|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$941.80 |
| Max. Negotiated Rate |
$39,622.51 |
| Rate for Payer: Aetna Commercial |
$2,713.20
|
| Rate for Payer: Aetna Medicare |
$13,110.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,074.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$4,339.88
|
| Rate for Payer: BCN Commercial |
$4,339.88
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,234.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| Rate for Payer: Healthscope Commercial |
$2,872.80
|
| Rate for Payer: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: Nomi Health Commercial |
$26,473.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Commercial |
$2,713.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,622.51
|
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Priority Health Narrow Network |
$31,698.01
|
| Rate for Payer: Priority Health SBD |
$2,010.96
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.80
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$7,097.54
|
| Rate for Payer: VA VA |
$12,606.65
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$333.89 |
| Max. Negotiated Rate |
$156,758.00 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$886.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.31
|
| Rate for Payer: BCBS Complete |
$604.31
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCBS Trust/PPO |
$333.89
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Healthscope Commercial |
$1,576.76
|
| Rate for Payer: Healthscope Commercial |
$1,363.68
|
| Rate for Payer: Mclaren Medicaid |
$575.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.92
|
| Rate for Payer: Meridian Medicaid |
$604.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156,758.00
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.23
|
| Rate for Payer: Priority Health Medicare |
$852.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,363.23
|
| Rate for Payer: Priority Health SBD |
$1,363.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,000.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Exchange |
$1,000.00
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
| Rate for Payer: UHCCP Medicaid |
$575.53
|
|
|
PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT
|
Professional
|
Both
|
$2,377.00
|
|
|
Service Code
|
HCPCS 23616
|
| Min. Negotiated Rate |
$496.07 |
| Max. Negotiated Rate |
$219,361.00 |
| Rate for Payer: Aetna Commercial |
$1,592.67
|
| Rate for Payer: Aetna Medicare |
$1,236.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,592.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.53
|
| Rate for Payer: BCBS Complete |
$838.47
|
| Rate for Payer: BCBS MAPPO |
$1,188.56
|
| Rate for Payer: BCBS Trust/PPO |
$496.07
|
| Rate for Payer: BCN Commercial |
$1,809.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,188.56
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cofinity Commercial |
$1,711.53
|
| Rate for Payer: Cofinity Commercial |
$1,592.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,188.56
|
| Rate for Payer: Healthscope Commercial |
$2,198.84
|
| Rate for Payer: Healthscope Commercial |
$1,901.70
|
| Rate for Payer: Mclaren Medicaid |
$798.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.99
|
| Rate for Payer: Meridian Medicaid |
$838.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219,361.00
|
| Rate for Payer: Nomi Health Commercial |
$1,426.27
|
| Rate for Payer: PACE SWMI |
$1,188.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,188.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,545.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,897.54
|
| Rate for Payer: Priority Health Medicare |
$1,188.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,897.54
|
| Rate for Payer: Priority Health SBD |
$1,897.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,739.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,188.56
|
| Rate for Payer: UHC Exchange |
$1,739.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,188.56
|
| Rate for Payer: UHCCP Medicaid |
$798.54
|
|
|
PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ
|
Professional
|
Both
|
$3,098.00
|
|
|
Service Code
|
HCPCS 27226
|
| Min. Negotiated Rate |
$558.94 |
| Max. Negotiated Rate |
$187,497.00 |
| Rate for Payer: Aetna Commercial |
$1,360.42
|
| Rate for Payer: Aetna Medicare |
$1,055.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,360.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.95
|
| Rate for Payer: BCBS Complete |
$716.13
|
| Rate for Payer: BCBS MAPPO |
$1,015.24
|
| Rate for Payer: BCBS Trust/PPO |
$558.94
|
| Rate for Payer: BCN Commercial |
$1,546.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,015.24
