|
PR OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC
|
Professional
|
Both
|
$3,087.00
|
|
|
Service Code
|
HCPCS 22212
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$2,336.18 |
| Rate for Payer: Aetna Commercial |
$1,981.14
|
| Rate for Payer: Aetna Medicare |
$1,537.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,981.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,128.98
|
| Rate for Payer: BCBS Complete |
$1,036.17
|
| Rate for Payer: BCBS MAPPO |
$1,478.46
|
| Rate for Payer: BCBS Trust/PPO |
$24.96
|
| Rate for Payer: BCN Commercial |
$2,222.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,478.46
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cofinity Commercial |
$1,981.14
|
| Rate for Payer: Cofinity Commercial |
$2,128.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,478.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,552.38
|
| Rate for Payer: Meridian Medicaid |
$1,036.17
|
| Rate for Payer: Nomi Health Commercial |
$1,774.15
|
| Rate for Payer: PACE SWMI |
$1,478.46
|
| Rate for Payer: PHP Commercial |
$2,069.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,478.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$986.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,006.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,336.18
|
| Rate for Payer: Priority Health Medicare |
$1,478.46
|
| Rate for Payer: Priority Health Narrow Network |
$2,336.18
|
| Rate for Payer: Priority Health SBD |
$2,336.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,478.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,478.46
|
| Rate for Payer: UHCCP Medicaid |
$986.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,420.02
|
|
|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM CRV
|
Professional
|
Both
|
$3,290.00
|
|
|
Service Code
|
HCPCS 22220
|
| Min. Negotiated Rate |
$180.34 |
| Max. Negotiated Rate |
$2,617.72 |
| Rate for Payer: Aetna Commercial |
$2,130.08
|
| Rate for Payer: Aetna Medicare |
$1,653.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,289.04
|
| Rate for Payer: BCBS Complete |
$1,111.32
|
| Rate for Payer: BCBS MAPPO |
$1,589.61
|
| Rate for Payer: BCBS Trust/PPO |
$180.34
|
| Rate for Payer: BCN Commercial |
$2,617.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,589.61
|
| Rate for Payer: Cash Price |
$2,632.00
|
| Rate for Payer: Cash Price |
$2,632.00
|
| Rate for Payer: Cofinity Commercial |
$2,130.08
|
| Rate for Payer: Cofinity Commercial |
$2,289.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,589.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,669.09
|
| Rate for Payer: Meridian Medicaid |
$1,111.32
|
| Rate for Payer: Nomi Health Commercial |
$1,907.53
|
| Rate for Payer: PACE SWMI |
$1,589.61
|
| Rate for Payer: PHP Commercial |
$2,225.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,589.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,058.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,138.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,496.98
|
| Rate for Payer: Priority Health Medicare |
$1,589.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,496.98
|
| Rate for Payer: Priority Health SBD |
$2,496.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,589.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,589.61
|
| Rate for Payer: UHCCP Medicaid |
$1,058.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,513.40
|
|
|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM EA ADDL
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 22226
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$573.58 |
| Rate for Payer: Aetna Commercial |
$469.64
|
| Rate for Payer: Aetna Medicare |
$364.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.69
|
| Rate for Payer: BCBS Complete |
$241.76
|
| Rate for Payer: BCBS MAPPO |
$350.48
|
| Rate for Payer: BCBS Trust/PPO |
$233.52
|
| Rate for Payer: BCN Commercial |
$573.58
|
| Rate for Payer: BCN Medicare Advantage |
$350.48
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$469.64
|
| Rate for Payer: Cofinity Commercial |
$504.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.00
|
| Rate for Payer: Meridian Medicaid |
$241.76
|
| Rate for Payer: Nomi Health Commercial |
$420.58
|
| Rate for Payer: PACE SWMI |
$350.48
|
| Rate for Payer: PHP Commercial |
$490.67
|
| Rate for Payer: PHP Medicare Advantage |
$350.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.49
|
| Rate for Payer: Priority Health Medicare |
$350.48
|
| Rate for Payer: Priority Health Narrow Network |
$544.49
|
| Rate for Payer: Priority Health SBD |
