|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$436.01 |
| Max. Negotiated Rate |
$3,768.36 |
| Rate for Payer: Aetna Commercial |
$879.71
|
| Rate for Payer: Aetna Medicare |
$682.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$945.36
|
| Rate for Payer: BCBS Complete |
$457.81
|
| Rate for Payer: BCBS MAPPO |
$656.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,768.36
|
| Rate for Payer: BCN Commercial |
$996.41
|
| Rate for Payer: BCN Medicare Advantage |
$656.50
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$879.71
|
| Rate for Payer: Cofinity Commercial |
$945.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$689.32
|
| Rate for Payer: Meridian Medicaid |
$457.81
|
| Rate for Payer: Nomi Health Commercial |
$787.80
|
| Rate for Payer: PACE SWMI |
$656.50
|
| Rate for Payer: PHP Commercial |
$919.10
|
| Rate for Payer: PHP Medicare Advantage |
$656.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.69
|
| Rate for Payer: Priority Health Medicare |
$656.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.69
|
| Rate for Payer: Priority Health SBD |
$1,208.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$656.50
|
| Rate for Payer: UHC Medicare Advantage |
$656.50
|
| Rate for Payer: UHCCP Medicaid |
$436.01
|
| Rate for Payer: UMR Bronson Commercial |
$553.38
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$603.22 |
| Max. Negotiated Rate |
$1,531.40 |
| Rate for Payer: Aetna Commercial |
$1,221.12
|
| Rate for Payer: Aetna Medicare |
$947.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,221.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,312.24
|
| Rate for Payer: BCBS Complete |
$633.38
|
| Rate for Payer: BCBS MAPPO |
$911.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,195.01
|
| Rate for Payer: BCN Commercial |
$1,367.81
|
| Rate for Payer: BCN Medicare Advantage |
$911.28
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cofinity Commercial |
$1,221.12
|
| Rate for Payer: Cofinity Commercial |
$1,312.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$911.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$956.84
|
| Rate for Payer: Meridian Medicaid |
$633.38
|
| Rate for Payer: Nomi Health Commercial |
$1,093.54
|
| Rate for Payer: PACE SWMI |
$911.28
|
| Rate for Payer: PHP Commercial |
$1,275.79
|
| Rate for Payer: PHP Medicare Advantage |
$911.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$603.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,296.31
|
| Rate for Payer: Priority Health Medicare |
$911.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,296.31
|
| Rate for Payer: Priority Health SBD |
$1,296.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$911.28
|
| Rate for Payer: UHC Medicare Advantage |
$911.28
|
| Rate for Payer: UHCCP Medicaid |
$603.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,083.76
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$241.43 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$919.35
|
| Rate for Payer: Aetna Medicare |
$713.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.96
|
| Rate for Payer: BCBS Complete |
$489.12
|
| Rate for Payer: BCBS MAPPO |
$686.08
|
| Rate for Payer: BCBS Trust/PPO |
$241.43
|
| Rate for Payer: BCN Commercial |
$1,049.19
|
| Rate for Payer: BCN Medicare Advantage |
$686.08
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$919.35
|
| Rate for Payer: Cofinity Commercial |
$987.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.38
|
| Rate for Payer: Meridian Medicaid |
$489.12
|
| Rate for Payer: Nomi Health Commercial |
$823.30
|
| Rate for Payer: PACE SWMI |
$686.08
|
| Rate for Payer: PHP Commercial |
$960.51
|
| Rate for Payer: PHP Medicare Advantage |
$686.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.73
|
| Rate for Payer: Priority Health Medicare |
$686.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.73
|
| Rate for Payer: Priority Health SBD |
$1,104.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.08
|
| Rate for Payer: UHC Medicare Advantage |
$686.08
|
| Rate for Payer: UHCCP Medicaid |
$465.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,057.08
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,458.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$860.73 |
| Max. Negotiated Rate |
$2,897.70 |
| Rate for Payer: Aetna Commercial |
$1,744.59
|
| Rate for Payer: Aetna Medicare |
$1,354.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,874.78
|
| Rate for Payer: BCBS Complete |
$903.77
|
| Rate for Payer: BCBS MAPPO |
$1,301.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,561.65
|
| Rate for Payer: BCN Commercial |
$2,141.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,301.93
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cofinity Commercial |