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cofinity Commercial |
$1,461.95
|
| Rate for Payer: Cofinity Commercial |
$1,360.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,015.24
|
| Rate for Payer: Healthscope Commercial |
$1,878.19
|
| Rate for Payer: Healthscope Commercial |
$1,624.38
|
| Rate for Payer: Mclaren Medicaid |
$682.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.00
|
| Rate for Payer: Meridian Medicaid |
$716.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187,497.00
|
| Rate for Payer: Nomi Health Commercial |
$1,218.29
|
| Rate for Payer: PACE SWMI |
$1,015.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,015.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,625.30
|
| Rate for Payer: Priority Health Medicare |
$1,015.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,625.30
|
| Rate for Payer: Priority Health SBD |
$1,625.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,296.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,015.24
|
| Rate for Payer: UHC Exchange |
$1,296.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,015.24
|
| Rate for Payer: UHCCP Medicaid |
$682.03
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$2,540.00
|
|
|
Service Code
|
HCPCS 25575
|
| Min. Negotiated Rate |
$590.86 |
| Max. Negotiated Rate |
$160,475.00 |
| Rate for Payer: Aetna Commercial |
$1,170.48
|
| Rate for Payer: Aetna Medicare |
$908.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,257.83
|
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: BCBS MAPPO |
$873.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.82
|
| Rate for Payer: BCN Commercial |
$1,331.16
|
| Rate for Payer: BCN Medicare Advantage |
$873.49
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cofinity Commercial |
$1,257.83
|
| Rate for Payer: Cofinity Commercial |
$1,170.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.49
|
| Rate for Payer: Healthscope Commercial |
$1,615.96
|
| Rate for Payer: Healthscope Commercial |
$1,397.58
|
| Rate for Payer: Mclaren Medicaid |
$590.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.16
|
| Rate for Payer: Meridian Medicaid |
$620.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160,475.00
|
| Rate for Payer: Nomi Health Commercial |
$1,048.19
|
| Rate for Payer: PACE SWMI |
$873.49
|
| Rate for Payer: PHP Medicare Advantage |
$873.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,398.35
|
| Rate for Payer: Priority Health Medicare |
$873.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,398.35
|
| Rate for Payer: Priority Health SBD |
$1,398.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,015.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.49
|
| Rate for Payer: UHC Exchange |
$1,015.79
|
| Rate for Payer: UHC Medicare Advantage |
$873.49
|
| Rate for Payer: UHCCP Medicaid |
$590.86
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 25574
|
| Min. Negotiated Rate |
$444.11 |
| Max. Negotiated Rate |
$120,080.00 |
| Rate for Payer: Aetna Commercial |
$877.12
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.58
|
| Rate for Payer: BCBS Complete |
$466.32
|
| Rate for Payer: BCBS MAPPO |
$654.57
|
| Rate for Payer: BCBS Trust/PPO |
$4,249.65
|
| Rate for Payer: BCN Commercial |
$998.86
|
| Rate for Payer: BCN Medicare Advantage |
$654.57
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cofinity Commercial |
$942.58
|
| Rate for Payer: Cofinity Commercial |
$877.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.57
|
| Rate for Payer: Healthscope Commercial |
$1,210.95
|
| Rate for Payer: Healthscope Commercial |
$1,047.31
|
| Rate for Payer: Mclaren Medicaid |
$444.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.30
|
| Rate for Payer: Meridian Medicaid |
$466.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120,080.00
|
| Rate for Payer: Nomi Health Commercial |
$785.48
|
| Rate for Payer: PACE SWMI |
$654.57
|
| Rate for Payer: PHP Medicare Advantage |
$654.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,215.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.27
|
| Rate for Payer: Priority Health Medicare |
$654.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,049.27
|
| Rate for Payer: Priority Health SBD |
$1,049.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.57
|
| Rate for Payer: UHC Exchange |
$750.00
|
| Rate for Payer: UHC Medicare Advantage |
$654.57
|
| Rate for Payer: UHCCP Medicaid |
$444.11
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$5,711.00
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$298,199.00 |
| Rate for Payer: Aetna Commercial |
$2,184.88
|
| Rate for Payer: Aetna Medicare |
$1,695.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,184.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.93
