|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,740.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$640.28 |
| Max. Negotiated Rate |
$3,555.00 |
| Rate for Payer: Aetna Commercial |
$1,314.77
|
| Rate for Payer: Aetna Medicare |
$1,020.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.88
|
| Rate for Payer: BCBS Complete |
$672.29
|
| Rate for Payer: BCBS MAPPO |
$981.17
|
| Rate for Payer: BCN Commercial |
$1,642.84
|
| Rate for Payer: BCN Medicare Advantage |
$981.17
|
| Rate for Payer: Cash Price |
$3,792.00
|
| Rate for Payer: Cash Price |
$3,792.00
|
| Rate for Payer: Cofinity Commercial |
$1,314.77
|
| Rate for Payer: Cofinity Commercial |
$1,412.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.23
|
| Rate for Payer: Meridian Medicaid |
$672.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,079.29
|
| Rate for Payer: Nomi Health Commercial |
$1,177.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,555.00
|
| Rate for Payer: PACE SWMI |
$981.17
|
| Rate for Payer: PHP Commercial |
$1,373.64
|
| Rate for Payer: PHP Medicare Advantage |
$981.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,756.15
|
| Rate for Payer: Priority Health Medicare |
$981.17
|
| Rate for Payer: Priority Health SBD |
$1,756.15
|
| Rate for Payer: Priority Health Tiered Network |
$1,756.15
|
| Rate for Payer: Railroad Medicare Medicare |
$981.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,878.87
|
| Rate for Payer: UHC Core |
$1,878.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$981.17
|
| Rate for Payer: UHC Exchange |
$1,878.87
|
| Rate for Payer: UHC Medicaid |
$640.28
|
| Rate for Payer: UHCCP Medicaid |
$640.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,180.40
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$618.34 |
| Max. Negotiated Rate |
$2,233.50 |
| Rate for Payer: Aetna Commercial |
$1,273.75
|
| Rate for Payer: Aetna Medicare |
$988.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,368.81
|
| Rate for Payer: BCBS Complete |
$649.26
|
| Rate for Payer: BCBS MAPPO |
$950.56
|
| Rate for Payer: BCN Commercial |
$1,603.50
|
| Rate for Payer: BCN Medicare Advantage |
$950.56
|
| Rate for Payer: Cash Price |
$2,382.40
|
| Rate for Payer: Cash Price |
$2,382.40
|
| Rate for Payer: Cofinity Commercial |
$1,273.75
|
| Rate for Payer: Cofinity Commercial |
$1,368.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$950.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$998.09
|
| Rate for Payer: Meridian Medicaid |
$649.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,045.62
|
| Rate for Payer: Nomi Health Commercial |
$1,140.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,233.50
|
| Rate for Payer: PACE SWMI |
$950.56
|
| Rate for Payer: PHP Commercial |
$1,330.78
|
| Rate for Payer: PHP Medicare Advantage |
$950.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,714.10
|
| Rate for Payer: Priority Health Medicare |
$950.56
|
| Rate for Payer: Priority Health SBD |
$1,714.10
|
| Rate for Payer: Priority Health Tiered Network |
$1,714.10
|
| Rate for Payer: Railroad Medicare Medicare |
$950.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,849.48
|
| Rate for Payer: UHC Core |
$1,849.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$950.56
|
| Rate for Payer: UHC Exchange |
$1,849.48
|
| Rate for Payer: UHC Medicaid |
$618.34
|
| Rate for Payer: UHCCP Medicaid |
$618.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,369.88
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,443.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$471.16 |
| Max. Negotiated Rate |
$1,377.91 |
| Rate for Payer: Aetna Commercial |
$967.10
|
| Rate for Payer: Aetna Medicare |
$750.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.10
|
| Rate for Payer: BCBS Complete |
$494.72
|
| Rate for Payer: BCBS MAPPO |
$721.72
|
| Rate for Payer: BCN Commercial |
$1,204.12
|
| Rate for Payer: BCN Medicare Advantage |
$721.72
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cofinity Commercial |
$1,039.28
|
| Rate for Payer: Cofinity Commercial |
$967.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.81
|
| Rate for Payer: Meridian Medicaid |
$494.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$793.89
|
| Rate for Payer: Nomi Health Commercial |
$866.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,082.25
|
| Rate for Payer: PACE SWMI |
$721.72
|
| Rate for Payer: PHP Commercial |
$1,010.41
|
| Rate for Payer: PHP Medicare Advantage |
$721.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,287.17
|
| Rate for Payer: Priority Health Medicare |
$721.72
|
| Rate for Payer: Priority Health SBD |
$1,287.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,287.17
|
| Rate for Payer: Railroad Medicare Medicare |
$721.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,377.91
|
| Rate for Payer: UHC Core |
$1,377.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$721.72
|
| Rate for Payer: UHC Exchange |
$1,377.91
|
| Rate for Payer: UHC Medicaid |
$471.16
|
| Rate for Payer: UHCCP Medicaid |
$471.16
|
| Rate for Payer: UMR Bronson Commercial |
$663.78
