |
$208.33
|
| Rate for Payer: PACE SWMI |
$173.61
|
| Rate for Payer: PHP Commercial |
$243.05
|
| Rate for Payer: PHP Medicare Advantage |
$173.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.50
|
| Rate for Payer: Priority Health Medicare |
$173.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.61
|
| Rate for Payer: UHC Medicare Advantage |
$173.61
|
| Rate for Payer: UMR Bronson Commercial |
$308.20
|
|
|
PR OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,451.00
|
|
|
Service Code
|
HCPCS 23530
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,593.15 |
| Rate for Payer: Aetna Commercial |
$748.03
|
| Rate for Payer: Aetna Medicare |
$580.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.03
|
| Rate for Payer: BCBS Complete |
$980.40
|
| Rate for Payer: BCBS MAPPO |
$558.23
|
| Rate for Payer: BCN Medicare Advantage |
$558.23
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cofinity Commercial |
$803.85
|
| Rate for Payer: Cofinity Commercial |
$748.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.14
|
| Rate for Payer: Nomi Health Commercial |
$669.88
|
| Rate for Payer: PACE SWMI |
$558.23
|
| Rate for Payer: PHP Commercial |
$781.52
|
| Rate for Payer: PHP Medicare Advantage |
$558.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,593.15
|
| Rate for Payer: Priority Health Medicare |
$558.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.23
|
| Rate for Payer: UHC Medicare Advantage |
$558.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.46
|
|
|
PR OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 21825
|
| Min. Negotiated Rate |
$401.60 |
| Max. Negotiated Rate |
$767.45 |
| Rate for Payer: Aetna Commercial |
$714.15
|
| Rate for Payer: Aetna Medicare |
$554.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$714.15
|
| Rate for Payer: BCBS Complete |
$401.60
|
| Rate for Payer: BCBS MAPPO |
$532.95
|
| Rate for Payer: BCN Medicare Advantage |
$532.95
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cofinity Commercial |
$767.45
|
| Rate for Payer: Cofinity Commercial |
$714.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$532.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$559.60
|
| Rate for Payer: Nomi Health Commercial |
$639.54
|
| Rate for Payer: PACE SWMI |
$532.95
|
| Rate for Payer: PHP Commercial |
$746.13
|
| Rate for Payer: PHP Medicare Advantage |
$532.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.60
|
| Rate for Payer: Priority Health Medicare |
$532.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$532.95
|
| Rate for Payer: UHC Medicare Advantage |
$532.95
|
| Rate for Payer: UMR Bronson Commercial |
$461.84
|
|
|
PR OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 28465
|
| Min. Negotiated Rate |
$616.27 |
| Max. Negotiated Rate |
$1,021.15 |
| Rate for Payer: Aetna Commercial |
$825.80
|
| Rate for Payer: Aetna Medicare |
$640.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.80
|
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: BCBS MAPPO |
$616.27
|
| Rate for Payer: BCN Medicare Advantage |
$616.27
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$887.43
|
| Rate for Payer: Cofinity Commercial |
$825.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.08
|
| Rate for Payer: Nomi Health Commercial |
$739.52
|
| Rate for Payer: PACE SWMI |
$616.27
|
| Rate for Payer: PHP Commercial |
$862.78
|
| Rate for Payer: PHP Medicare Advantage |
$616.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health Medicare |
$616.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.27
|
| Rate for Payer: UHC Medicare Advantage |
$616.27
|
| Rate for Payer: UMR Bronson Commercial |
$722.66
|
|
|
PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$2,786.00
|
|
|
Service Code
|
HCPCS 27535
|
| Min. Negotiated Rate |
$864.44 |
| Max. Negotiated Rate |
$1,810.90 |
| Rate for Payer: Aetna Commercial |
$1,158.35
|
| Rate for Payer: Aetna Medicare |
$899.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.35
|
| Rate for Payer: BCBS Complete |
$1,114.40
|
| Rate for Payer: BCBS MAPPO |
$864.44
|
| Rate for Payer: BCN Medicare Advantage |
$864.44
|
| Rate for Payer: Cash Price |
$2,228.80
|
| Rate for Payer: Cash Price |
$2,228.80
|
| Rate for Payer: Cofinity Commercial |