|
| Rate for Payer: BCBS Complete |
$1,130.56
|
| Rate for Payer: BCBS MAPPO |
$1,630.51
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$2,682.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,630.51
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cofinity Commercial |
$2,347.93
|
| Rate for Payer: Cofinity Commercial |
$2,184.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,630.51
|
| Rate for Payer: Healthscope Commercial |
$3,016.44
|
| Rate for Payer: Healthscope Commercial |
$2,608.82
|
| Rate for Payer: Mclaren Medicaid |
$1,076.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,712.04
|
| Rate for Payer: Meridian Medicaid |
$1,130.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298,199.00
|
| Rate for Payer: Nomi Health Commercial |
$1,956.61
|
| Rate for Payer: PACE SWMI |
$1,630.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,630.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,076.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,565.68
|
| Rate for Payer: Priority Health Medicare |
$1,630.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,565.68
|
| Rate for Payer: Priority Health SBD |
$2,565.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,770.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,630.51
|
| Rate for Payer: UHC Exchange |
$1,770.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,630.51
|
| Rate for Payer: UHCCP Medicaid |
$1,076.72
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$10,742.00
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,196.21 |
| Max. Negotiated Rate |
$331,582.00 |
| Rate for Payer: Aetna Commercial |
$2,433.61
|
| Rate for Payer: Aetna Medicare |
$1,888.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,433.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,615.23
|
| Rate for Payer: BCBS Complete |
$1,256.02
|
| Rate for Payer: BCBS MAPPO |
$1,816.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: BCN Commercial |
$2,704.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,816.13
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cofinity Commercial |
$2,615.23
|
| Rate for Payer: Cofinity Commercial |
$2,433.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,816.13
|
| Rate for Payer: Healthscope Commercial |
$3,359.84
|
| Rate for Payer: Healthscope Commercial |
$2,905.81
|
| Rate for Payer: Mclaren Medicaid |
$1,196.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,906.94
|
| Rate for Payer: Meridian Medicaid |
$1,256.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331,582.00
|
| Rate for Payer: Nomi Health Commercial |
$2,179.36
|
| Rate for Payer: PACE SWMI |
$1,816.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,816.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,982.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,844.53
|
| Rate for Payer: Priority Health Medicare |
$1,816.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,844.53
|
| Rate for Payer: Priority Health SBD |
$2,844.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,008.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,816.13
|
| Rate for Payer: UHC Exchange |
$2,008.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,816.13
|
| Rate for Payer: UHCCP Medicaid |
$1,196.21
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$4,067.00
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$984.70 |
| Max. Negotiated Rate |
$271,845.00 |
| Rate for Payer: Aetna Commercial |
$1,989.32
|
| Rate for Payer: Aetna Medicare |
$1,543.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,989.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.78
|
| Rate for Payer: BCBS Complete |
$1,033.94
|
| Rate for Payer: BCBS MAPPO |
$1,484.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.59
|
| Rate for Payer: BCN Commercial |
$2,452.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,484.57
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cofinity Commercial |
$2,137.78
|
| Rate for Payer: Cofinity Commercial |
$1,989.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,484.57
|
| Rate for Payer: Healthscope Commercial |
$2,746.45
|
| Rate for Payer: Healthscope Commercial |
$2,375.31
|
| Rate for Payer: Mclaren Medicaid |
$984.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,558.80
|
| Rate for Payer: Meridian Medicaid |
$1,033.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271,845.00
|
| Rate for Payer: Nomi Health Commercial |
$1,781.48
|
| Rate for Payer: PACE SWMI |
$1,484.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,484.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$984.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,643.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,340.25
|
