|
PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26650
|
| Min. Negotiated Rate |
$466.36 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$624.92
|
| Rate for Payer: Aetna Medicare |
$485.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.92
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$466.36
|
| Rate for Payer: BCN Medicare Advantage |
$466.36
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$671.56
|
| Rate for Payer: Cofinity Commercial |
$624.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.68
|
| Rate for Payer: Nomi Health Commercial |
$559.63
|
| Rate for Payer: PACE SWMI |
$466.36
|
| Rate for Payer: PHP Commercial |
$652.90
|
| Rate for Payer: PHP Medicare Advantage |
$466.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$466.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.36
|
| Rate for Payer: UHC Medicare Advantage |
$466.36
|
| Rate for Payer: UMR Bronson Commercial |
$708.40
|
|
|
PR PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 28406
|
| Min. Negotiated Rate |
$565.75 |
| Max. Negotiated Rate |
$1,021.15 |
| Rate for Payer: Aetna Commercial |
$758.11
|
| Rate for Payer: Aetna Medicare |
$588.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.11
|
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: BCBS MAPPO |
$565.75
|
| Rate for Payer: BCN Medicare Advantage |
$565.75
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$814.68
|
| Rate for Payer: Cofinity Commercial |
$758.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$565.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$594.04
|
| Rate for Payer: Nomi Health Commercial |
$678.90
|
| Rate for Payer: PACE SWMI |
$565.75
|
| Rate for Payer: PHP Commercial |
$792.05
|
| Rate for Payer: PHP Medicare Advantage |
$565.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health Medicare |
$565.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$565.75
|
| Rate for Payer: UHC Medicare Advantage |
$565.75
|
| Rate for Payer: UMR Bronson Commercial |
$722.66
|
|
|
PR PRQ SKELETAL FIXJ FEMORAL FX DISTAL END
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 27509
|
| Min. Negotiated Rate |
$647.52 |
| Max. Negotiated Rate |
$1,453.40 |
| Rate for Payer: Aetna Commercial |
$867.68
|
| Rate for Payer: Aetna Medicare |
$673.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.68
|
| Rate for Payer: BCBS Complete |
$894.40
|
| Rate for Payer: BCBS MAPPO |
$647.52
|
| Rate for Payer: BCN Medicare Advantage |
$647.52
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cofinity Commercial |
$932.43
|
| Rate for Payer: Cofinity Commercial |
$867.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.90
|
| Rate for Payer: Nomi Health Commercial |
$777.02
|
| Rate for Payer: PACE SWMI |
$647.52
|
| Rate for Payer: PHP Commercial |
$906.53
|
| Rate for Payer: PHP Medicare Advantage |
$647.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health Medicare |
$647.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.52
|
| Rate for Payer: UHC Medicare Advantage |
$647.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,028.56
|
|
|
PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26608
|
| Min. Negotiated Rate |
$465.04 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$623.15
|
| Rate for Payer: Aetna Medicare |
$483.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$669.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.15
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$465.04
|
| Rate for Payer: BCN Medicare Advantage |
$465.04
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$669.66
|
| Rate for Payer: Cofinity Commercial |
$623.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.29
|
| Rate for Payer: Nomi Health Commercial |
$558.05
|
| Rate for Payer: PACE SWMI |
$465.04
|
| Rate for Payer: PHP Commercial |
$651.06
|
| Rate for Payer: PHP Medicare Advantage |
$465.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$465.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.04
|
| Rate for Payer: UHC Medicare Advantage |
$465.04
|
| Rate for Payer: UMR Bronson Commercial |
$708.40
|
|
|
PR PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 26676
|
| Min. Negotiated Rate |
$493.20 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Aetna Commercial |
$660.89
|
| Rate for Payer: Aetna Medicare |
$512.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.89