$1,244.79
|
| Rate for Payer: Cofinity Commercial |
$1,158.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.66
|
| Rate for Payer: Nomi Health Commercial |
$1,037.33
|
| Rate for Payer: PACE SWMI |
$864.44
|
| Rate for Payer: PHP Commercial |
$1,210.22
|
| Rate for Payer: PHP Medicare Advantage |
$864.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,810.90
|
| Rate for Payer: Priority Health Medicare |
$864.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.44
|
| Rate for Payer: UHC Medicare Advantage |
$864.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,281.56
|
|
|
PR OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC
|
Professional
|
Both
|
$2,108.00
|
|
|
Service Code
|
HCPCS 25685
|
| Min. Negotiated Rate |
$712.26 |
| Max. Negotiated Rate |
$1,370.20 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna Medicare |
$740.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.65
|
| Rate for Payer: BCBS Complete |
$843.20
|
| Rate for Payer: BCBS MAPPO |
$712.26
|
| Rate for Payer: BCN Medicare Advantage |
$712.26
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Cash Price |
$1,686.40
|
| Rate for Payer: Cofinity Commercial |
$954.43
|
| Rate for Payer: Cofinity Commercial |
$1,025.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.87
|
| Rate for Payer: Nomi Health Commercial |
$854.71
|
| Rate for Payer: PACE SWMI |
$712.26
|
| Rate for Payer: PHP Commercial |
$997.16
|
| Rate for Payer: PHP Medicare Advantage |
$712.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.20
|
| Rate for Payer: Priority Health Medicare |
$712.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.26
|
| Rate for Payer: UHC Medicare Advantage |
$712.26
|
| Rate for Payer: UMR Bronson Commercial |
$969.68
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP
|
Professional
|
Both
|
$4,168.00
|
|
|
Service Code
|
HCPCS 27823
|
| Min. Negotiated Rate |
$939.78 |
| Max. Negotiated Rate |
$2,709.20 |
| Rate for Payer: Aetna Commercial |
$1,259.31
|
| Rate for Payer: Aetna Medicare |
$977.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.31
|
| Rate for Payer: BCBS Complete |
$1,667.20
|
| Rate for Payer: BCBS MAPPO |
$939.78
|
| Rate for Payer: BCN Medicare Advantage |
$939.78
|
| Rate for Payer: Cash Price |
$3,334.40
|
| Rate for Payer: Cash Price |
$3,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,353.28
|
| Rate for Payer: Cofinity Commercial |
$1,259.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.77
|
| Rate for Payer: Nomi Health Commercial |
$1,127.74
|
| Rate for Payer: PACE SWMI |
$939.78
|
| Rate for Payer: PHP Commercial |
$1,315.69
|
| Rate for Payer: PHP Medicare Advantage |
$939.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,709.20
|
| Rate for Payer: Priority Health Medicare |
$939.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.78
|
| Rate for Payer: UHC Medicare Advantage |
$939.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,917.28
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 27822
|
| Min. Negotiated Rate |
$832.31 |
| Max. Negotiated Rate |
$2,299.05 |
| Rate for Payer: Aetna Commercial |
$1,115.30
|
| Rate for Payer: Aetna Medicare |
$865.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,198.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.30
|
| Rate for Payer: BCBS Complete |
$1,414.80
|
| Rate for Payer: BCBS MAPPO |
$832.31
|
| Rate for Payer: BCN Medicare Advantage |
$832.31
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,198.53
|
| Rate for Payer: Cofinity Commercial |
$1,115.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$832.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$873.93
|
| Rate for Payer: Nomi Health Commercial |
$998.77
|
| Rate for Payer: PACE SWMI |
$832.31
|
| Rate for Payer: PHP Commercial |
$1,165.23
|
| Rate for Payer: PHP Medicare Advantage |
$832.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health Medicare |
$832.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$832.31
|
| Rate for Payer: UHC Medicare Advantage |
$832.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,627.02
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92014
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Aetna Medicare |