$544.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.48
|
| Rate for Payer: UHC Medicare Advantage |
$350.48
|
| Rate for Payer: UHCCP Medicaid |
$230.25
|
| Rate for Payer: UMR Bronson Commercial |
$307.74
|
|
|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM LUMBAR
|
Professional
|
Both
|
$3,280.00
|
|
|
Service Code
|
HCPCS 22224
|
| Min. Negotiated Rate |
$180.34 |
| Max. Negotiated Rate |
$2,434.38 |
| Rate for Payer: Aetna Commercial |
$2,062.43
|
| Rate for Payer: Aetna Medicare |
$1,600.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,062.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,216.35
|
| Rate for Payer: BCBS Complete |
$1,080.01
|
| Rate for Payer: BCBS MAPPO |
$1,539.13
|
| Rate for Payer: BCBS Trust/PPO |
$180.34
|
| Rate for Payer: BCN Commercial |
$2,319.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,539.13
|
| Rate for Payer: Cash Price |
$2,624.00
|
| Rate for Payer: Cash Price |
$2,624.00
|
| Rate for Payer: Cofinity Commercial |
$2,062.43
|
| Rate for Payer: Cofinity Commercial |
$2,216.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,539.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,616.09
|
| Rate for Payer: Meridian Medicaid |
$1,080.01
|
| Rate for Payer: Nomi Health Commercial |
$1,846.96
|
| Rate for Payer: PACE SWMI |
$1,539.13
|
| Rate for Payer: PHP Commercial |
$2,154.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,539.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,028.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,132.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,434.38
|
| Rate for Payer: Priority Health Medicare |
$1,539.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,434.38
|
| Rate for Payer: Priority Health SBD |
$2,434.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,539.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,539.13
|
| Rate for Payer: UHCCP Medicaid |
$1,028.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,508.80
|
|
|
PR OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 28304
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$1,211.44 |
| Rate for Payer: Aetna Commercial |
$792.90
|
| Rate for Payer: Aetna Medicare |
$615.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.08
|
| Rate for Payer: BCBS Complete |
$419.79
|
| Rate for Payer: BCBS MAPPO |
$591.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.98
|
| Rate for Payer: BCN Commercial |
$1,211.44
|
| Rate for Payer: BCN Medicare Advantage |
$591.72
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cofinity Commercial |
$792.90
|
| Rate for Payer: Cofinity Commercial |
$852.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.31
|
| Rate for Payer: Meridian Medicaid |
$419.79
|
| Rate for Payer: Nomi Health Commercial |
$710.06
|
| Rate for Payer: PACE SWMI |
$591.72
|
| Rate for Payer: PHP Commercial |
$828.41
|
| Rate for Payer: PHP Medicare Advantage |
$591.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$945.46
|
| Rate for Payer: Priority Health Medicare |
$591.72
|
| Rate for Payer: Priority Health Narrow Network |
$945.46
|
| Rate for Payer: Priority Health SBD |
$945.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.72
|
| Rate for Payer: UHC Medicare Advantage |
$591.72
|
| Rate for Payer: UHCCP Medicaid |
$399.80
|
| Rate for Payer: UMR Bronson Commercial |
$697.36
|
|
|
PR OSTEOTOMY TIBIA
|
Professional
|
Both
|
$3,036.00
|
|
|
Service Code
|
HCPCS 27705
|
| Min. Negotiated Rate |
$483.30 |
| Max. Negotiated Rate |
$2,650.81 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna Medicare |
$744.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.65
|
| Rate for Payer: BCBS Complete |
$507.46
|
| Rate for Payer: BCBS MAPPO |
$716.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,650.81
|
| Rate for Payer: BCN Commercial |
$1,107.35
|
| Rate for Payer: BCN Medicare Advantage |
$716.16
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cofinity Commercial |
$1,031.27
|
| Rate for Payer: Cofinity Commercial |
$959.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.97
|
| Rate for Payer: Meridian Medicaid |
$507.46
|
| Rate for Payer: Nomi Health Commercial |
$859.39
|
| Rate for Payer: PACE SWMI |
$716.16
|
| Rate for Payer: PHP Commercial |
$1,002.62
|
| Rate for Payer: PHP Medicare Advantage |
$716.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$483.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,973.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,155.12
|
| Rate for Payer: Priority Health Medicare |
$716.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,155.12