|
| Rate for Payer: BCBS Complete |
$660.00
|
| Rate for Payer: BCBS MAPPO |
$493.20
|
| Rate for Payer: BCN Medicare Advantage |
$493.20
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$710.21
|
| Rate for Payer: Cofinity Commercial |
$660.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$517.86
|
| Rate for Payer: Nomi Health Commercial |
$591.84
|
| Rate for Payer: PACE SWMI |
$493.20
|
| Rate for Payer: PHP Commercial |
$690.48
|
| Rate for Payer: PHP Medicare Advantage |
$493.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.50
|
| Rate for Payer: Priority Health Medicare |
$493.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.20
|
| Rate for Payer: UHC Medicare Advantage |
$493.20
|
| Rate for Payer: UMR Bronson Commercial |
$759.00
|
|
|
PR PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26756
|
| Min. Negotiated Rate |
$409.15 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$548.26
|
| Rate for Payer: Aetna Medicare |
$425.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.26
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: BCBS MAPPO |
$409.15
|
| Rate for Payer: BCN Medicare Advantage |
$409.15
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$589.18
|
| Rate for Payer: Cofinity Commercial |
$548.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$429.61
|
| Rate for Payer: Nomi Health Commercial |
$490.98
|
| Rate for Payer: PACE SWMI |
$409.15
|
| Rate for Payer: PHP Commercial |
$572.81
|
| Rate for Payer: PHP Medicare Advantage |
$409.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health Medicare |
$409.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$409.15
|
| Rate for Payer: UHC Medicare Advantage |
$409.15
|
| Rate for Payer: UMR Bronson Commercial |
$506.00
|
|
|
PR PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$3,359.00
|
|
|
Service Code
|
HCPCS 27235
|
| Min. Negotiated Rate |
$874.41 |
| Max. Negotiated Rate |
$2,183.35 |
| Rate for Payer: Aetna Commercial |
$1,171.71
|
| Rate for Payer: Aetna Medicare |
$909.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.71
|
| Rate for Payer: BCBS Complete |
$1,343.60
|
| Rate for Payer: BCBS MAPPO |
$874.41
|
| Rate for Payer: BCN Medicare Advantage |
$874.41
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,259.15
|
| Rate for Payer: Cofinity Commercial |
$1,171.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$918.13
|
| Rate for Payer: Nomi Health Commercial |
$1,049.29
|
| Rate for Payer: PACE SWMI |
$874.41
|
| Rate for Payer: PHP Commercial |
$1,224.17
|
| Rate for Payer: PHP Medicare Advantage |
$874.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,183.35
|
| Rate for Payer: Priority Health Medicare |
$874.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.41
|
| Rate for Payer: UHC Medicare Advantage |
$874.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,545.14
|
|
|
PR PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$1,122.00
|
|
|
Service Code
|
HCPCS 28496
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$729.30 |
| Rate for Payer: Aetna Commercial |
$352.58
|
| Rate for Payer: Aetna Medicare |
$273.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.58
|
| Rate for Payer: BCBS Complete |
$448.80
|
| Rate for Payer: BCBS MAPPO |
$263.12
|
| Rate for Payer: BCN Medicare Advantage |
$263.12
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cofinity Commercial |
$378.89
|
| Rate for Payer: Cofinity Commercial |
$352.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.28
|
| Rate for Payer: Nomi Health Commercial |
$315.74
|
| Rate for Payer: PACE SWMI |
$263.12
|
| Rate for Payer: PHP Commercial |
$368.37
|
| Rate for Payer: PHP Medicare Advantage |
$263.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.30
|
| Rate for Payer: Priority Health Medicare |
$263.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.12
|
| Rate for Payer: UHC Medicare Advantage |
$263.12
|
| Rate for Payer: UMR Bronson Commercial |
$516.12
|
|
|
PR PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 24582
|
| Min. Negotiated Rate |
$788.60 |
| Max. Negotiated Rate |
$1,543.75 |
| Rate for Payer: Aetna Commercial |
$1,056.72
|
| Rate for Payer: Aetna Medicare |
$820.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,135.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.72
|
| Rate for Payer: BCBS Complete |
$950.00
|
| Rate for Payer: BCBS MAPPO |
$788.60