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$368.49 |
| Max. Negotiated Rate |
$1,071.63 |
| Rate for Payer: Aetna Commercial |
$755.96
|
| Rate for Payer: Aetna Medicare |
$586.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.38
|
| Rate for Payer: BCBS Complete |
$386.91
|
| Rate for Payer: BCBS MAPPO |
$564.15
|
| Rate for Payer: BCN Commercial |
$935.21
|
| Rate for Payer: BCN Medicare Advantage |
$564.15
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cofinity Commercial |
$755.96
|
| Rate for Payer: Cofinity Commercial |
$812.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.36
|
| Rate for Payer: Meridian Medicaid |
$386.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$620.57
|
| Rate for Payer: Nomi Health Commercial |
$676.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.50
|
| Rate for Payer: PACE SWMI |
$564.15
|
| Rate for Payer: PHP Commercial |
$789.81
|
| Rate for Payer: PHP Medicare Advantage |
$564.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$999.72
|
| Rate for Payer: Priority Health Medicare |
$564.15
|
| Rate for Payer: Priority Health SBD |
$999.72
|
| Rate for Payer: Priority Health Tiered Network |
$999.72
|
| Rate for Payer: Railroad Medicare Medicare |
$564.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,071.63
|
| Rate for Payer: UHC Core |
$1,071.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$564.15
|
| Rate for Payer: UHC Exchange |
$1,071.63
|
| Rate for Payer: UHC Medicaid |
$368.49
|
| Rate for Payer: UHCCP Medicaid |
$368.49
|
| Rate for Payer: UMR Bronson Commercial |
$624.68
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$4,020.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$517.38 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna Commercial |
$1,062.79
|
| Rate for Payer: Aetna Medicare |
$824.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.11
|
| Rate for Payer: BCBS Complete |
$543.25
|
| Rate for Payer: BCBS MAPPO |
$793.13
|
| Rate for Payer: BCN Commercial |
$1,327.62
|
| Rate for Payer: BCN Medicare Advantage |
$793.13
|
| Rate for Payer: Cash Price |
$3,216.00
|
| Rate for Payer: Cash Price |
$3,216.00
|
| Rate for Payer: Cofinity Commercial |
$1,062.79
|
| Rate for Payer: Cofinity Commercial |
$1,142.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.79
|
| Rate for Payer: Meridian Medicaid |
$543.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$872.44
|
| Rate for Payer: Nomi Health Commercial |
$951.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,015.00
|
| Rate for Payer: PACE SWMI |
$793.13
|
| Rate for Payer: PHP Commercial |
$1,110.38
|
| Rate for Payer: PHP Medicare Advantage |
$793.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,419.19
|
| Rate for Payer: Priority Health Medicare |
$793.13
|
| Rate for Payer: Priority Health SBD |
$1,419.19
|
| Rate for Payer: Priority Health Tiered Network |
$1,419.19
|
| Rate for Payer: Railroad Medicare Medicare |
$793.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,530.97
|
| Rate for Payer: UHC Core |
$1,530.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$793.13
|
| Rate for Payer: UHC Exchange |
$1,530.97
|
| Rate for Payer: UHC Medicaid |
$517.38
|
| Rate for Payer: UHCCP Medicaid |
$517.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,849.20
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$531.44 |
| Max. Negotiated Rate |
$2,956.50 |
| Rate for Payer: Aetna Commercial |
$1,091.85
|
| Rate for Payer: Aetna Medicare |
$847.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.33
|
| Rate for Payer: BCBS Complete |
$558.01
|
| Rate for Payer: BCBS MAPPO |
$814.81
|
| Rate for Payer: BCN Commercial |
$1,362.98
|
| Rate for Payer: BCN Medicare Advantage |
$814.81
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cofinity Commercial |
$1,091.85
|
| Rate for Payer: Cofinity Commercial |
$1,173.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$814.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$855.55
|
| Rate for Payer: Meridian Medicaid |
$558.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$896.29
|
| Rate for Payer: Nomi Health Commercial |
$977.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,956.50
|
| Rate for Payer: PACE SWMI |
$814.81
|
| Rate for Payer: PHP Commercial |
$1,140.73
|
| Rate for Payer: PHP Medicare Advantage |
$814.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,456.97
|
| Rate for Payer: Priority Health Medicare |
$814.81
|
| Rate for Payer: Priority Health SBD |
$1,456.97
|
| Rate for Payer: Priority Health Tiered Network |
$1,456.97
|
| Rate for Payer: Railroad Medicare Medicare |
$814.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,560.76
|
| Rate for Payer: UHC Core |
$1,560.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$814.81
|
| Rate for Payer: UHC Exchange |
$1,560.76
|
| Rate for Payer: UHC Medicaid |
$531.44
|
| Rate for Payer: UHCCP Medicaid |
$531.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,813.32
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$1,187.01 |
| Rate for Payer: Aetna Commercial |
$815.59
|
| Rate for Payer: Aetna Medicare |