$1,744.59
|
| Rate for Payer: Cofinity Commercial |
$1,874.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,301.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,367.03
|
| Rate for Payer: Meridian Medicaid |
$903.77
|
| Rate for Payer: Nomi Health Commercial |
$1,562.32
|
| Rate for Payer: PACE SWMI |
$1,301.93
|
| Rate for Payer: PHP Commercial |
$1,822.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,301.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,897.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,286.80
|
| Rate for Payer: Priority Health Medicare |
$1,301.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,286.80
|
| Rate for Payer: Priority Health SBD |
$2,286.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,301.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.93
|
| Rate for Payer: UHCCP Medicaid |
$860.73
|
| Rate for Payer: UMR Bronson Commercial |
$2,050.68
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,092.69 |
| Max. Negotiated Rate |
$3,309.80 |
| Rate for Payer: Aetna Commercial |
$2,217.12
|
| Rate for Payer: Aetna Medicare |
$1,720.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,217.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,382.58
|
| Rate for Payer: BCBS Complete |
$1,147.32
|
| Rate for Payer: BCBS MAPPO |
$1,654.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.73
|
| Rate for Payer: BCN Commercial |
$2,718.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,654.57
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cofinity Commercial |
$2,217.12
|
| Rate for Payer: Cofinity Commercial |
$2,382.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,654.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,737.30
|
| Rate for Payer: Meridian Medicaid |
$1,147.32
|
| Rate for Payer: Nomi Health Commercial |
$1,985.48
|
| Rate for Payer: PACE SWMI |
$1,654.57
|
| Rate for Payer: PHP Commercial |
$2,316.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,654.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,092.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,902.72
|
| Rate for Payer: Priority Health Medicare |
$1,654.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,902.72
|
| Rate for Payer: Priority Health SBD |
$2,902.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,654.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,654.57
|
| Rate for Payer: UHCCP Medicaid |
$1,092.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,342.32
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,361.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,210.91 |
| Max. Negotiated Rate |
$3,484.65 |
| Rate for Payer: Aetna Commercial |
$2,461.06
|
| Rate for Payer: Aetna Medicare |
$1,910.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,461.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,644.72
|
| Rate for Payer: BCBS Complete |
$1,271.46
|
| Rate for Payer: BCBS MAPPO |
$1,836.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.41
|
| Rate for Payer: BCN Commercial |
$2,738.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,836.61
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cofinity Commercial |
$2,461.06
|
| Rate for Payer: Cofinity Commercial |
$2,644.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,836.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,928.44
|
| Rate for Payer: Meridian Medicaid |
$1,271.46
|
| Rate for Payer: Nomi Health Commercial |
$2,203.93
|
| Rate for Payer: PACE SWMI |
$1,836.61
|
| Rate for Payer: PHP Commercial |
$2,571.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,836.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,210.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,484.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,218.36
|
| Rate for Payer: Priority Health Medicare |
$1,836.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,218.36
|
| Rate for Payer: Priority Health SBD |
$3,218.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,836.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,836.61
|
| Rate for Payer: UHCCP Medicaid |
$1,210.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,466.06
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$511.72 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.98
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS MAPPO |
$103.46
|
| Rate for Payer: BCBS Trust/PPO |
$511.72
|
| Rate for Payer: BCN Commercial |
$274.15
|
| Rate for Payer: BCN Medicare Advantage |
$103.46
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$138.64
|
| Rate for Payer: Cofinity Commercial |
$148.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.63
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Nomi Health Commercial |
$124.15