| Rate for Payer: Priority Health Medicare |
$1,484.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,340.25
|
| Rate for Payer: Priority Health SBD |
$2,340.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,829.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,484.57
|
| Rate for Payer: UHC Exchange |
$1,829.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.57
|
| Rate for Payer: UHCCP Medicaid |
$984.70
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$180.84 |
| Max. Negotiated Rate |
$50,900.00 |
| Rate for Payer: Aetna Commercial |
$370.93
|
| Rate for Payer: Aetna Medicare |
$287.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.61
|
| Rate for Payer: BCBS Complete |
$189.88
|
| Rate for Payer: BCBS MAPPO |
$276.81
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$453.59
|
| Rate for Payer: BCN Medicare Advantage |
$276.81
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cofinity Commercial |
$398.61
|
| Rate for Payer: Cofinity Commercial |
$370.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.81
|
| Rate for Payer: Healthscope Commercial |
$512.10
|
| Rate for Payer: Healthscope Commercial |
$442.90
|
| Rate for Payer: Mclaren Medicaid |
$180.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.65
|
| Rate for Payer: Meridian Medicaid |
$189.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50,900.00
|
| Rate for Payer: Nomi Health Commercial |
$332.17
|
| Rate for Payer: PACE SWMI |
$276.81
|
| Rate for Payer: PHP Medicare Advantage |
$276.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.46
|
| Rate for Payer: Priority Health Medicare |
$276.81
|
| Rate for Payer: Priority Health Narrow Network |
$428.46
|
| Rate for Payer: Priority Health SBD |
$428.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.81
|
| Rate for Payer: UHC Exchange |
$365.26
|
| Rate for Payer: UHC Medicare Advantage |
$276.81
|
| Rate for Payer: UHCCP Medicaid |
$180.84
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$3,741.00
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$966.38 |
| Max. Negotiated Rate |
$264,526.00 |
| Rate for Payer: Aetna Commercial |
$1,945.84
|
| Rate for Payer: Aetna Medicare |
$1,510.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,091.05
|
| Rate for Payer: BCBS Complete |
$1,014.70
|
| Rate for Payer: BCBS MAPPO |
$1,452.12
|
| Rate for Payer: BCBS Trust/PPO |
$17,177.60
|
| Rate for Payer: BCN Commercial |
$2,172.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,452.12
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cofinity Commercial |
$2,091.05
|
| Rate for Payer: Cofinity Commercial |
$1,945.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,452.12
|
| Rate for Payer: Healthscope Commercial |
$2,686.42
|
| Rate for Payer: Healthscope Commercial |
$2,323.39
|
| Rate for Payer: Mclaren Medicaid |
$966.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.73
|
| Rate for Payer: Meridian Medicaid |
$1,014.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264,526.00
|
| Rate for Payer: Nomi Health Commercial |
$1,742.54
|
| Rate for Payer: PACE SWMI |
$1,452.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,452.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$966.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,287.32
|
| Rate for Payer: Priority Health Medicare |
$1,452.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,287.32
|
| Rate for Payer: Priority Health SBD |
$2,287.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,496.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,452.12
|
| Rate for Payer: UHC Exchange |
$1,496.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,452.12
|
| Rate for Payer: UHCCP Medicaid |
$966.38
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$3,905.00
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$950.50 |
| Max. Negotiated Rate |
$275,828.00 |
| Rate for Payer: Aetna Commercial |
$2,022.38
|
| Rate for Payer: Aetna Medicare |
$1,569.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,022.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,173.31
|
| Rate for Payer: BCBS Complete |
$1,053.84
|
| Rate for Payer: BCBS MAPPO |
$1,509.24
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$2,264.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,509.24
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cofinity Commercial |
$2,173.31
|
| Rate for Payer: Cofinity Commercial |
$2,022.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,509.24
|
| Rate for Payer: Healthscope Commercial |
$2,792.09
|
| Rate for Payer: Healthscope Commercial |
$2,414.78
|
| Rate for Payer: Mclaren Medicaid |
$1,003.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,584.70
|
| Rate for Payer: Meridian Medicaid |