$633.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$876.46
|
| Rate for Payer: BCBS Complete |
$414.88
|
| Rate for Payer: BCBS MAPPO |
$608.65
|
| Rate for Payer: BCN Commercial |
$1,021.36
|
| Rate for Payer: BCN Medicare Advantage |
$608.65
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$815.59
|
| Rate for Payer: Cofinity Commercial |
$876.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$639.08
|
| Rate for Payer: Meridian Medicaid |
$414.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$669.51
|
| Rate for Payer: Nomi Health Commercial |
$730.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$608.65
|
| Rate for Payer: PHP Commercial |
$852.11
|
| Rate for Payer: PHP Medicare Advantage |
$608.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,112.60
|
| Rate for Payer: Priority Health Medicare |
$608.65
|
| Rate for Payer: Priority Health SBD |
$1,112.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,112.60
|
| Rate for Payer: Railroad Medicare Medicare |
$608.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.01
|
| Rate for Payer: UHC Core |
$1,187.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$608.65
|
| Rate for Payer: UHC Exchange |
$1,187.01
|
| Rate for Payer: UHC Medicaid |
$395.12
|
| Rate for Payer: UHCCP Medicaid |
$395.12
|
| Rate for Payer: UMR Bronson Commercial |
$657.80
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS BY LIGATION
|
Professional
|
Both
|
$4,534.00
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$590.01 |
| Max. Negotiated Rate |
$3,400.50 |
| Rate for Payer: Aetna Commercial |
$1,234.81
|
| Rate for Payer: Aetna Medicare |
$958.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,234.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.96
|
| Rate for Payer: BCBS Complete |
$619.51
|
| Rate for Payer: BCBS MAPPO |
$921.50
|
| Rate for Payer: BCN Commercial |
$1,433.69
|
| Rate for Payer: BCN Medicare Advantage |
$921.50
|
| Rate for Payer: Cash Price |
$3,627.20
|
| Rate for Payer: Cash Price |
$3,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,234.81
|
| Rate for Payer: Cofinity Commercial |
$1,326.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.58
|
| Rate for Payer: Meridian Medicaid |
$619.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,013.65
|
| Rate for Payer: Nomi Health Commercial |
$1,105.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,400.50
|
| Rate for Payer: PACE SWMI |
$921.50
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: PHP Medicare Advantage |
$921.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,541.76
|
| Rate for Payer: Priority Health Medicare |
$921.50
|
| Rate for Payer: Priority Health SBD |
$1,541.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,541.76
|
| Rate for Payer: Railroad Medicare Medicare |
$921.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,717.38
|
| Rate for Payer: UHC Core |
$1,717.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$921.50
|
| Rate for Payer: UHC Exchange |
$1,717.38
|
| Rate for Payer: UHC Medicaid |
$590.01
|
| Rate for Payer: UHCCP Medicaid |
$590.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,085.64
|
|
|
PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC
|
Professional
|
Both
|
$4,265.00
|
|
|
Service Code
|
HCPCS 21743
|
| Min. Negotiated Rate |
$421.31 |
| Max. Negotiated Rate |
$3,198.75 |
| Rate for Payer: Aetna Commercial |
$2,118.84
|
| Rate for Payer: Aetna Medicare |
$2,132.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.84
|
| Rate for Payer: BCBS Complete |
$442.38
|
| Rate for Payer: BCN Commercial |
$3,033.71
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Meridian Medicaid |
$442.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,198.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,544.00
|
| Rate for Payer: Priority Health SBD |
$2,544.00
|
| Rate for Payer: Priority Health Tiered Network |
$2,544.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,771.23
|
| Rate for Payer: UHC Core |
$2,771.23
|
| Rate for Payer: UHC Exchange |
$2,771.23
|
| Rate for Payer: UHC Medicaid |
$421.31
|
| Rate for Payer: UHCCP Medicaid |
$421.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,961.90
|
|
|
PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN
|
Professional
|
Both
|
$4,265.00
|
|
|
Service Code
|
HCPCS 21740
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$3,198.75 |
| Rate for Payer: Aetna Commercial |
$1,319.15
|
| Rate for Payer: Aetna Medicare |
$1,023.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,417.59
|
| Rate for Payer: BCBS Complete |
$662.68
|
| Rate for Payer: BCBS MAPPO |
$984.44
|
| Rate for Payer: BCN Commercial |
$1,530.30
|
| Rate for Payer: BCN Medicare Advantage |
$984.44
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cofinity Commercial |
$1,417.59
|
| Rate for Payer: Cofinity Commercial |
$1,319.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$984.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,033.66
|
| Rate for Payer: Meridian Medicaid |
$662.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,082.88
|
| Rate for Payer: Nomi Health Commercial |