$72.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.00
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$70.14
|
| Rate for Payer: BCN Medicare Advantage |
$70.14
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$93.99
|
| Rate for Payer: Cofinity Commercial |
$101.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.65
|
| Rate for Payer: Nomi Health Commercial |
$84.17
|
| Rate for Payer: PACE SWMI |
$70.14
|
| Rate for Payer: PHP Commercial |
$98.20
|
| Rate for Payer: PHP Medicare Advantage |
$70.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$70.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.14
|
| Rate for Payer: UHC Medicare Advantage |
$70.14
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 92004
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$116.46
|
| Rate for Payer: Aetna Medicare |
$90.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.46
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$86.91
|
| Rate for Payer: BCN Medicare Advantage |
$86.91
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$125.15
|
| Rate for Payer: Cofinity Commercial |
$116.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.26
|
| Rate for Payer: Nomi Health Commercial |
$104.29
|
| Rate for Payer: PACE SWMI |
$86.91
|
| Rate for Payer: PHP Commercial |
$121.67
|
| Rate for Payer: PHP Medicare Advantage |
$86.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$86.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.91
|
| Rate for Payer: UHC Medicare Advantage |
$86.91
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92012
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Commercial |
$62.32
|
| Rate for Payer: Aetna Medicare |
$48.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.32
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$46.51
|
| Rate for Payer: BCN Medicare Advantage |
$46.51
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.84
|
| Rate for Payer: Nomi Health Commercial |
$55.81
|
| Rate for Payer: PACE SWMI |
$46.51
|
| Rate for Payer: PHP Commercial |
$65.11
|
| Rate for Payer: PHP Medicare Advantage |
$46.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health Medicare |
$46.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.51
|
| Rate for Payer: UHC Medicare Advantage |
$46.51
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE NEW PT
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 92002
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Aetna Commercial |
$56.53
|
| Rate for Payer: Aetna Medicare |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.53
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$42.19
|
| Rate for Payer: BCN Medicare Advantage |
$42.19
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$60.75
|
| Rate for Payer: Cofinity Commercial |
$56.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.30
|
| Rate for Payer: Nomi Health Commercial |
$50.63
|
| Rate for Payer: PACE SWMI |
$42.19
|
| Rate for Payer: PHP Commercial |
$59.07
|
| Rate for Payer: PHP Medicare Advantage |
$42.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$42.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.19
|
| Rate for Payer: UHC Medicare Advantage |
$42.19
|
| Rate for Payer: UMR Bronson Commercial |
$51.06
|
|
|
PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 34716
|
| Min. Negotiated Rate |
$314.80 |
| Max. Negotiated Rate |
$514.17 |
| Rate for Payer: Aetna Commercial |
$478.46
|
| Rate for Payer: Aetna Medicare |
$371.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.46
|
| Rate for Payer: BCBS Complete |
$314.80
|
| Rate for Payer: BCBS MAPPO |
$357.06
|
| Rate for Payer: BCN Medicare Advantage |
$357.06
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cofinity Commercial |
$514.17
|
| Rate for Payer: Cofinity Commercial |
$478.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.91
|
| Rate for Payer: Nomi Health Commercial |
$428.47
|
| Rate for Payer: PACE SWMI |
$357.06
|
| Rate for Payer: PHP Commercial |
$499.88
|
| Rate for Payer: PHP Medicare Advantage |
$357.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.55
|
| Rate for Payer: Priority Health Medicare |
$357.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.06
|
| Rate for Payer: UHC Medicare Advantage |