$1,053.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275,828.00
|
| Rate for Payer: Nomi Health Commercial |
$1,811.09
|
| Rate for Payer: PACE SWMI |
$1,509.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,509.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,538.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,383.51
|
| Rate for Payer: Priority Health Medicare |
$1,509.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,383.51
|
| Rate for Payer: Priority Health SBD |
$2,383.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,723.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,509.24
|
| Rate for Payer: UHC Exchange |
$1,723.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,509.24
|
| Rate for Payer: UHCCP Medicaid |
$1,003.66
|
|
|
PR OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 25525
|
| Min. Negotiated Rate |
$517.59 |
| Max. Negotiated Rate |
$140,422.00 |
| Rate for Payer: Aetna Commercial |
$1,024.19
|
| Rate for Payer: Aetna Medicare |
$794.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.62
|
| Rate for Payer: BCBS Complete |
$543.47
|
| Rate for Payer: BCBS MAPPO |
$764.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.84
|
| Rate for Payer: BCN Commercial |
$1,166.47
|
| Rate for Payer: BCN Medicare Advantage |
$764.32
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cofinity Commercial |
$1,100.62
|
| Rate for Payer: Cofinity Commercial |
$1,024.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.32
|
| Rate for Payer: Healthscope Commercial |
$1,413.99
|
| Rate for Payer: Healthscope Commercial |
$1,222.91
|
| Rate for Payer: Mclaren Medicaid |
$517.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.54
|
| Rate for Payer: Meridian Medicaid |
$543.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140,422.00
|
| Rate for Payer: Nomi Health Commercial |
$917.18
|
| Rate for Payer: PACE SWMI |
$764.32
|
| Rate for Payer: PHP Medicare Advantage |
$764.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,225.33
|
| Rate for Payer: Priority Health Medicare |
$764.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,225.33
|
| Rate for Payer: Priority Health SBD |
$1,225.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$764.32
|
| Rate for Payer: UHC Exchange |
$1,072.16
|
| Rate for Payer: UHC Medicare Advantage |
$764.32
|
| Rate for Payer: UHCCP Medicaid |
$517.59
|
|
|
PR OPTX RDL SHAFT FX&OPTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25526
|
| Min. Negotiated Rate |
$623.88 |
| Max. Negotiated Rate |
$169,787.00 |
| Rate for Payer: Aetna Commercial |
$1,237.61
|
| Rate for Payer: Aetna Medicare |
$960.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,329.97
|
| Rate for Payer: BCBS Complete |
$655.07
|
| Rate for Payer: BCBS MAPPO |
$923.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.05
|
| Rate for Payer: BCN Commercial |
$1,406.91
|
| Rate for Payer: BCN Medicare Advantage |
$923.59
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,329.97
|
| Rate for Payer: Cofinity Commercial |
$1,237.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$923.59
|
| Rate for Payer: Healthscope Commercial |
$1,708.64
|
| Rate for Payer: Healthscope Commercial |
$1,477.74
|
| Rate for Payer: Mclaren Medicaid |
$623.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$969.77
|
| Rate for Payer: Meridian Medicaid |
$655.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169,787.00
|
| Rate for Payer: Nomi Health Commercial |
$1,108.31
|
| Rate for Payer: PACE SWMI |
$923.59
|
| Rate for Payer: PHP Medicare Advantage |
$923.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,478.24
|
| Rate for Payer: Priority Health Medicare |
$923.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,478.24
|
| Rate for Payer: Priority Health SBD |
$1,478.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,264.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.59
|
| Rate for Payer: UHC Exchange |
$1,264.89
|
| Rate for Payer: UHC Medicare Advantage |
$923.59
|
| Rate for Payer: UHCCP Medicaid |
$623.88
|
|
|
PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ
|
Professional
|
Both
|
$2,939.00
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$196.12 |
| Max. Negotiated Rate |
$154,595.00 |
| Rate for Payer: Aetna Commercial |
$1,130.17
|
| Rate for Payer: Aetna Medicare |
$877.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,130.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: BCBS Complete |
$597.60
|
| Rate for Payer: BCBS MAPPO |
$843.41
|
| Rate for Payer: BCBS Trust/PPO |
$196.12
|
| Rate for Payer: BCN Commercial |
$1,279.85
|
| Rate for Payer: BCN Medicare Advantage |
$843.41
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cofinity Commercial |
$1,214.51
|