$1,181.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,198.75
|
| Rate for Payer: PACE SWMI |
$984.44
|
| Rate for Payer: PHP Commercial |
$1,378.22
|
| Rate for Payer: PHP Medicare Advantage |
$984.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,635.85
|
| Rate for Payer: Priority Health Medicare |
$984.44
|
| Rate for Payer: Priority Health SBD |
$1,635.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,635.85
|
| Rate for Payer: Railroad Medicare Medicare |
$984.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,825.42
|
| Rate for Payer: UHC Core |
$1,825.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$984.44
|
| Rate for Payer: UHC Exchange |
$1,825.42
|
| Rate for Payer: UHC Medicaid |
$631.12
|
| Rate for Payer: UHCCP Medicaid |
$631.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,961.90
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,680.00
|
|
|
Service Code
|
HCPCS 27650
|
| Min. Negotiated Rate |
$398.10 |
| Max. Negotiated Rate |
$2,010.00 |
| Rate for Payer: Aetna Commercial |
$812.72
|
| Rate for Payer: Aetna Medicare |
$630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.37
|
| Rate for Payer: BCBS Complete |
$418.00
|
| Rate for Payer: BCBS MAPPO |
$606.51
|
| Rate for Payer: BCN Commercial |
$1,102.89
|
| Rate for Payer: BCN Medicare Advantage |
$606.51
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cofinity Commercial |
$812.72
|
| Rate for Payer: Cofinity Commercial |
$873.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.84
|
| Rate for Payer: Meridian Medicaid |
$418.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$667.16
|
| Rate for Payer: Nomi Health Commercial |
$727.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,010.00
|
| Rate for Payer: PACE SWMI |
$606.51
|
| Rate for Payer: PHP Commercial |
$849.11
|
| Rate for Payer: PHP Medicare Advantage |
$606.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,073.18
|
| Rate for Payer: Priority Health Medicare |
$606.51
|
| Rate for Payer: Priority Health SBD |
$1,073.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,073.18
|
| Rate for Payer: Railroad Medicare Medicare |
$606.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,145.42
|
| Rate for Payer: UHC Core |
$1,145.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$606.51
|
| Rate for Payer: UHC Exchange |
$1,145.42
|
| Rate for Payer: UHC Medicaid |
$398.10
|
| Rate for Payer: UHCCP Medicaid |
$398.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,232.80
|
|
|
PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 27407
|
| Min. Negotiated Rate |
$477.12 |
| Max. Negotiated Rate |
$1,401.00 |
| Rate for Payer: Aetna Commercial |
$978.29
|
| Rate for Payer: Aetna Medicare |
$759.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.29
|
| Rate for Payer: BCBS Complete |
$500.98
|
| Rate for Payer: BCBS MAPPO |
$730.07
|
| Rate for Payer: BCN Commercial |
$1,218.06
|
| Rate for Payer: BCN Medicare Advantage |
$730.07
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cofinity Commercial |
$1,051.30
|
| Rate for Payer: Cofinity Commercial |
$978.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$730.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$766.57
|
| Rate for Payer: Meridian Medicaid |
$500.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$803.08
|
| Rate for Payer: Nomi Health Commercial |
$876.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.00
|
| Rate for Payer: PACE SWMI |
$730.07
|
| Rate for Payer: PHP Commercial |
$1,022.10
|
| Rate for Payer: PHP Medicare Advantage |
$730.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,302.08
|
| Rate for Payer: Priority Health Medicare |
$730.07
|
| Rate for Payer: Priority Health SBD |
$1,302.08
|
| Rate for Payer: Priority Health Tiered Network |
$1,302.08
|
| Rate for Payer: Railroad Medicare Medicare |
$730.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.98
|
| Rate for Payer: UHC Core |
$1,387.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$730.07
|
| Rate for Payer: UHC Exchange |
$1,387.98
|
| Rate for Payer: UHC Medicaid |
$477.12
|
| Rate for Payer: UHCCP Medicaid |
$477.12
|
| Rate for Payer: UMR Bronson Commercial |
$859.28
|
|
|
PR REPAIR RECTOCELE SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 45560
|
| Min. Negotiated Rate |
$404.06 |
| Max. Negotiated Rate |
$1,265.08 |
| Rate for Payer: Aetna Commercial |
$837.39
|
| Rate for Payer: Aetna Medicare |
$649.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.88
|
| Rate for Payer: BCBS Complete |
$424.26
|
| Rate for Payer: BCBS MAPPO |
$624.92
|
| Rate for Payer: BCN Commercial |
$1,038.29
|
| Rate for Payer: BCN Medicare Advantage |
$624.92
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$837.39
|
| Rate for Payer: Cofinity Commercial |
$899.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.17
|
| Rate for Payer: Meridian Medicaid |
$424.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.41
|
| Rate for Payer: Nomi Health Commercial |
$749.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$995.25
|
| Rate for Payer: PACE SWMI |
$624.92
|
| Rate for Payer: PHP Commercial |
$874.89
|