|
| Rate for Payer: Priority Health SBD |
$1,155.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.16
|
| Rate for Payer: UHC Medicare Advantage |
$716.16
|
| Rate for Payer: UHCCP Medicaid |
$483.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,396.56
|
|
|
PR OSTEOTOMY TIBIA & FIBULA
|
Professional
|
Both
|
$3,469.00
|
|
|
Service Code
|
HCPCS 27709
|
| Min. Negotiated Rate |
$490.37 |
| Max. Negotiated Rate |
$2,254.85 |
| Rate for Payer: Aetna Commercial |
$1,471.36
|
| Rate for Payer: Aetna Medicare |
$1,141.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,471.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.16
|
| Rate for Payer: BCBS Complete |
$774.72
|
| Rate for Payer: BCBS MAPPO |
$1,098.03
|
| Rate for Payer: BCBS Trust/PPO |
$490.37
|
| Rate for Payer: BCN Commercial |
$1,659.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.03
|
| Rate for Payer: Cash Price |
$2,775.20
|
| Rate for Payer: Cash Price |
$2,775.20
|
| Rate for Payer: Cofinity Commercial |
$1,471.36
|
| Rate for Payer: Cofinity Commercial |
$1,581.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,152.93
|
| Rate for Payer: Meridian Medicaid |
$774.72
|
| Rate for Payer: Nomi Health Commercial |
$1,317.64
|
| Rate for Payer: PACE SWMI |
$1,098.03
|
| Rate for Payer: PHP Commercial |
$1,537.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$737.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,254.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.10
|
| Rate for Payer: Priority Health Medicare |
$1,098.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,757.10
|
| Rate for Payer: Priority Health SBD |
$1,757.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,098.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,098.03
|
| Rate for Payer: UHCCP Medicaid |
$737.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,595.74
|
|
|
PR OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX
|
Professional
|
Both
|
$3,164.00
|
|
|
Service Code
|
HCPCS 27140
|
| Min. Negotiated Rate |
$583.62 |
| Max. Negotiated Rate |
$2,056.60 |
| Rate for Payer: Aetna Commercial |
$1,160.99
|
| Rate for Payer: Aetna Medicare |
$901.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,160.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.63
|
| Rate for Payer: BCBS Complete |
$612.80
|
| Rate for Payer: BCBS MAPPO |
$866.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.54
|
| Rate for Payer: BCN Commercial |
$1,316.01
|
| Rate for Payer: BCN Medicare Advantage |
$866.41
|
| Rate for Payer: Cash Price |
$2,531.20
|
| Rate for Payer: Cash Price |
$2,531.20
|
| Rate for Payer: Cofinity Commercial |
$1,160.99
|
| Rate for Payer: Cofinity Commercial |
$1,247.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.73
|
| Rate for Payer: Meridian Medicaid |
$612.80
|
| Rate for Payer: Nomi Health Commercial |
$1,039.69
|
| Rate for Payer: PACE SWMI |
$866.41
|
| Rate for Payer: PHP Commercial |
$1,212.97
|
| Rate for Payer: PHP Medicare Advantage |
$866.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$583.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,382.07
|
| Rate for Payer: Priority Health Medicare |
$866.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,382.07
|
| Rate for Payer: Priority Health SBD |
$1,382.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$866.41
|
| Rate for Payer: UHC Medicare Advantage |
$866.41
|
| Rate for Payer: UHCCP Medicaid |
$583.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,455.44
|
|
|
PR OSTEOTOMY ULNA
|
Professional
|
Both
|
$2,228.00
|
|
|
Service Code
|
HCPCS 25360
|
| Min. Negotiated Rate |
$430.47 |
| Max. Negotiated Rate |
$1,448.20 |
| Rate for Payer: Aetna Commercial |
$851.05
|
| Rate for Payer: Aetna Medicare |
$660.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$914.56
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCBS MAPPO |
$635.11
|
| Rate for Payer: BCBS Trust/PPO |
$677.28
|
| Rate for Payer: BCN Commercial |
$969.05
|
| Rate for Payer: BCN Medicare Advantage |
$635.11
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cofinity Commercial |
$851.05
|
| Rate for Payer: Cofinity Commercial |
$914.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$666.87
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Nomi Health Commercial |
$762.13
|
| Rate for Payer: PACE SWMI |
$635.11
|
| Rate for Payer: PHP Commercial |
$889.15
|
| Rate for Payer: PHP Medicare Advantage |
$635.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,019.25
|
| Rate for Payer: Priority Health Medicare |