|
| Rate for Payer: BCN Medicare Advantage |
$788.60
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,135.58
|
| Rate for Payer: Cofinity Commercial |
$1,056.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$788.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$828.03
|
| Rate for Payer: Nomi Health Commercial |
$946.32
|
| Rate for Payer: PACE SWMI |
$788.60
|
| Rate for Payer: PHP Commercial |
$1,104.04
|
| Rate for Payer: PHP Medicare Advantage |
$788.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,543.75
|
| Rate for Payer: Priority Health Medicare |
$788.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$788.60
|
| Rate for Payer: UHC Medicare Advantage |
$788.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,092.50
|
|
|
PR PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ
|
Professional
|
Both
|
$1,886.00
|
|
|
Service Code
|
HCPCS 24566
|
| Min. Negotiated Rate |
$697.59 |
| Max. Negotiated Rate |
$1,225.90 |
| Rate for Payer: Aetna Commercial |
$934.77
|
| Rate for Payer: Aetna Medicare |
$725.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.53
|
| Rate for Payer: BCBS Complete |
$754.40
|
| Rate for Payer: BCBS MAPPO |
$697.59
|
| Rate for Payer: BCN Medicare Advantage |
$697.59
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cofinity Commercial |
$934.77
|
| Rate for Payer: Cofinity Commercial |
$1,004.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.47
|
| Rate for Payer: Nomi Health Commercial |
$837.11
|
| Rate for Payer: PACE SWMI |
$697.59
|
| Rate for Payer: PHP Commercial |
$976.63
|
| Rate for Payer: PHP Medicare Advantage |
$697.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,225.90
|
| Rate for Payer: Priority Health Medicare |
$697.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.59
|
| Rate for Payer: UHC Medicare Advantage |
$697.59
|
| Rate for Payer: UMR Bronson Commercial |
$867.56
|
|
|
PR PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 28666
|
| Min. Negotiated Rate |
$165.03 |
| Max. Negotiated Rate |
$384.15 |
| Rate for Payer: Aetna Commercial |
$221.14
|
| Rate for Payer: Aetna Medicare |
$171.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.14
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS MAPPO |
$165.03
|
| Rate for Payer: BCN Medicare Advantage |
$165.03
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cofinity Commercial |
$237.64
|
| Rate for Payer: Cofinity Commercial |
$221.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.28
|
| Rate for Payer: Nomi Health Commercial |
$198.04
|
| Rate for Payer: PACE SWMI |
$165.03
|
| Rate for Payer: PHP Commercial |
$231.04
|
| Rate for Payer: PHP Medicare Advantage |
$165.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.15
|
| Rate for Payer: Priority Health Medicare |
$165.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.03
|
| Rate for Payer: UHC Medicare Advantage |
$165.03
|
| Rate for Payer: UMR Bronson Commercial |
$271.86
|
|
|
PR PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
HCPCS 26776
|
| Min. Negotiated Rate |
$434.96 |
| Max. Negotiated Rate |
$902.85 |
| Rate for Payer: Aetna Commercial |
$582.85
|
| Rate for Payer: Aetna Medicare |
$452.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.85
|
| Rate for Payer: BCBS Complete |
$555.60
|
| Rate for Payer: BCBS MAPPO |
$434.96
|
| Rate for Payer: BCN Medicare Advantage |
$434.96
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cofinity Commercial |
$626.34
|
| Rate for Payer: Cofinity Commercial |
$582.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.71
|
| Rate for Payer: Nomi Health Commercial |
$521.95
|
| Rate for Payer: PACE SWMI |
$434.96
|
| Rate for Payer: PHP Commercial |
$608.94
|
| Rate for Payer: PHP Medicare Advantage |
$434.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.85
|
| Rate for Payer: Priority Health Medicare |
$434.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.96
|
| Rate for Payer: UHC Medicare Advantage |
$434.96
|
| Rate for Payer: UMR Bronson Commercial |
$638.94
|
|
|
PR PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 26706
|
| Min. Negotiated Rate |
$433.61 |
| Max. Negotiated Rate |
$893.75 |
| Rate for Payer: Aetna Commercial |
$581.04
|
| Rate for Payer: Aetna Medicare |
$450.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.04
|
| Rate for Payer: BCBS Complete |
$550.00
|
| Rate for Payer: BCBS MAPPO |