| Rate for Payer: PHP Medicare Advantage |
$624.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,265.08
|
| Rate for Payer: Priority Health Medicare |
$624.92
|
| Rate for Payer: Priority Health SBD |
$1,265.08
|
| Rate for Payer: Priority Health Tiered Network |
$1,265.08
|
| Rate for Payer: Railroad Medicare Medicare |
$624.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,220.66
|
| Rate for Payer: UHC Core |
$1,220.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$624.92
|
| Rate for Payer: UHC Exchange |
$1,220.66
|
| Rate for Payer: UHC Medicaid |
$404.06
|
| Rate for Payer: UHCCP Medicaid |
$404.06
|
| Rate for Payer: UMR Bronson Commercial |
$610.42
|
|
|
PR REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT
|
Professional
|
Both
|
$2,858.00
|
|
|
Service Code
|
HCPCS 27654
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$2,143.50 |
| Rate for Payer: Aetna Commercial |
$882.73
|
| Rate for Payer: Aetna Medicare |
$685.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.60
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS MAPPO |
$658.75
|
| Rate for Payer: BCN Commercial |
$1,092.07
|
| Rate for Payer: BCN Medicare Advantage |
$658.75
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Cofinity Commercial |
$882.73
|
| Rate for Payer: Cofinity Commercial |
$948.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.69
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.62
|
| Rate for Payer: Nomi Health Commercial |
$790.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,143.50
|
| Rate for Payer: PACE SWMI |
$658.75
|
| Rate for Payer: PHP Commercial |
$922.25
|
| Rate for Payer: PHP Medicare Advantage |
$658.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,167.40
|
| Rate for Payer: Priority Health Medicare |
$658.75
|
| Rate for Payer: Priority Health SBD |
$1,167.40
|
| Rate for Payer: Priority Health Tiered Network |
$1,167.40
|
| Rate for Payer: Railroad Medicare Medicare |
$658.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,244.31
|
| Rate for Payer: UHC Core |
$1,244.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.75
|
| Rate for Payer: UHC Exchange |
$1,244.31
|
| Rate for Payer: UHC Medicaid |
$431.11
|
| Rate for Payer: UHCCP Medicaid |
$431.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,314.68
|
|
|
PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$3,083.00
|
|
|
Service Code
|
HCPCS 27698
|
| Min. Negotiated Rate |
$380.63 |
| Max. Negotiated Rate |
$2,312.25 |
| Rate for Payer: Aetna Commercial |
$781.22
|
| Rate for Payer: Aetna Medicare |
$606.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.52
|
| Rate for Payer: BCBS Complete |
$399.66
|
| Rate for Payer: BCBS MAPPO |
$583.00
|
| Rate for Payer: BCN Commercial |
$970.06
|
| Rate for Payer: BCN Medicare Advantage |
$583.00
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Cash Price |
$2,466.40
|
| Rate for Payer: Cofinity Commercial |
$781.22
|
| Rate for Payer: Cofinity Commercial |
$839.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$612.15
|
| Rate for Payer: Meridian Medicaid |
$399.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$641.30
|
| Rate for Payer: Nomi Health Commercial |
$699.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,312.25
|
| Rate for Payer: PACE SWMI |
$583.00
|
| Rate for Payer: PHP Commercial |
$816.20
|
| Rate for Payer: PHP Medicare Advantage |
$583.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,036.97
|
| Rate for Payer: Priority Health Medicare |
$583.00
|
| Rate for Payer: Priority Health SBD |
$1,036.97
|
| Rate for Payer: Priority Health Tiered Network |
$1,036.97
|
| Rate for Payer: Railroad Medicare Medicare |
$583.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,115.44
|
| Rate for Payer: UHC Core |
$1,115.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$583.00
|
| Rate for Payer: UHC Exchange |
$1,115.44
|
| Rate for Payer: UHC Medicaid |
$380.63
|
| Rate for Payer: UHCCP Medicaid |
$380.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,418.18
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE COMPLEX
|
Professional
|
Both
|
$2,329.00
|
|
|
Service Code
|
HCPCS 26562
|
| Min. Negotiated Rate |
$835.17 |
| Max. Negotiated Rate |
$2,339.80 |
| Rate for Payer: Aetna Commercial |
$1,699.01
|
| Rate for Payer: Aetna Medicare |
$1,318.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,699.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,825.80
|
| Rate for Payer: BCBS Complete |
$876.93
|
| Rate for Payer: BCBS MAPPO |
$1,267.92
|
| Rate for Payer: BCN Commercial |
$2,079.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,267.92
|
| Rate for Payer: Cash Price |
$1,863.20
|
| Rate for Payer: Cash Price |
$1,863.20
|
| Rate for Payer: Cofinity Commercial |
$1,699.01
|
| Rate for Payer: Cofinity Commercial |
$1,825.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,267.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,331.32
|
| Rate for Payer: Meridian Medicaid |
$876.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,394.71
|
| Rate for Payer: Nomi Health Commercial |
$1,521.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,746.75