$635.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,019.25
|
| Rate for Payer: Priority Health SBD |
$1,019.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$635.11
|
| Rate for Payer: UHC Medicare Advantage |
$635.11
|
| Rate for Payer: UHCCP Medicaid |
$430.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,024.88
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL
|
Professional
|
Both
|
$2,723.00
|
|
|
Service Code
|
HCPCS 27457
|
| Min. Negotiated Rate |
$619.83 |
| Max. Negotiated Rate |
$1,769.95 |
| Rate for Payer: Aetna Commercial |
$1,235.44
|
| Rate for Payer: Aetna Medicare |
$958.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,235.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.64
|
| Rate for Payer: BCBS Complete |
$650.82
|
| Rate for Payer: BCBS MAPPO |
$921.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,269.50
|
| Rate for Payer: BCN Commercial |
$1,408.86
|
| Rate for Payer: BCN Medicare Advantage |
$921.97
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cofinity Commercial |
$1,235.44
|
| Rate for Payer: Cofinity Commercial |
$1,327.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$968.07
|
| Rate for Payer: Meridian Medicaid |
$650.82
|
| Rate for Payer: Nomi Health Commercial |
$1,106.36
|
| Rate for Payer: PACE SWMI |
$921.97
|
| Rate for Payer: PHP Commercial |
$1,290.76
|
| Rate for Payer: PHP Medicare Advantage |
$921.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,769.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,451.78
|
| Rate for Payer: Priority Health Medicare |
$921.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,451.78
|
| Rate for Payer: Priority Health SBD |
$1,451.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.97
|
| Rate for Payer: UHC Medicare Advantage |
$921.97
|
| Rate for Payer: UHCCP Medicaid |
$619.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,252.58
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 27455
|
| Min. Negotiated Rate |
$623.66 |
| Max. Negotiated Rate |
$1,479.77 |
| Rate for Payer: Aetna Commercial |
$1,238.83
|
| Rate for Payer: Aetna Medicare |
$961.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.28
|
| Rate for Payer: BCBS Complete |
$654.84
|
| Rate for Payer: BCBS MAPPO |
$924.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.98
|
| Rate for Payer: BCN Commercial |
$1,412.28
|
| Rate for Payer: BCN Medicare Advantage |
$924.50
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,238.83
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.72
|
| Rate for Payer: Meridian Medicaid |
$654.84
|
| Rate for Payer: Nomi Health Commercial |
$1,109.40
|
| Rate for Payer: PACE SWMI |
$924.50
|
| Rate for Payer: PHP Commercial |
$1,294.30
|
| Rate for Payer: PHP Medicare Advantage |
$924.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.77
|
| Rate for Payer: Priority Health Medicare |
$924.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.77
|
| Rate for Payer: Priority Health SBD |
$1,479.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.50
|
| Rate for Payer: UHC Medicare Advantage |
$924.50
|
| Rate for Payer: UHCCP Medicaid |
$623.66
|
| Rate for Payer: UMR Bronson Commercial |
$935.18
|
|
|
PR OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 28312
|
| Min. Negotiated Rate |
$231.74 |
| Max. Negotiated Rate |
$1,771.92 |
| Rate for Payer: Aetna Commercial |
$455.32
|
| Rate for Payer: Aetna Medicare |
$353.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.30
|
| Rate for Payer: BCBS Complete |
$243.33
|
| Rate for Payer: BCBS MAPPO |
$339.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,771.92
|
| Rate for Payer: BCN Commercial |
$777.49
|
| Rate for Payer: BCN Medicare Advantage |
$339.79
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$455.32
|
| Rate for Payer: Cofinity Commercial |
$489.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.78
|
| Rate for Payer: Meridian Medicaid |
$243.33
|
| Rate for Payer: Nomi Health Commercial |
$407.75
|
| Rate for Payer: PACE SWMI |
$339.79
|
| Rate for Payer: PHP Commercial |
$475.71
|
| Rate for Payer: PHP Medicare Advantage |
$339.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.28
|
| Rate for Payer: Priority Health Medicare |
$339.79
|
| Rate for Payer: Priority Health Narrow Network |
$533.28
|
| Rate for Payer: Priority Health SBD |
$533.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.79
|
| Rate for Payer: UHC Medicare Advantage |
$339.79
|
| Rate for Payer: UHCCP Medicaid |
$231.74
|
| Rate for Payer: UMR Bronson Commercial |
$373.06
|
|
|
PR OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28310