$433.61
|
| Rate for Payer: BCN Medicare Advantage |
$433.61
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cofinity Commercial |
$624.40
|
| Rate for Payer: Cofinity Commercial |
$581.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.29
|
| Rate for Payer: Nomi Health Commercial |
$520.33
|
| Rate for Payer: PACE SWMI |
$433.61
|
| Rate for Payer: PHP Commercial |
$607.05
|
| Rate for Payer: PHP Medicare Advantage |
$433.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.75
|
| Rate for Payer: Priority Health Medicare |
$433.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.61
|
| Rate for Payer: UHC Medicare Advantage |
$433.61
|
| Rate for Payer: UMR Bronson Commercial |
$632.50
|
|
|
PR PRQ SKEL FIXJ METAR FX W/MANJ
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 28476
|
| Min. Negotiated Rate |
$370.07 |
| Max. Negotiated Rate |
$700.05 |
| Rate for Payer: Aetna Commercial |
$495.89
|
| Rate for Payer: Aetna Medicare |
$384.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.89
|
| Rate for Payer: BCBS Complete |
$430.80
|
| Rate for Payer: BCBS MAPPO |
$370.07
|
| Rate for Payer: BCN Medicare Advantage |
$370.07
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$532.90
|
| Rate for Payer: Cofinity Commercial |
$495.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.57
|
| Rate for Payer: Nomi Health Commercial |
$444.08
|
| Rate for Payer: PACE SWMI |
$370.07
|
| Rate for Payer: PHP Commercial |
$518.10
|
| Rate for Payer: PHP Medicare Advantage |
$370.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health Medicare |
$370.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.07
|
| Rate for Payer: UHC Medicare Advantage |
$370.07
|
| Rate for Payer: UMR Bronson Commercial |
$495.42
|
|
|
PR PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 28636
|
| Min. Negotiated Rate |
$215.92 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$289.33
|
| Rate for Payer: Aetna Medicare |
$224.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.33
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$215.92
|
| Rate for Payer: BCN Medicare Advantage |
$215.92
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$310.92
|
| Rate for Payer: Cofinity Commercial |
$289.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.72
|
| Rate for Payer: Nomi Health Commercial |
$259.10
|
| Rate for Payer: PACE SWMI |
$215.92
|
| Rate for Payer: PHP Commercial |
$302.29
|
| Rate for Payer: PHP Medicare Advantage |
$215.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$215.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.92
|
| Rate for Payer: UHC Medicare Advantage |
$215.92
|
| Rate for Payer: UMR Bronson Commercial |
$302.22
|
|
|
PR PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26727
|
| Min. Negotiated Rate |
$458.98 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$615.03
|
| Rate for Payer: Aetna Medicare |
$477.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.03
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$458.98
|
| Rate for Payer: BCN Medicare Advantage |
$458.98
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$660.93
|
| Rate for Payer: Cofinity Commercial |
$615.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$481.93
|
| Rate for Payer: Nomi Health Commercial |
$550.78
|
| Rate for Payer: PACE SWMI |
$458.98
|
| Rate for Payer: PHP Commercial |
$642.57
|
| Rate for Payer: PHP Medicare Advantage |
$458.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$458.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.98
|
| Rate for Payer: UHC Medicare Advantage |
$458.98
|
| Rate for Payer: UMR Bronson Commercial |
$708.40
|
|
|
PR PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 24538
|
| Min. Negotiated Rate |
$756.93 |
| Max. Negotiated Rate |
$1,675.05 |
| Rate for Payer: Aetna Commercial |
$1,014.29
|
| Rate for Payer: Aetna Medicare |
$787.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.29
|
| Rate for Payer: BCBS Complete |
$1,030.80
|
| Rate for Payer: BCBS MAPPO |
$756.93
|
| Rate for Payer: BCN Medicare Advantage |
$756.93
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.98
|
| Rate for Payer: Cofinity Commercial |
$1,014.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.78
|
| Rate for Payer: Nomi Health Commercial |
$908.32
|
| Rate for Payer: PACE SWMI |
$756.93
|
| Rate for Payer: PHP Commercial |
$1,059.70
|