|
| Rate for Payer: PACE SWMI |
$1,267.92
|
| Rate for Payer: PHP Commercial |
$1,775.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,267.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,223.00
|
| Rate for Payer: Priority Health Medicare |
$1,267.92
|
| Rate for Payer: Priority Health SBD |
$2,223.00
|
| Rate for Payer: Priority Health Tiered Network |
$2,223.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,267.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,339.80
|
| Rate for Payer: UHC Core |
$2,339.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,267.92
|
| Rate for Payer: UHC Exchange |
$2,339.80
|
| Rate for Payer: UHC Medicaid |
$835.17
|
| Rate for Payer: UHCCP Medicaid |
$835.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,071.34
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 26560
|
| Min. Negotiated Rate |
$406.83 |
| Max. Negotiated Rate |
$1,531.50 |
| Rate for Payer: Aetna Commercial |
$812.56
|
| Rate for Payer: Aetna Medicare |
$630.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.20
|
| Rate for Payer: BCBS Complete |
$427.17
|
| Rate for Payer: BCBS MAPPO |
$606.39
|
| Rate for Payer: BCN Commercial |
$959.61
|
| Rate for Payer: BCN Medicare Advantage |
$606.39
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cofinity Commercial |
$812.56
|
| Rate for Payer: Cofinity Commercial |
$873.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.71
|
| Rate for Payer: Meridian Medicaid |
$427.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$667.03
|
| Rate for Payer: Nomi Health Commercial |
$727.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,531.50
|
| Rate for Payer: PACE SWMI |
$606.39
|
| Rate for Payer: PHP Commercial |
$848.95
|
| Rate for Payer: PHP Medicare Advantage |
$606.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,025.80
|
| Rate for Payer: Priority Health Medicare |
$606.39
|
| Rate for Payer: Priority Health SBD |
$1,025.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,025.80
|
| Rate for Payer: Railroad Medicare Medicare |
$606.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,035.56
|
| Rate for Payer: UHC Core |
$1,035.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$606.39
|
| Rate for Payer: UHC Exchange |
$1,035.56
|
| Rate for Payer: UHC Medicaid |
$406.83
|
| Rate for Payer: UHCCP Medicaid |
$406.83
|
| Rate for Payer: UMR Bronson Commercial |
$939.32
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT
|
Professional
|
Both
|
$2,476.00
|
|
|
Service Code
|
HCPCS 26561
|
| Min. Negotiated Rate |
$603.43 |
| Max. Negotiated Rate |
$1,857.00 |
| Rate for Payer: Aetna Commercial |
$1,222.12
|
| Rate for Payer: Aetna Medicare |
$948.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,222.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.32
|
| Rate for Payer: BCBS Complete |
$633.60
|
| Rate for Payer: BCBS MAPPO |
$912.03
|
| Rate for Payer: BCN Commercial |
$1,481.99
|
| Rate for Payer: BCN Medicare Advantage |
$912.03
|
| Rate for Payer: Cash Price |
$1,980.80
|
| Rate for Payer: Cash Price |
$1,980.80
|
| Rate for Payer: Cofinity Commercial |
$1,222.12
|
| Rate for Payer: Cofinity Commercial |
$1,313.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$912.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$957.63
|
| Rate for Payer: Meridian Medicaid |
$633.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,003.23
|
| Rate for Payer: Nomi Health Commercial |
$1,094.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,857.00
|
| Rate for Payer: PACE SWMI |
$912.03
|
| Rate for Payer: PHP Commercial |
$1,276.84
|
| Rate for Payer: PHP Medicare Advantage |
$912.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$603.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,584.20
|
| Rate for Payer: Priority Health Medicare |
$912.03
|
| Rate for Payer: Priority Health SBD |
$1,584.20
|
| Rate for Payer: Priority Health Tiered Network |
$1,584.20
|
| Rate for Payer: Railroad Medicare Medicare |
$912.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,653.84
|
| Rate for Payer: UHC Core |
$1,653.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$912.03
|
| Rate for Payer: UHC Exchange |
$1,653.84
|
| Rate for Payer: UHC Medicaid |
$603.43
|
| Rate for Payer: UHCCP Medicaid |
$603.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.96
|
|
|
PR REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 28208
|
| Min. Negotiated Rate |
$197.45 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$401.34
|
| Rate for Payer: Aetna Medicare |
$311.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.29
|
| Rate for Payer: BCBS Complete |
$207.32
|
| Rate for Payer: BCBS MAPPO |
$299.51
|
| Rate for Payer: BCN Commercial |
$488.02
|
| Rate for Payer: BCN Medicare Advantage |
$299.51
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cofinity Commercial |
$401.34
|
| Rate for Payer: Cofinity Commercial |
$431.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.49
|
| Rate for Payer: Meridian Medicaid |
$207.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$329.46
|