|
| Min. Negotiated Rate |
$238.77 |
| Max. Negotiated Rate |
$1,691.62 |
| Rate for Payer: Aetna Commercial |
$471.40
|
| Rate for Payer: Aetna Medicare |
$365.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.58
|
| Rate for Payer: BCBS Complete |
$250.71
|
| Rate for Payer: BCBS MAPPO |
$351.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.62
|
| Rate for Payer: BCN Commercial |
$790.19
|
| Rate for Payer: BCN Medicare Advantage |
$351.79
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$471.40
|
| Rate for Payer: Cofinity Commercial |
$506.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.38
|
| Rate for Payer: Meridian Medicaid |
$250.71
|
| Rate for Payer: Nomi Health Commercial |
$422.15
|
| Rate for Payer: PACE SWMI |
$351.79
|
| Rate for Payer: PHP Commercial |
$492.51
|
| Rate for Payer: PHP Medicare Advantage |
$351.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.27
|
| Rate for Payer: Priority Health Medicare |
$351.79
|
| Rate for Payer: Priority Health Narrow Network |
$561.27
|
| Rate for Payer: Priority Health SBD |
$561.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.79
|
| Rate for Payer: UHC Medicare Advantage |
$351.79
|
| Rate for Payer: UHCCP Medicaid |
$238.77
|
| Rate for Payer: UMR Bronson Commercial |
$439.76
|
|
|
PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 22216
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$1,714.05 |
| Rate for Payer: Aetna Commercial |
$473.88
|
| Rate for Payer: Aetna Medicare |
$367.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.24
|
| Rate for Payer: BCBS Complete |
$243.78
|
| Rate for Payer: BCBS MAPPO |
$353.64
|
| Rate for Payer: BCBS Trust/PPO |
$106.88
|
| Rate for Payer: BCN Commercial |
$580.04
|
| Rate for Payer: BCN Medicare Advantage |
$353.64
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cofinity Commercial |
$473.88
|
| Rate for Payer: Cofinity Commercial |
$509.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.32
|
| Rate for Payer: Meridian Medicaid |
$243.78
|
| Rate for Payer: Nomi Health Commercial |
$424.37
|
| Rate for Payer: PACE SWMI |
$353.64
|
| Rate for Payer: PHP Commercial |
$495.10
|
| Rate for Payer: PHP Medicare Advantage |
$353.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,714.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.08
|
| Rate for Payer: Priority Health Medicare |
$353.64
|
| Rate for Payer: Priority Health Narrow Network |
$550.08
|
| Rate for Payer: Priority Health SBD |
$550.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.64
|
| Rate for Payer: UHC Medicare Advantage |
$353.64
|
| Rate for Payer: UHCCP Medicaid |
$232.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,213.02
|
|
|
PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 28305
|
| Min. Negotiated Rate |
$436.22 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$866.93
|
| Rate for Payer: Aetna Medicare |
$672.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.62
|
| Rate for Payer: BCBS Complete |
$458.03
|
| Rate for Payer: BCBS MAPPO |
$646.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$979.31
|
| Rate for Payer: BCN Medicare Advantage |
$646.96
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$866.93
|
| Rate for Payer: Cofinity Commercial |
$931.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.31
|
| Rate for Payer: Meridian Medicaid |
$458.03
|
| Rate for Payer: Nomi Health Commercial |
$776.35
|
| Rate for Payer: PACE SWMI |
$646.96
|
| Rate for Payer: PHP Commercial |
$905.74
|
| Rate for Payer: PHP Medicare Advantage |
$646.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,119.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,038.08
|
| Rate for Payer: Priority Health Medicare |
$646.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,038.08
|
| Rate for Payer: Priority Health SBD |
$1,038.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$646.96
|
| Rate for Payer: UHC Medicare Advantage |
$646.96
|
| Rate for Payer: UHCCP Medicaid |
$436.22
|
| Rate for Payer: UMR Bronson Commercial |
$792.12
|
|
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
Professional
|
Both
|
$3,962.00
|
|
|
Service Code
|
HCPCS 28309
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,575.30 |
| Rate for Payer: Aetna Commercial |
$1,166.72
|
| Rate for Payer: Aetna Medicare |
$905.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,166.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.79
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS MAPPO |
$870.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.07
|
| Rate for Payer: BCN Commercial |