| Rate for Payer: Cofinity Commercial |
$1,130.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$843.41
|
| Rate for Payer: Healthscope Commercial |
$1,560.31
|
| Rate for Payer: Healthscope Commercial |
$1,349.46
|
| Rate for Payer: Mclaren Medicaid |
$569.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$885.58
|
| Rate for Payer: Meridian Medicaid |
$597.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154,595.00
|
| Rate for Payer: Nomi Health Commercial |
$1,012.09
|
| Rate for Payer: PACE SWMI |
$843.41
|
| Rate for Payer: PHP Medicare Advantage |
$843.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$569.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,346.95
|
| Rate for Payer: Priority Health Medicare |
$843.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.95
|
| Rate for Payer: Priority Health SBD |
$1,346.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$843.41
|
| Rate for Payer: UHC Exchange |
$727.57
|
| Rate for Payer: UHC Medicare Advantage |
$843.41
|
| Rate for Payer: UHCCP Medicaid |
$569.14
|
|
|
PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$165,100.00 |
| Rate for Payer: Aetna Commercial |
$1,204.45
|
| Rate for Payer: Aetna Medicare |
$934.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.33
|
| Rate for Payer: BCBS Complete |
$636.29
|
| Rate for Payer: BCBS MAPPO |
$898.84
|
| Rate for Payer: BCBS Trust/PPO |
$228.81
|
| Rate for Payer: BCN Commercial |
$1,365.86
|
| Rate for Payer: BCN Medicare Advantage |
$898.84
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,294.33
|
| Rate for Payer: Cofinity Commercial |
$1,204.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.84
|
| Rate for Payer: Healthscope Commercial |
$1,662.85
|
| Rate for Payer: Healthscope Commercial |
$1,438.14
|
| Rate for Payer: Mclaren Medicaid |
$605.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.78
|
| Rate for Payer: Meridian Medicaid |
$636.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165,100.00
|
| Rate for Payer: Nomi Health Commercial |
$1,078.61
|
| Rate for Payer: PACE SWMI |
$898.84
|
| Rate for Payer: PHP Medicare Advantage |
$898.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$605.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,419.72
|
| Rate for Payer: Priority Health Medicare |
$898.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,419.72
|
| Rate for Payer: Priority Health SBD |
$1,419.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$915.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$898.84
|
| Rate for Payer: UHC Exchange |
$915.86
|
| Rate for Payer: UHC Medicare Advantage |
$898.84
|
| Rate for Payer: UHCCP Medicaid |
$605.99
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$600.23 |
| Max. Negotiated Rate |
$163,732.00 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.67
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCBS Trust/PPO |
$969.43
|
| Rate for Payer: BCN Commercial |
$1,355.11
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Healthscope Commercial |
$1,646.59
|
| Rate for Payer: Healthscope Commercial |
$1,424.08
|
| Rate for Payer: Mclaren Medicaid |
$600.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163,732.00
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$600.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.75
|
| Rate for Payer: Priority Health Medicare |
$890.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,421.75
|
| Rate for Payer: Priority Health SBD |
$1,421.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,094.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Exchange |
$1,094.77
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
| Rate for Payer: UHCCP Medicaid |
$600.23
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$198,598.00 |
| Rate for Payer: Aetna Commercial |
$1,447.17
|
| Rate for Payer: Aetna Medicare |
$1,123.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,447.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,555.17
|
| Rate for Payer: BCBS Complete |
$763.10
|
| Rate for Payer: BCBS MAPPO |
$1,079.98
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$1,640.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,079.98
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cofinity Commercial |
$1,555.17
|
| Rate for Payer: Cofinity Commercial |
$1,447.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,079.98
|
| Rate for Payer: Healthscope Commercial |
$1,997.96
|
| Rate for Payer: Healthscope Commercial |
$1,727.97
|
| Rate for Payer: Mclaren Medicaid |
$726.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,133.98
|
| Rate for Payer: Meridian Medicaid |
$763.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198,598.00
|
| Rate for Payer: Nomi Health Commercial |