|
| Rate for Payer: PACE SWMI |
$103.46
|
| Rate for Payer: PHP Commercial |
$144.84
|
| Rate for Payer: PHP Medicare Advantage |
$103.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.55
|
| Rate for Payer: Priority Health Medicare |
$103.46
|
| Rate for Payer: Priority Health Narrow Network |
$148.55
|
| Rate for Payer: Priority Health SBD |
$148.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.46
|
| Rate for Payer: UHC Medicare Advantage |
$103.46
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
| Rate for Payer: UMR Bronson Commercial |
$182.16
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$1,180.40 |
| Rate for Payer: Aetna Commercial |
$832.38
|
| Rate for Payer: Aetna Medicare |
$646.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.50
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS MAPPO |
$621.18
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: BCN Commercial |
$995.44
|
| Rate for Payer: BCN Medicare Advantage |
$621.18
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cofinity Commercial |
$832.38
|
| Rate for Payer: Cofinity Commercial |
$894.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.24
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Nomi Health Commercial |
$745.42
|
| Rate for Payer: PACE SWMI |
$621.18
|
| Rate for Payer: PHP Commercial |
$869.65
|
| Rate for Payer: PHP Medicare Advantage |
$621.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.06
|
| Rate for Payer: Priority Health Medicare |
$621.18
|
| Rate for Payer: Priority Health Narrow Network |
$938.06
|
| Rate for Payer: Priority Health SBD |
$938.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.18
|
| Rate for Payer: UHC Medicare Advantage |
$621.18
|
| Rate for Payer: UHCCP Medicaid |
$427.28
|
| Rate for Payer: UMR Bronson Commercial |
$835.36
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$522.49 |
| Max. Negotiated Rate |
$1,519.78 |
| Rate for Payer: Aetna Commercial |
$1,282.06
|
| Rate for Payer: Aetna Medicare |
$995.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,282.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.73
|
| Rate for Payer: BCBS Complete |
$687.50
|
| Rate for Payer: BCBS MAPPO |
$956.76
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$1,519.78
|
| Rate for Payer: BCN Medicare Advantage |
$956.76
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$1,282.06
|
| Rate for Payer: Cofinity Commercial |
$1,377.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.60
|
| Rate for Payer: Meridian Medicaid |
$687.50
|
| Rate for Payer: Nomi Health Commercial |
$1,148.11
|
| Rate for Payer: PACE SWMI |
$956.76
|
| Rate for Payer: PHP Commercial |
$1,339.46
|
| Rate for Payer: PHP Medicare Advantage |
$956.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,436.74
|
| Rate for Payer: Priority Health Medicare |
$956.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,436.74
|
| Rate for Payer: Priority Health SBD |
$1,436.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.76
|
| Rate for Payer: UHC Medicare Advantage |
$956.76
|
| Rate for Payer: UHCCP Medicaid |
$654.76
|
| Rate for Payer: UMR Bronson Commercial |
$776.02
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$432.68 |
| Max. Negotiated Rate |
$2,991.30 |
| Rate for Payer: Aetna Commercial |
$1,394.44
|
| Rate for Payer: Aetna Medicare |
$1,082.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,498.51
|
| Rate for Payer: BCBS Complete |
$737.82
|
| Rate for Payer: BCBS MAPPO |
$1,040.63
|
| Rate for Payer: BCBS Trust/PPO |
$432.68
|
| Rate for Payer: BCN Commercial |
$1,583.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.63
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cofinity Commercial |
$1,394.44
|
| Rate for Payer: Cofinity Commercial |
$1,498.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.66
|
| Rate for Payer: Meridian Medicaid |
$737.82
|
| Rate for Payer: Nomi Health Commercial |
$1,248.76
|
| Rate for Payer: PACE SWMI |
$1,040.63
|
| Rate for Payer: PHP Commercial |
$1,456.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$702.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,666.01
|
| Rate for Payer: Priority Health Medicare |
$1,040.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,666.01
|
| Rate for Payer: Priority Health SBD |
$1,666.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,040.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.63
|
| Rate for Payer: UHCCP Medicaid |
$702.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,116.92
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$335.47 |
| Max. Negotiated Rate |
$1,879.15 |
| Rate for Payer: Aetna Commercial |
$1,364.94
|
| Rate for Payer: Aetna Medicare |
$1,059.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,466.80