| Rate for Payer: Nomi Health Commercial |
$359.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.00
|
| Rate for Payer: PACE SWMI |
$299.51
|
| Rate for Payer: PHP Commercial |
$419.31
|
| Rate for Payer: PHP Medicare Advantage |
$299.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$521.69
|
| Rate for Payer: Priority Health Medicare |
$299.51
|
| Rate for Payer: Priority Health SBD |
$521.69
|
| Rate for Payer: Priority Health Tiered Network |
$521.69
|
| Rate for Payer: Railroad Medicare Medicare |
$299.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$550.26
|
| Rate for Payer: UHC Core |
$550.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$299.51
|
| Rate for Payer: UHC Exchange |
$550.26
|
| Rate for Payer: UHC Medicaid |
$197.45
|
| Rate for Payer: UHCCP Medicaid |
$197.45
|
| Rate for Payer: UMR Bronson Commercial |
$360.64
|
|
|
PR REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC
|
Professional
|
Both
|
$2,405.00
|
|
|
Service Code
|
HCPCS 24341
|
| Min. Negotiated Rate |
$451.56 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$920.02
|
| Rate for Payer: Aetna Medicare |
$714.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$920.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.68
|
| Rate for Payer: BCBS Complete |
$474.14
|
| Rate for Payer: BCBS MAPPO |
$686.58
|
| Rate for Payer: BCN Commercial |
$1,148.35
|
| Rate for Payer: BCN Medicare Advantage |
$686.58
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cofinity Commercial |
$920.02
|
| Rate for Payer: Cofinity Commercial |
$988.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.91
|
| Rate for Payer: Meridian Medicaid |
$474.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$755.24
|
| Rate for Payer: Nomi Health Commercial |
$823.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,803.75
|
| Rate for Payer: PACE SWMI |
$686.58
|
| Rate for Payer: PHP Commercial |
$961.21
|
| Rate for Payer: PHP Medicare Advantage |
$686.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,227.55
|
| Rate for Payer: Priority Health Medicare |
$686.58
|
| Rate for Payer: Priority Health SBD |
$1,227.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,227.55
|
| Rate for Payer: Railroad Medicare Medicare |
$686.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,293.78
|
| Rate for Payer: UHC Core |
$1,293.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$686.58
|
| Rate for Payer: UHC Exchange |
$1,293.78
|
| Rate for Payer: UHC Medicaid |
$451.56
|
| Rate for Payer: UHCCP Medicaid |
$451.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,106.30
|
|
|
PR REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 33363
|
| Min. Negotiated Rate |
$778.73 |
| Max. Negotiated Rate |
$2,448.27 |
| Rate for Payer: Aetna Commercial |
$1,648.84
|
| Rate for Payer: Aetna Medicare |
$1,279.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,771.89
|
| Rate for Payer: BCBS Complete |
$817.67
|
| Rate for Payer: BCBS MAPPO |
$1,230.48
|
| Rate for Payer: BCN Commercial |
$1,998.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,230.48
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,648.84
|
| Rate for Payer: Cofinity Commercial |
$1,771.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,230.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,292.00
|
| Rate for Payer: Meridian Medicaid |
$817.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,353.53
|
| Rate for Payer: Nomi Health Commercial |
$1,476.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,988.25
|
| Rate for Payer: PACE SWMI |
$1,230.48
|
| Rate for Payer: PHP Commercial |
$1,722.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,230.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,149.03
|
| Rate for Payer: Priority Health Medicare |
$1,230.48
|
| Rate for Payer: Priority Health SBD |
$2,149.03
|
| Rate for Payer: Priority Health Tiered Network |
$2,149.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,230.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,448.27
|
| Rate for Payer: UHC Core |
$2,448.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,230.48
|
| Rate for Payer: UHC Exchange |
$2,448.27
|
| Rate for Payer: UHC Medicaid |
$778.73
|
| Rate for Payer: UHCCP Medicaid |
$778.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.46
|
|
|
PR REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH
|
Professional
|
Both
|
$4,445.00
|
|
|
Service Code
|
HCPCS 33362
|
| Min. Negotiated Rate |
$749.55 |
| Max. Negotiated Rate |
$3,333.75 |
| Rate for Payer: Aetna Commercial |
$1,587.04
|
| Rate for Payer: Aetna Medicare |
$1,231.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,587.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,705.48
|
| Rate for Payer: BCBS Complete |
$787.03
|
| Rate for Payer: BCBS MAPPO |
$1,184.36
|
| Rate for Payer: BCN Commercial |
$1,929.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.36
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cofinity Commercial |
$1,587.04
|
| Rate for Payer: Cofinity Commercial |
$1,705.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.58
|
| Rate for Payer: Meridian Medicaid |