$357.06
|
| Rate for Payer: UMR Bronson Commercial |
$362.02
|
|
|
PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 34834
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$166.36
|
| Rate for Payer: Aetna Medicare |
$129.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.36
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$124.15
|
| Rate for Payer: BCN Medicare Advantage |
$124.15
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$178.78
|
| Rate for Payer: Cofinity Commercial |
$166.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.36
|
| Rate for Payer: Nomi Health Commercial |
$148.98
|
| Rate for Payer: PACE SWMI |
$124.15
|
| Rate for Payer: PHP Commercial |
$173.81
|
| Rate for Payer: PHP Medicare Advantage |
$124.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Medicare |
$124.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.15
|
| Rate for Payer: UHC Medicare Advantage |
$124.15
|
| Rate for Payer: UMR Bronson Commercial |
$133.40
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$1,267.00
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$197.63 |
| Max. Negotiated Rate |
$823.55 |
| Rate for Payer: Aetna Commercial |
$264.82
|
| Rate for Payer: Aetna Medicare |
$205.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.82
|
| Rate for Payer: BCBS Complete |
$506.80
|
| Rate for Payer: BCBS MAPPO |
$197.63
|
| Rate for Payer: BCN Medicare Advantage |
$197.63
|
| Rate for Payer: Cash Price |
$1,013.60
|
| Rate for Payer: Cash Price |
$1,013.60
|
| Rate for Payer: Cofinity Commercial |
$284.59
|
| Rate for Payer: Cofinity Commercial |
$264.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.51
|
| Rate for Payer: Nomi Health Commercial |
$237.16
|
| Rate for Payer: PACE SWMI |
$197.63
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: PHP Medicare Advantage |
$197.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.55
|
| Rate for Payer: Priority Health Medicare |
$197.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.63
|
| Rate for Payer: UHC Medicare Advantage |
$197.63
|
| Rate for Payer: UMR Bronson Commercial |
$582.82
|
|
|
PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 34714
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$346.11
|
| Rate for Payer: Aetna Medicare |
$268.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.11
|
| Rate for Payer: BCBS Complete |
$227.20
|
| Rate for Payer: BCBS MAPPO |
$258.29
|
| Rate for Payer: BCN Medicare Advantage |
$258.29
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cofinity Commercial |
$371.94
|
| Rate for Payer: Cofinity Commercial |
$346.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.20
|
| Rate for Payer: Nomi Health Commercial |
$309.95
|
| Rate for Payer: PACE SWMI |
$258.29
|
| Rate for Payer: PHP Commercial |
$361.61
|
| Rate for Payer: PHP Medicare Advantage |
$258.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health Medicare |
$258.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.29
|
| Rate for Payer: UHC Medicare Advantage |
$258.29
|
| Rate for Payer: UMR Bronson Commercial |
$261.28
|
|
|
PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP
|
Professional
|
Both
|
$2,232.00
|
|
|
Service Code
|
HCPCS 34833
|
| Min. Negotiated Rate |
$378.73 |
| Max. Negotiated Rate |
$1,450.80 |
| Rate for Payer: Aetna Commercial |
$507.50
|
| Rate for Payer: Aetna Medicare |
$393.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.50
|
| Rate for Payer: BCBS Complete |
$892.80
|
| Rate for Payer: BCBS MAPPO |
$378.73
|
| Rate for Payer: BCN Medicare Advantage |
$378.73
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cofinity Commercial |
$545.37
|
| Rate for Payer: Cofinity Commercial |
$507.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.67
|
| Rate for Payer: Nomi Health Commercial |
$454.48
|
| Rate for Payer: PACE SWMI |
$378.73
|
| Rate for Payer: PHP Commercial |
$530.22
|
| Rate for Payer: PHP Medicare Advantage |
$378.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,450.80
|
| Rate for Payer: Priority Health Medicare |
$378.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.73
|
| Rate for Payer: UHC Medicare Advantage |
$378.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,026.72
|
|