|
| Rate for Payer: BCBS Complete |
$720.15
|
| Rate for Payer: BCBS MAPPO |
$1,018.61
|
| Rate for Payer: BCBS Trust/PPO |
$335.47
|
| Rate for Payer: BCN Commercial |
$1,548.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.61
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cofinity Commercial |
$1,364.94
|
| Rate for Payer: Cofinity Commercial |
$1,466.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.54
|
| Rate for Payer: Meridian Medicaid |
$720.15
|
| Rate for Payer: Nomi Health Commercial |
$1,222.33
|
| Rate for Payer: PACE SWMI |
$1,018.61
|
| Rate for Payer: PHP Commercial |
$1,426.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,623.77
|
| Rate for Payer: Priority Health Medicare |
$1,018.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,623.77
|
| Rate for Payer: Priority Health SBD |
$1,623.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.61
|
| Rate for Payer: UHCCP Medicaid |
$685.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,329.86
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$448.70 |
| Max. Negotiated Rate |
$1,219.23 |
| Rate for Payer: Aetna Commercial |
$1,022.13
|
| Rate for Payer: Aetna Medicare |
$793.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.40
|
| Rate for Payer: BCBS Complete |
$540.78
|
| Rate for Payer: BCBS MAPPO |
$762.78
|
| Rate for Payer: BCBS Trust/PPO |
$448.70
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: BCN Medicare Advantage |
$762.78
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,022.13
|
| Rate for Payer: Cofinity Commercial |
$1,098.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$800.92
|
| Rate for Payer: Meridian Medicaid |
$540.78
|
| Rate for Payer: Nomi Health Commercial |
$915.34
|
| Rate for Payer: PACE SWMI |
$762.78
|
| Rate for Payer: PHP Commercial |
$1,067.89
|
| Rate for Payer: PHP Medicare Advantage |
$762.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,219.23
|
| Rate for Payer: Priority Health Medicare |
$762.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,219.23
|
| Rate for Payer: Priority Health SBD |
$1,219.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.78
|
| Rate for Payer: UHC Medicare Advantage |
$762.78
|
| Rate for Payer: UHCCP Medicaid |
$515.03
|
| Rate for Payer: UMR Bronson Commercial |
$644.46
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$400.01 |
| Max. Negotiated Rate |
$2,281.73 |
| Rate for Payer: Aetna Commercial |
$793.49
|
| Rate for Payer: Aetna Medicare |
$615.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.71
|
| Rate for Payer: BCBS Complete |
$420.01
|
| Rate for Payer: BCBS MAPPO |
$592.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,281.73
|
| Rate for Payer: BCN Commercial |
$895.26
|
| Rate for Payer: BCN Medicare Advantage |
$592.16
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cofinity Commercial |
$793.49
|
| Rate for Payer: Cofinity Commercial |
$852.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.77
|
| Rate for Payer: Meridian Medicaid |
$420.01
|
| Rate for Payer: Nomi Health Commercial |
$710.59
|
| Rate for Payer: PACE SWMI |
$592.16
|
| Rate for Payer: PHP Commercial |
$829.02
|
| Rate for Payer: PHP Medicare Advantage |
$592.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.55
|
| Rate for Payer: Priority Health Medicare |
$592.16
|
| Rate for Payer: Priority Health Narrow Network |
$950.55
|
| Rate for Payer: Priority Health SBD |
$950.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.16
|
| Rate for Payer: UHC Medicare Advantage |
$592.16
|
| Rate for Payer: UHCCP Medicaid |
$400.01
|
| Rate for Payer: UMR Bronson Commercial |
$606.28
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$3,903.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$567.86 |
| Max. Negotiated Rate |
$2,536.95 |
| Rate for Payer: Aetna Commercial |
$1,127.54
|
| Rate for Payer: Aetna Medicare |
$875.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,211.69
|
| Rate for Payer: BCBS Complete |
$596.25
|
| Rate for Payer: BCBS MAPPO |
$841.45
|
| Rate for Payer: BCBS Trust/PPO |
$677.28
|
| Rate for Payer: BCN Commercial |
$1,281.80
|
| Rate for Payer: BCN Medicare Advantage |
$841.45
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cofinity Commercial |
$1,127.54
|
| Rate for Payer: Cofinity Commercial |
$1,211.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$841.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$883.52
|
| Rate for Payer: Meridian Medicaid |
$596.25
|
| Rate for Payer: Nomi Health Commercial |
$1,009.74
|
| Rate for Payer: PACE SWMI |
$841.45
|
| Rate for Payer: PHP Commercial |
$1,178.03
|
| Rate for Payer: PHP Medicare Advantage |
$841.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,536.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.42