$1,295.98
|
| Rate for Payer: PACE SWMI |
$1,079.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,079.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$726.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,722.49
|
| Rate for Payer: Priority Health Medicare |
$1,079.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,722.49
|
| Rate for Payer: Priority Health SBD |
$1,722.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,270.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,079.98
|
| Rate for Payer: UHC Exchange |
$1,270.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.98
|
| Rate for Payer: UHCCP Medicaid |
$726.76
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$723.77 |
| Max. Negotiated Rate |
$197,926.00 |
| Rate for Payer: Aetna Commercial |
$1,441.18
|
| Rate for Payer: Aetna Medicare |
$1,118.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,548.73
|
| Rate for Payer: BCBS Complete |
$759.96
|
| Rate for Payer: BCBS MAPPO |
$1,075.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.86
|
| Rate for Payer: BCN Commercial |
$1,635.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,075.51
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,548.73
|
| Rate for Payer: Cofinity Commercial |
$1,441.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,075.51
|
| Rate for Payer: Healthscope Commercial |
$1,989.69
|
| Rate for Payer: Healthscope Commercial |
$1,720.82
|
| Rate for Payer: Mclaren Medicaid |
$723.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,129.29
|
| Rate for Payer: Meridian Medicaid |
$759.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197,926.00
|
| Rate for Payer: Nomi Health Commercial |
$1,290.61
|
| Rate for Payer: PACE SWMI |
$1,075.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,075.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$723.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,715.37
|
| Rate for Payer: Priority Health Medicare |
$1,075.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,715.37
|
| Rate for Payer: Priority Health SBD |
$1,715.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,075.51
|
| Rate for Payer: UHC Exchange |
$1,360.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,075.51
|
| Rate for Payer: UHCCP Medicaid |
$723.77
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$197,208.00 |
| Rate for Payer: Aetna Commercial |
$1,435.33
|
| Rate for Payer: Aetna Medicare |
$1,113.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,542.44
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCBS MAPPO |
$1,071.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,598.71
|
| Rate for Payer: BCN Commercial |
$1,628.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.14
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,542.44
|
| Rate for Payer: Cofinity Commercial |
$1,435.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.14
|
| Rate for Payer: Healthscope Commercial |
$1,981.61
|
| Rate for Payer: Healthscope Commercial |
$1,713.82
|
| Rate for Payer: Mclaren Medicaid |
$720.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.70
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197,208.00
|
| Rate for Payer: Nomi Health Commercial |
$1,285.37
|
| Rate for Payer: PACE SWMI |
$1,071.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.24
|
| Rate for Payer: Priority Health Medicare |
$1,071.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,708.24
|
| Rate for Payer: Priority Health SBD |
$1,708.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.14
|
| Rate for Payer: UHC Exchange |
$1,465.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.14
|
| Rate for Payer: UHCCP Medicaid |
$720.37
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$411.73 |
| Max. Negotiated Rate |
$111,479.00 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna Medicare |
$631.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.86
|
| Rate for Payer: BCBS Complete |
$432.32
|
| Rate for Payer: BCBS MAPPO |
$607.54
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$926.54
|
| Rate for Payer: BCN Medicare Advantage |
$607.54
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cofinity Commercial |
$874.86
|
| Rate for Payer: Cofinity Commercial |
$814.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.54
|
| Rate for Payer: Healthscope Commercial |
$972.06
|
| Rate for Payer: Healthscope Commercial |
$1,123.95
|
| Rate for Payer: Mclaren Medicaid |
$411.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.92
|
| Rate for Payer: Meridian Medicaid |
$432.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111,479.00
|
| Rate for Payer: Nomi Health Commercial |
$729.05
|
| Rate for Payer: PACE SWMI |
$607.54
|