$1,315.04
|
| Rate for Payer: BCN Medicare Advantage |
$870.69
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cofinity Commercial |
$1,166.72
|
| Rate for Payer: Cofinity Commercial |
$1,253.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.22
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Nomi Health Commercial |
$1,044.83
|
| Rate for Payer: PACE SWMI |
$870.69
|
| Rate for Payer: PHP Commercial |
$1,218.97
|
| Rate for Payer: PHP Medicare Advantage |
$870.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,391.22
|
| Rate for Payer: Priority Health Medicare |
$870.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,391.22
|
| Rate for Payer: Priority Health SBD |
$1,391.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.69
|
| Rate for Payer: UHC Medicare Advantage |
$870.69
|
| Rate for Payer: UHCCP Medicaid |
$586.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,822.52
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 28306
|
| Min. Negotiated Rate |
$264.76 |
| Max. Negotiated Rate |
$1,500.90 |
| Rate for Payer: Aetna Commercial |
$523.06
|
| Rate for Payer: Aetna Medicare |
$405.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.09
|
| Rate for Payer: BCBS Complete |
$278.00
|
| Rate for Payer: BCBS MAPPO |
$390.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.90
|
| Rate for Payer: BCN Commercial |
$886.46
|
| Rate for Payer: BCN Medicare Advantage |
$390.34
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cofinity Commercial |
$523.06
|
| Rate for Payer: Cofinity Commercial |
$562.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.86
|
| Rate for Payer: Meridian Medicaid |
$278.00
|
| Rate for Payer: Nomi Health Commercial |
$468.41
|
| Rate for Payer: PACE SWMI |
$390.34
|
| Rate for Payer: PHP Commercial |
$546.48
|
| Rate for Payer: PHP Medicare Advantage |
$390.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.95
|
| Rate for Payer: Priority Health Medicare |
$390.34
|
| Rate for Payer: Priority Health Narrow Network |
$628.95
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.34
|
| Rate for Payer: UHC Medicare Advantage |
$390.34
|
| Rate for Payer: UHCCP Medicaid |
$264.76
|
| Rate for Payer: UMR Bronson Commercial |
$651.82
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 28308
|
| Min. Negotiated Rate |
$252.83 |
| Max. Negotiated Rate |
$1,566.94 |
| Rate for Payer: Aetna Commercial |
$497.23
|
| Rate for Payer: Aetna Medicare |
$385.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.34
|
| Rate for Payer: BCBS Complete |
$265.47
|
| Rate for Payer: BCBS MAPPO |
$371.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.94
|
| Rate for Payer: BCN Commercial |
$829.77
|
| Rate for Payer: BCN Medicare Advantage |
$371.07
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$497.23
|
| Rate for Payer: Cofinity Commercial |
$534.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.62
|
| Rate for Payer: Meridian Medicaid |
$265.47
|
| Rate for Payer: Nomi Health Commercial |
$445.28
|
| Rate for Payer: PACE SWMI |
$371.07
|
| Rate for Payer: PHP Commercial |
$519.50
|
| Rate for Payer: PHP Medicare Advantage |
$371.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.44
|
| Rate for Payer: Priority Health Medicare |
$371.07
|
| Rate for Payer: Priority Health Narrow Network |
$599.44
|
| Rate for Payer: Priority Health SBD |
$599.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.07
|
| Rate for Payer: UHC Medicare Advantage |
$371.07
|
| Rate for Payer: UHCCP Medicaid |
$252.83
|
| Rate for Payer: UMR Bronson Commercial |
$500.02
|
|
|
PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 63295
|
| Min. Negotiated Rate |
$212.57 |
| Max. Negotiated Rate |
$825.50 |
| Rate for Payer: Aetna Commercial |
$438.74
|
| Rate for Payer: Aetna Medicare |
$340.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.48
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$327.42
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: BCN Commercial |
$483.30
|
| Rate for Payer: BCN Medicare Advantage |
$327.42
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$438.74
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.79
|
| Rate for Payer: Meridian Medicaid |
$223.20
|
| Rate for Payer: Nomi Health Commercial |
$392.90
|
| Rate for Payer: PACE SWMI |
$327.42
|
| Rate for Payer: PHP Commercial |
$458.39
|
| Rate for Payer: PHP Medicare Advantage |
$327.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.89
|
| Rate for Payer: Priority Health Medicare |
$327.42
|
| Rate for Payer: Priority Health Narrow Network |
$561.89
|