$787.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,302.80
|
| Rate for Payer: Nomi Health Commercial |
$1,421.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,333.75
|
| Rate for Payer: PACE SWMI |
$1,184.36
|
| Rate for Payer: PHP Commercial |
$1,658.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,075.13
|
| Rate for Payer: Priority Health Medicare |
$1,184.36
|
| Rate for Payer: Priority Health SBD |
$2,075.13
|
| Rate for Payer: Priority Health Tiered Network |
$2,075.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,184.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,361.34
|
| Rate for Payer: UHC Core |
$2,361.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,184.36
|
| Rate for Payer: UHC Exchange |
$2,361.34
|
| Rate for Payer: UHC Medicaid |
$749.55
|
| Rate for Payer: UHCCP Medicaid |
$749.55
|
| Rate for Payer: UMR Bronson Commercial |
$2,044.70
|
|
|
PR REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH
|
Professional
|
Both
|
$5,371.00
|
|
|
Service Code
|
HCPCS 33365
|
| Min. Negotiated Rate |
$812.60 |
| Max. Negotiated Rate |
$4,028.25 |
| Rate for Payer: Aetna Commercial |
$1,720.61
|
| Rate for Payer: Aetna Medicare |
$1,335.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,720.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,849.02
|
| Rate for Payer: BCBS Complete |
$853.23
|
| Rate for Payer: BCBS MAPPO |
$1,284.04
|
| Rate for Payer: BCN Commercial |
$2,081.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,284.04
|
| Rate for Payer: Cash Price |
$4,296.80
|
| Rate for Payer: Cash Price |
$4,296.80
|
| Rate for Payer: Cofinity Commercial |
$1,720.61
|
| Rate for Payer: Cofinity Commercial |
$1,849.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,284.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,348.24
|
| Rate for Payer: Meridian Medicaid |
$853.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,412.44
|
| Rate for Payer: Nomi Health Commercial |
$1,540.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,028.25
|
| Rate for Payer: PACE SWMI |
$1,284.04
|
| Rate for Payer: PHP Commercial |
$1,797.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,284.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,238.45
|
| Rate for Payer: Priority Health Medicare |
$1,284.04
|
| Rate for Payer: Priority Health SBD |
$2,238.45
|
| Rate for Payer: Priority Health Tiered Network |
$2,238.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,284.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,585.36
|
| Rate for Payer: UHC Core |
$2,585.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,284.04
|
| Rate for Payer: UHC Exchange |
$2,585.36
|
| Rate for Payer: UHC Medicaid |
$812.60
|
| Rate for Payer: UHCCP Medicaid |
$812.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,470.66
|
|
|
PR REPLACE AORTIC VALVE OPEN TRANSTHORACIC APPROACH
|
Professional
|
Both
|
$3,266.00
|
|
|
Service Code
|
HCPCS 0318T
|
| Min. Negotiated Rate |
$1,306.40 |
| Max. Negotiated Rate |
$2,449.50 |
| Rate for Payer: Aetna Medicare |
$1,633.00
|
| Rate for Payer: BCBS Complete |
$1,306.40
|
| Rate for Payer: Cash Price |
$2,612.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,449.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,502.36
|
|
|
PR REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH
|
Professional
|
Both
|
$4,063.00
|
|
|
Service Code
|
HCPCS 33361
|
| Min. Negotiated Rate |
$688.20 |
| Max. Negotiated Rate |
$3,047.25 |
| Rate for Payer: Aetna Commercial |
$1,456.46
|
| Rate for Payer: Aetna Medicare |
$1,130.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,565.15
|
| Rate for Payer: BCBS Complete |
$722.61
|
| Rate for Payer: BCBS MAPPO |
$1,086.91
|
| Rate for Payer: BCN Commercial |
$1,768.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,086.91
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cofinity Commercial |
$1,565.15
|
| Rate for Payer: Cofinity Commercial |
$1,456.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,086.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,141.26
|
| Rate for Payer: Meridian Medicaid |
$722.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,195.60
|
| Rate for Payer: Nomi Health Commercial |
$1,304.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,047.25
|
| Rate for Payer: PACE SWMI |
$1,086.91
|
| Rate for Payer: PHP Commercial |
$1,521.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,086.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$688.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,901.61
|
| Rate for Payer: Priority Health Medicare |
$1,086.91
|
| Rate for Payer: Priority Health SBD |
$1,901.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,901.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,086.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,166.60
|
| Rate for Payer: UHC Core |
$2,166.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,086.91
|
| Rate for Payer: UHC Exchange |
$2,166.60
|
| Rate for Payer: UHC Medicaid |
$688.20
|
| Rate for Payer: UHCCP Medicaid |
$688.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,868.98
|
|