| Rate for Payer: PHP Medicare Advantage |
$607.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$973.96
|
| Rate for Payer: Priority Health Medicare |
$607.54
|
| Rate for Payer: Priority Health Narrow Network |
$973.96
|
| Rate for Payer: Priority Health SBD |
$973.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.54
|
| Rate for Payer: UHC Exchange |
$772.51
|
| Rate for Payer: UHC Medicare Advantage |
$607.54
|
| Rate for Payer: UHCCP Medicaid |
$411.73
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$769.57 |
| Max. Negotiated Rate |
$210,488.00 |
| Rate for Payer: Aetna Commercial |
$1,533.71
|
| Rate for Payer: Aetna Medicare |
$1,190.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,533.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.17
|
| Rate for Payer: BCBS Complete |
$808.05
|
| Rate for Payer: BCBS MAPPO |
$1,144.56
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: BCN Commercial |
$1,737.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.56
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,648.17
|
| Rate for Payer: Cofinity Commercial |
$1,533.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.56
|
| Rate for Payer: Healthscope Commercial |
$2,117.44
|
| Rate for Payer: Healthscope Commercial |
$1,831.30
|
| Rate for Payer: Mclaren Medicaid |
$769.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,201.79
|
| Rate for Payer: Meridian Medicaid |
$808.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210,488.00
|
| Rate for Payer: Nomi Health Commercial |
$1,373.47
|
| Rate for Payer: PACE SWMI |
$1,144.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$769.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,823.75
|
| Rate for Payer: Priority Health Medicare |
$1,144.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,823.75
|
| Rate for Payer: Priority Health SBD |
$1,823.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.56
|
| Rate for Payer: UHC Exchange |
$1,352.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.56
|
| Rate for Payer: UHCCP Medicaid |
$769.57
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$583.19 |
| Max. Negotiated Rate |
$159,005.00 |
| Rate for Payer: Aetna Commercial |
$1,158.03
|
| Rate for Payer: Aetna Medicare |
$898.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.45
|
| Rate for Payer: BCBS Complete |
$612.35
|
| Rate for Payer: BCBS MAPPO |
$864.20
|
| Rate for Payer: BCBS Trust/PPO |
$623.39
|
| Rate for Payer: BCN Commercial |
$1,316.50
|
| Rate for Payer: BCN Medicare Advantage |
$864.20
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cofinity Commercial |
$1,244.45
|
| Rate for Payer: Cofinity Commercial |
$1,158.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.20
|
| Rate for Payer: Healthscope Commercial |
$1,598.77
|
| Rate for Payer: Healthscope Commercial |
$1,382.72
|
| Rate for Payer: Mclaren Medicaid |
$583.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.41
|
| Rate for Payer: Meridian Medicaid |
$612.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159,005.00
|
| Rate for Payer: Nomi Health Commercial |
$1,037.04
|
| Rate for Payer: PACE SWMI |
$864.20
|
| Rate for Payer: PHP Medicare Advantage |
$864.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$583.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,330.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,382.57
|
| Rate for Payer: Priority Health Medicare |
$864.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,382.57
|
| Rate for Payer: Priority Health SBD |
$1,382.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.20
|
| Rate for Payer: UHC Exchange |
$1,086.05
|
| Rate for Payer: UHC Medicare Advantage |
$864.20
|
| Rate for Payer: UHCCP Medicaid |
$583.19
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$251.04
|
|
|
Service Code
|
NDC 00480924201
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna Medicare |
$125.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.18
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$175.73
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.38
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| Rate for Payer: Priority Health SBD |
$158.16
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 00480924201
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Aetna Commercial |
$213.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.18
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$175.73
|
| Rate for Payer: Cofinity Commercial |
$215.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$225.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.38
|
| Rate for Payer: PHP Commercial |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.18
|
| Rate for Payer: Priority Health SBD |
$158.16
|
|