| Rate for Payer: Priority Health SBD |
$561.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.42
|
| Rate for Payer: UHC Medicare Advantage |
$327.42
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
| Rate for Payer: UMR Bronson Commercial |
$584.20
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$135.40
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$121.86 |
| Rate for Payer: Aetna American Axle |
$88.01
|
| Rate for Payer: Aetna American Axle |
$29.30
|
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna Medicare |
$67.70
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: BCBS Complete |
$18.03
|
| Rate for Payer: BCBS Complete |
$54.16
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Cofinity Commercial |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.30
|
| Rate for Payer: Priority Health SBD |
$28.40
|
| Rate for Payer: Priority Health SBD |
$85.30
|
| Rate for Payer: UMR Bronson Commercial |
$50.10
|
| Rate for Payer: UMR Bronson Commercial |
$16.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.55
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.40
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.58 |
| Max. Negotiated Rate |
$121.86 |
| Rate for Payer: Aetna American Axle |
$88.01
|
| Rate for Payer: Aetna American Axle |
$29.30
|
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Cofinity Commercial |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.30
|
| Rate for Payer: Priority Health SBD |
$85.30
|
| Rate for Payer: Priority Health SBD |
$28.40
|
| Rate for Payer: UMR Bronson Commercial |
$59.58
|
| Rate for Payer: UMR Bronson Commercial |
$19.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.81
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA
|
Professional
|
Both
|
$4,482.00
|
|
|
Service Code
|
HCPCS 61345
|
| Min. Negotiated Rate |
$660.90 |
| Max. Negotiated Rate |
$4,181.49 |
| Rate for Payer: Aetna Commercial |
$2,717.29
|
| Rate for Payer: Aetna Medicare |
$2,108.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,717.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,920.08
|
| Rate for Payer: BCBS Complete |
$1,397.81
|
| Rate for Payer: BCBS MAPPO |
$2,027.83
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$4,181.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,027.83
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cofinity Commercial |
$2,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,920.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,027.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,129.22
|
| Rate for Payer: Meridian Medicaid |
$1,397.81
|
| Rate for Payer: Nomi Health Commercial |
$2,433.40
|
| Rate for Payer: PACE SWMI |
$2,027.83
|
| Rate for Payer: PHP Commercial |
$2,838.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,027.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,331.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,913.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,538.55
|
| Rate for Payer: Priority Health Medicare |
$2,027.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,538.55
|
| Rate for Payer: Priority Health SBD |
$3,538.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,027.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,027.83
|
| Rate for Payer: UHCCP Medicaid |
$1,331.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,061.72
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$1,298.03 |
| Rate for Payer: Aetna Commercial |
$119.89
|
| Rate for Payer: Aetna Medicare |
$93.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.84
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS MAPPO |
$89.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,298.03
|
| Rate for Payer: BCN Commercial |
$137.32
|
| Rate for Payer: BCN Medicare Advantage |
$89.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Cofinity Commercial |
$128.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.94
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Nomi Health Commercial |
$107.36
|
| Rate for Payer: PACE SWMI |
$89.47
|
| Rate for Payer: PHP Commercial |
$125.26
|
| Rate for Payer: PHP Medicare Advantage |
$89.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.91
|
| Rate for Payer: Priority Health Medicare |
$89.47
|
| Rate for Payer: Priority Health Narrow Network |
$128.91
|
| Rate for Payer: Priority Health SBD |
$128.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.47
|
| Rate for Payer: UHC Medicare Advantage |
$89.47
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
| Rate for Payer: UMR Bronson Commercial |
$153.18
|
|