|
| Rate for Payer: Priority Health Medicare |
$841.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.42
|
| Rate for Payer: Priority Health SBD |
$1,344.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$841.45
|
| Rate for Payer: UHC Medicare Advantage |
$841.45
|
| Rate for Payer: UHCCP Medicaid |
$567.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,795.38
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,827.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$2,487.55 |
| Rate for Payer: Aetna Commercial |
$1,157.73
|
| Rate for Payer: Aetna Medicare |
$898.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.13
|
| Rate for Payer: BCBS Complete |
$612.13
|
| Rate for Payer: BCBS MAPPO |
$863.98
|
| Rate for Payer: BCBS Trust/PPO |
$635.54
|
| Rate for Payer: BCN Commercial |
$1,314.06
|
| Rate for Payer: BCN Medicare Advantage |
$863.98
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,157.73
|
| Rate for Payer: Cofinity Commercial |
$1,244.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.18
|
| Rate for Payer: Meridian Medicaid |
$612.13
|
| Rate for Payer: Nomi Health Commercial |
$1,036.78
|
| Rate for Payer: PACE SWMI |
$863.98
|
| Rate for Payer: PHP Commercial |
$1,209.57
|
| Rate for Payer: PHP Medicare Advantage |
$863.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,381.04
|
| Rate for Payer: Priority Health Medicare |
$863.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,381.04
|
| Rate for Payer: Priority Health SBD |
$1,381.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.98
|
| Rate for Payer: UHC Medicare Advantage |
$863.98
|
| Rate for Payer: UHCCP Medicaid |
$582.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,760.42
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$436.86 |
| Max. Negotiated Rate |
$1,755.01 |
| Rate for Payer: Aetna Commercial |
$870.02
|
| Rate for Payer: Aetna Medicare |
$675.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.95
|
| Rate for Payer: BCBS Complete |
$458.70
|
| Rate for Payer: BCBS MAPPO |
$649.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,755.01
|
| Rate for Payer: BCN Commercial |
$979.80
|
| Rate for Payer: BCN Medicare Advantage |
$649.27
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$870.02
|
| Rate for Payer: Cofinity Commercial |
$934.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$681.73
|
| Rate for Payer: Meridian Medicaid |
$458.70
|
| Rate for Payer: Nomi Health Commercial |
$779.12
|
| Rate for Payer: PACE SWMI |
$649.27
|
| Rate for Payer: PHP Commercial |
$908.98
|
| Rate for Payer: PHP Medicare Advantage |
$649.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,084.37
|
| Rate for Payer: Priority Health Medicare |
$649.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,084.37
|
| Rate for Payer: Priority Health SBD |
$1,084.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$649.27
|
| Rate for Payer: UHC Medicare Advantage |
$649.27
|
| Rate for Payer: UHCCP Medicaid |
$436.86
|
| Rate for Payer: UMR Bronson Commercial |
$638.48
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS BY LIGATION
|
Professional
|
Both
|
$4,402.00
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$613.23 |
| Max. Negotiated Rate |
$2,861.30 |
| Rate for Payer: Aetna Commercial |
$1,247.65
|
| Rate for Payer: Aetna Medicare |
$968.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,340.76
|
| Rate for Payer: BCBS Complete |
$643.89
|
| Rate for Payer: BCBS MAPPO |
$931.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,613.43
|
| Rate for Payer: BCN Commercial |
$1,392.74
|
| Rate for Payer: BCN Medicare Advantage |
$931.08
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cofinity Commercial |
$1,340.76
|
| Rate for Payer: Cofinity Commercial |
$1,247.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.63
|
| Rate for Payer: Meridian Medicaid |
$643.89
|
| Rate for Payer: Nomi Health Commercial |
$1,117.30
|
| Rate for Payer: PACE SWMI |
$931.08
|
| Rate for Payer: PHP Commercial |
$1,303.51
|
| Rate for Payer: PHP Medicare Advantage |
$931.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$613.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,861.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,524.21
|
| Rate for Payer: Priority Health Medicare |
$931.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,524.21
|
| Rate for Payer: Priority Health SBD |
$1,524.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.08
|
| Rate for Payer: UHC Medicare Advantage |
$931.08
|
| Rate for Payer: UHCCP Medicaid |
$613.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,024.92
|
|
|
PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC
|
Professional
|
Both
|
$4,141.00
|
|
|
Service Code
|