| Rate for Payer: PHP Medicare Advantage |
$756.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.05
|
| Rate for Payer: Priority Health Medicare |
$756.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.93
|
| Rate for Payer: UHC Medicare Advantage |
$756.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,185.42
|
|
|
PR PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 28576
|
| Min. Negotiated Rate |
$379.24 |
| Max. Negotiated Rate |
$635.70 |
| Rate for Payer: Aetna Commercial |
$508.18
|
| Rate for Payer: Aetna Medicare |
$394.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.18
|
| Rate for Payer: BCBS Complete |
$391.20
|
| Rate for Payer: BCBS MAPPO |
$379.24
|
| Rate for Payer: BCN Medicare Advantage |
$379.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cofinity Commercial |
$546.11
|
| Rate for Payer: Cofinity Commercial |
$508.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.20
|
| Rate for Payer: Nomi Health Commercial |
$455.09
|
| Rate for Payer: PACE SWMI |
$379.24
|
| Rate for Payer: PHP Commercial |
$530.94
|
| Rate for Payer: PHP Medicare Advantage |
$379.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.70
|
| Rate for Payer: Priority Health Medicare |
$379.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.24
|
| Rate for Payer: UHC Medicare Advantage |
$379.24
|
| Rate for Payer: UMR Bronson Commercial |
$449.88
|
|
|
PR PRQ SKEL FIXJ TARS JT DISLC W/MANJ
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28606
|
| Min. Negotiated Rate |
$384.56 |
| Max. Negotiated Rate |
$874.90 |
| Rate for Payer: Aetna Commercial |
$515.31
|
| Rate for Payer: Aetna Medicare |
$399.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.31
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS MAPPO |
$384.56
|
| Rate for Payer: BCN Medicare Advantage |
$384.56
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$553.77
|
| Rate for Payer: Cofinity Commercial |
$515.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.79
|
| Rate for Payer: Nomi Health Commercial |
$461.47
|
| Rate for Payer: PACE SWMI |
$384.56
|
| Rate for Payer: PHP Commercial |
$538.38
|
| Rate for Payer: PHP Medicare Advantage |
$384.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health Medicare |
$384.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.56
|
| Rate for Payer: UHC Medicare Advantage |
$384.56
|
| Rate for Payer: UMR Bronson Commercial |
$619.16
|
|
|
PR PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
HCPCS 28546
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna Commercial |
$455.53
|
| Rate for Payer: Aetna Medicare |
$353.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.53
|
| Rate for Payer: BCBS Complete |
$319.20
|
| Rate for Payer: BCBS MAPPO |
$339.95
|
| Rate for Payer: BCN Medicare Advantage |
$339.95
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cofinity Commercial |
$489.53
|
| Rate for Payer: Cofinity Commercial |
$455.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.95
|
| Rate for Payer: Nomi Health Commercial |
$407.94
|
| Rate for Payer: PACE SWMI |
$339.95
|
| Rate for Payer: PHP Commercial |
$475.93
|
| Rate for Payer: PHP Medicare Advantage |
$339.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.70
|
| Rate for Payer: Priority Health Medicare |
$339.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.95
|
| Rate for Payer: UHC Medicare Advantage |
$339.95
|
| Rate for Payer: UMR Bronson Commercial |
$367.08
|
|
|
PR PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 28456
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$504.92 |
| Rate for Payer: Aetna Commercial |
$469.86
|
| Rate for Payer: Aetna Medicare |
$364.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.86
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: BCBS MAPPO |
$350.64
|
| Rate for Payer: BCN Medicare Advantage |
$350.64
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cofinity Commercial |
$504.92
|
| Rate for Payer: Cofinity Commercial |
$469.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.17
|
| Rate for Payer: Nomi Health Commercial |
$420.77
|
| Rate for Payer: PACE SWMI |
$350.64
|
| Rate for Payer: PHP Commercial |
$490.90
|
| Rate for Payer: PHP Medicare Advantage |
$350.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
| Rate for Payer: Priority Health Medicare |
$350.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.64