HCPCS 21743
|
| Min. Negotiated Rate |
$432.39 |
| Max. Negotiated Rate |
$3,437.80 |
| Rate for Payer: Aetna Commercial |
$2,118.84
|
| Rate for Payer: Aetna Medicare |
$2,070.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,118.84
|
| Rate for Payer: BCBS Complete |
$454.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,437.80
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Meridian Medicaid |
$454.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,439.99
|
| Rate for Payer: Priority Health Narrow Network |
$2,439.99
|
| Rate for Payer: Priority Health SBD |
$2,439.99
|
| Rate for Payer: UHCCP Medicaid |
$432.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,904.86
|
|
|
PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN
|
Professional
|
Both
|
$4,141.00
|
|
|
Service Code
|
HCPCS 21740
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,330.15
|
| Rate for Payer: Aetna Medicare |
$1,032.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,429.42
|
| Rate for Payer: BCBS Complete |
$687.28
|
| Rate for Payer: BCBS MAPPO |
$992.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,485.09
|
| Rate for Payer: BCN Medicare Advantage |
$992.65
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Cofinity Commercial |
$1,330.15
|
| Rate for Payer: Cofinity Commercial |
$1,429.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,042.28
|
| Rate for Payer: Meridian Medicaid |
$687.28
|
| Rate for Payer: Nomi Health Commercial |
$1,191.18
|
| Rate for Payer: PACE SWMI |
$992.65
|
| Rate for Payer: PHP Commercial |
$1,389.71
|
| Rate for Payer: PHP Medicare Advantage |
$992.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,556.60
|
| Rate for Payer: Priority Health Medicare |
$992.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,556.60
|
| Rate for Payer: Priority Health SBD |
$1,556.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.65
|
| Rate for Payer: UHC Medicare Advantage |
$992.65
|
| Rate for Payer: UHCCP Medicaid |
$654.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,904.86
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Facility
|
OP
|
$2,602.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$633.92 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Cofinity Commercial |
$2,237.72
|
| Rate for Payer: Cofinity Commercial |
$1,821.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,821.40
|
| Rate for Payer: Aetna American Axle |
$1,691.30
|
| Rate for Payer: Aetna Commercial |
$2,211.70
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,587.36
|
| Rate for Payer: BCN Commercial |
$4,587.36
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$2,341.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,821.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,951.50
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,211.70
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$2,211.70
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$1,639.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.31
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$633.92
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: UMR Bronson Commercial |
$962.74
|
| Rate for Payer: VA VA |
$6,999.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,951.50
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27650
|
| Min. Negotiated Rate |
$429.41 |
| Max. Negotiated Rate |
$1,691.30 |
| Rate for Payer: Aetna Commercial |
$847.71
|
| Rate for Payer: Aetna Medicare |
$657.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.97
|
| Rate for Payer: BCBS Complete |
$450.88
|
| Rate for Payer: BCBS MAPPO |
$632.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.05
|
| Rate for Payer: BCN Commercial |
$1,063.77
|
| Rate for Payer: BCN Medicare Advantage |
$632.62
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Cofinity Commercial |
$910.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.25
|
| Rate for Payer: Meridian Medicaid |
$450.88
|
| Rate for Payer: Nomi Health Commercial |
$759.14
|
| Rate for Payer: PACE SWMI |
$632.62
|
| Rate for Payer: PHP Commercial |
$885.67
|
| Rate for Payer: PHP Medicare Advantage |
$632.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,014.66
|
| Rate for Payer: Priority Health Medicare |
$632.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,014.66
|
| Rate for Payer: Priority Health SBD |
$1,014.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$632.62
|
| Rate for Payer: UHCCP Medicaid |
$429.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,196.92
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Facility
|
IP
|
$2,602.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$1,144.88 |
| Max. Negotiated Rate |
$2,341.80 |
| Rate for Payer: Aetna American Axle |
$1,691.30