|
| Rate for Payer: UHC Medicare Advantage |
$350.64
|
| Rate for Payer: UMR Bronson Commercial |
$213.44
|
|
|
PR PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 93580
|
| Min. Negotiated Rate |
$821.20 |
| Max. Negotiated Rate |
$1,334.66 |
| Rate for Payer: Aetna Commercial |
$1,241.98
|
| Rate for Payer: Aetna Medicare |
$963.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.98
|
| Rate for Payer: BCBS Complete |
$821.20
|
| Rate for Payer: BCBS MAPPO |
$926.85
|
| Rate for Payer: BCN Medicare Advantage |
$926.85
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,241.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$973.19
|
| Rate for Payer: Nomi Health Commercial |
$1,112.22
|
| Rate for Payer: PACE SWMI |
$926.85
|
| Rate for Payer: PHP Commercial |
$1,297.59
|
| Rate for Payer: PHP Medicare Advantage |
$926.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.45
|
| Rate for Payer: Priority Health Medicare |
$926.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$926.85
|
| Rate for Payer: UHC Medicare Advantage |
$926.85
|
| Rate for Payer: UMR Bronson Commercial |
$944.38
|
|
|
PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 37197
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$410.53 |
| Rate for Payer: Aetna Commercial |
$382.02
|
| Rate for Payer: Aetna Medicare |
$296.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.02
|
| Rate for Payer: BCBS Complete |
$205.20
|
| Rate for Payer: BCBS MAPPO |
$285.09
|
| Rate for Payer: BCN Medicare Advantage |
$285.09
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$410.53
|
| Rate for Payer: Cofinity Commercial |
$382.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.34
|
| Rate for Payer: Nomi Health Commercial |
$342.11
|
| Rate for Payer: PACE SWMI |
$285.09
|
| Rate for Payer: PHP Commercial |
$399.13
|
| Rate for Payer: PHP Medicare Advantage |
$285.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health Medicare |
$285.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.09
|
| Rate for Payer: UHC Medicare Advantage |
$285.09
|
| Rate for Payer: UMR Bronson Commercial |
$235.98
|
|
|
PR PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY
|
Professional
|
Both
|
$1,046.00
|
|
|
Service Code
|
HCPCS 92973
|
| Min. Negotiated Rate |
$167.39 |
| Max. Negotiated Rate |
$679.90 |
| Rate for Payer: Aetna Commercial |
$224.30
|
| Rate for Payer: Aetna Medicare |
$174.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.30
|
| Rate for Payer: BCBS Complete |
$418.40
|
| Rate for Payer: BCBS MAPPO |
$167.39
|
| Rate for Payer: BCN Medicare Advantage |
$167.39
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cofinity Commercial |
$241.04
|
| Rate for Payer: Cofinity Commercial |
$224.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.76
|
| Rate for Payer: Nomi Health Commercial |
$200.87
|
| Rate for Payer: PACE SWMI |
$167.39
|
| Rate for Payer: PHP Commercial |
$234.35
|
| Rate for Payer: PHP Medicare Advantage |
$167.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.90
|
| Rate for Payer: Priority Health Medicare |
$167.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.39
|
| Rate for Payer: UHC Medicare Advantage |
$167.39
|
| Rate for Payer: UMR Bronson Commercial |
$481.16
|
|
|
PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN
|
Professional
|
Both
|
$1,841.00
|
|
|
Service Code
|
HCPCS 37187
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$1,196.65 |
| Rate for Payer: Aetna Commercial |
$499.71
|
| Rate for Payer: Aetna Medicare |
$387.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.71
|
| Rate for Payer: BCBS Complete |
$736.40
|
| Rate for Payer: BCBS MAPPO |
$372.92
|
| Rate for Payer: BCN Medicare Advantage |
$372.92
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cofinity Commercial |
$537.00
|
| Rate for Payer: Cofinity Commercial |
$499.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.57
|
| Rate for Payer: Nomi Health Commercial |
$447.50
|
| Rate for Payer: PACE SWMI |
$372.92
|
| Rate for Payer: PHP Commercial |
$522.09
|
| Rate for Payer: PHP Medicare Advantage |
$372.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,196.65
|
| Rate for Payer: Priority Health Medicare |
$372.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.92
|
| Rate for Payer: UHC Medicare Advantage |
$372.92
|
| Rate for Payer: UMR Bronson Commercial |
$846.86
|
|