|
| Rate for Payer: Aetna Commercial |
$2,211.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.30
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$1,821.40
|
| Rate for Payer: Cofinity Commercial |
$2,237.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,821.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.60
|
| Rate for Payer: Healthscope Commercial |
$2,341.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,821.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,951.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,211.70
|
| Rate for Payer: PHP Commercial |
$2,211.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health SBD |
$1,639.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,144.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,951.50
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$429.41 |
| Max. Negotiated Rate |
$1,691.30 |
| Rate for Payer: Aetna Commercial |
$847.71
|
| Rate for Payer: Aetna Medicare |
$657.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.97
|
| Rate for Payer: BCBS Complete |
$450.88
|
| Rate for Payer: BCBS MAPPO |
$632.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.05
|
| Rate for Payer: BCN Commercial |
$1,063.77
|
| Rate for Payer: BCN Medicare Advantage |
$632.62
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$910.97
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.25
|
| Rate for Payer: Meridian Medicaid |
$450.88
|
| Rate for Payer: Nomi Health Commercial |
$759.14
|
| Rate for Payer: PACE SWMI |
$632.62
|
| Rate for Payer: PHP Commercial |
$885.67
|
| Rate for Payer: PHP Medicare Advantage |
$632.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,014.66
|
| Rate for Payer: Priority Health Medicare |
$632.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,014.66
|
| Rate for Payer: Priority Health SBD |
$1,014.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$632.62
|
| Rate for Payer: UHCCP Medicaid |
$429.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,196.92
|
|
|
PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 27407
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$1,232.98 |
| Rate for Payer: Aetna Commercial |
$1,033.02
|
| Rate for Payer: Aetna Medicare |
$801.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.11
|
| Rate for Payer: BCBS Complete |
$547.05
|
| Rate for Payer: BCBS MAPPO |
$770.91
|
| Rate for Payer: BCBS Trust/PPO |
$95.09
|
| Rate for Payer: BCN Commercial |
$1,173.32
|
| Rate for Payer: BCN Medicare Advantage |
$770.91
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,033.02
|
| Rate for Payer: Cofinity Commercial |
$1,110.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.46
|
| Rate for Payer: Meridian Medicaid |
$547.05
|
| Rate for Payer: Nomi Health Commercial |
$925.09
|
| Rate for Payer: PACE SWMI |
$770.91
|
| Rate for Payer: PHP Commercial |
$1,079.27
|
| Rate for Payer: PHP Medicare Advantage |
$770.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.98
|
| Rate for Payer: Priority Health Medicare |
$770.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,232.98
|
| Rate for Payer: Priority Health SBD |
$1,232.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.91
|
| Rate for Payer: UHC Medicare Advantage |
$770.91
|
| Rate for Payer: UHCCP Medicaid |
$521.00
|
| Rate for Payer: UMR Bronson Commercial |
$834.44
|
|
|
PR REPAIR RECTOCELE SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 45560
|
| Min. Negotiated Rate |
$444.11 |
| Max. Negotiated Rate |
$2,240.52 |
| Rate for Payer: Aetna Commercial |
$888.55
|
| Rate for Payer: Aetna Medicare |
$689.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.86
|
| Rate for Payer: BCBS Complete |
$466.32
|
| Rate for Payer: BCBS MAPPO |
$663.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,240.52
|
| Rate for Payer: BCN Commercial |
$1,009.12
|
| Rate for Payer: BCN Medicare Advantage |
$663.10
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cofinity Commercial |
$888.55
|
| Rate for Payer: Cofinity Commercial |
$954.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.26
|
| Rate for Payer: Meridian Medicaid |
$466.32
|
| Rate for Payer: Nomi Health Commercial |
$795.72
|
| Rate for Payer: PACE SWMI |
$663.10
|
| Rate for Payer: PHP Commercial |
$928.34
|
| Rate for Payer: PHP Medicare Advantage |
$663.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,239.12
|
| Rate for Payer: Priority Health Medicare |
$663.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,239.12
|
| Rate for Payer: Priority Health SBD |
$1,239.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$663.10
|
| Rate for Payer: UHC Medicare Advantage |
$663.10
|
| Rate for Payer: UHCCP Medicaid |
$444.11
|
| Rate for Payer: UMR Bronson Commercial |
$592.48
|
|
