|
PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,679.00
|
|
|
Service Code
|
HCPCS 27220
|
| Min. Negotiated Rate |
$400.45 |
| Max. Negotiated Rate |
$1,091.35 |
| Rate for Payer: Aetna Commercial |
$536.60
|
| Rate for Payer: Aetna Medicare |
$416.47
|
| Rate for Payer: BCBS Complete |
$671.60
|
| Rate for Payer: BCBS MAPPO |
$400.45
|
| Rate for Payer: BCN Medicare Advantage |
$400.45
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cofinity Commercial |
$576.65
|
| Rate for Payer: Cofinity Commercial |
$536.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$420.47
|
| Rate for Payer: Nomi Health Commercial |
$480.54
|
| Rate for Payer: PACE SWMI |
$400.45
|
| Rate for Payer: PHP Medicare Advantage |
$400.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,091.35
|
| Rate for Payer: Priority Health Medicare |
$404.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.45
|
| Rate for Payer: UHC Exchange |
$400.45
|
| Rate for Payer: UHC Medicare Advantage |
$400.45
|
|
|
PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
HCPCS 27842
|
| Min. Negotiated Rate |
$477.98 |
| Max. Negotiated Rate |
$919.10 |
| Rate for Payer: Aetna Commercial |
$640.49
|
| Rate for Payer: Aetna Medicare |
$497.10
|
| Rate for Payer: BCBS Complete |
$565.60
|
| Rate for Payer: BCBS MAPPO |
$477.98
|
| Rate for Payer: BCN Medicare Advantage |
$477.98
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cofinity Commercial |
$688.29
|
| Rate for Payer: Cofinity Commercial |
$640.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.88
|
| Rate for Payer: Nomi Health Commercial |
$573.58
|
| Rate for Payer: PACE SWMI |
$477.98
|
| Rate for Payer: PHP Medicare Advantage |
$477.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.10
|
| Rate for Payer: Priority Health Medicare |
$482.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.98
|
| Rate for Payer: UHC Exchange |
$477.98
|
| Rate for Payer: UHC Medicare Advantage |
$477.98
|
|
|
PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 26742
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Aetna Commercial |
$440.61
|
| Rate for Payer: Aetna Medicare |
$341.96
|
| Rate for Payer: BCBS Complete |
$374.00
|
| Rate for Payer: BCBS MAPPO |
$328.81
|
| Rate for Payer: BCN Medicare Advantage |
$328.81
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$473.49
|
| Rate for Payer: Cofinity Commercial |
$440.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.25
|
| Rate for Payer: Nomi Health Commercial |
$394.57
|
| Rate for Payer: PACE SWMI |
$328.81
|
| Rate for Payer: PHP Medicare Advantage |
$328.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.75
|
| Rate for Payer: Priority Health Medicare |
$332.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.81
|
| Rate for Payer: UHC Exchange |
$328.81
|
| Rate for Payer: UHC Medicare Advantage |
$328.81
|
|
|
PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 26740
|
| Min. Negotiated Rate |
$217.01 |
| Max. Negotiated Rate |
$410.80 |
| Rate for Payer: Aetna Commercial |
$290.79
|
| Rate for Payer: Aetna Medicare |
$225.69
|
| Rate for Payer: BCBS Complete |
$252.80
|
| Rate for Payer: BCBS MAPPO |
$217.01
|
| Rate for Payer: BCN Medicare Advantage |
$217.01
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$312.49
|
| Rate for Payer: Cofinity Commercial |
$290.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.86
|
| Rate for Payer: Nomi Health Commercial |
$260.41
|
| Rate for Payer: PACE SWMI |
$217.01
|
| Rate for Payer: PHP Medicare Advantage |
$217.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.80
|
| Rate for Payer: Priority Health Medicare |
$219.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.01
|
| Rate for Payer: UHC Exchange |
$217.01
|
| Rate for Payer: UHC Medicare Advantage |
$217.01
|
|
|
PR CLTX CARPAL BONE FX W/MNPJ EACH BONE
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
HCPCS 25635
|
| Min. Negotiated Rate |
$413.75 |
| Max. Negotiated Rate |
$729.95 |
| Rate for Payer: Aetna Commercial |
$554.42
|
| Rate for Payer: Aetna Medicare |
$430.30
|
| Rate for Payer: BCBS Complete |
$449.20
|
| Rate for Payer: BCBS MAPPO |
$413.75
|
| Rate for Payer: BCN Medicare Advantage |
$413.75
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cofinity Commercial |
$595.80
|
| Rate for Payer: Cofinity Commercial |
$554.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.44
|
| Rate for Payer: Nomi Health Commercial |
$496.50
|
| Rate for Payer: PACE SWMI |
$413.75
|
| Rate for Payer: PHP Medicare Advantage |
$413.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.95
|
| Rate for Payer: Priority Health Medicare |
$417.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.75
|
| Rate for Payer: UHC Exchange |
$413.75
|
| Rate for Payer: UHC Medicare Advantage |
$413.75
|
|
|
PR CLTX CARPAL BONE FX W/O MNPJ EACH BONE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$280.11 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$375.35
|
| Rate for Payer: Aetna Medicare |
$291.31
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$280.11
|
| Rate for Payer: BCN Medicare Advantage |
$280.11
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$403.36
|
| Rate for Payer: Cofinity Commercial |
$375.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.12
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: PACE SWMI |
$280.11
|
| Rate for Payer: PHP Medicare Advantage |
$280.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$282.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.11
|
| Rate for Payer: UHC Exchange |
$280.11
|
| Rate for Payer: UHC Medicare Advantage |
$280.11
|
|
|
PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 26641
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$538.69 |
| Rate for Payer: Aetna Commercial |
$501.28
|
| Rate for Payer: Aetna Medicare |
$389.05
|
| Rate for Payer: BCBS Complete |
$300.40
|
| Rate for Payer: BCBS MAPPO |
$374.09
|
| Rate for Payer: BCN Medicare Advantage |
$374.09
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$538.69
|
| Rate for Payer: Cofinity Commercial |
$501.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.79
|
| Rate for Payer: Nomi Health Commercial |
$448.91
|
| Rate for Payer: PACE SWMI |
$374.09
|
| Rate for Payer: PHP Medicare Advantage |
$374.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health Medicare |
$377.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$374.09
|
| Rate for Payer: UHC Exchange |
$374.09
|
| Rate for Payer: UHC Medicare Advantage |
$374.09
|
|
|
PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 26645
|
| Min. Negotiated Rate |
$386.68 |
| Max. Negotiated Rate |
$661.70 |
| Rate for Payer: Aetna Commercial |
$518.15
|
| Rate for Payer: Aetna Medicare |
$402.15
|
| Rate for Payer: BCBS Complete |
$407.20
|
| Rate for Payer: BCBS MAPPO |
$386.68
|
| Rate for Payer: BCN Medicare Advantage |
$386.68
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cofinity Commercial |
$556.82
|
| Rate for Payer: Cofinity Commercial |
$518.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.01
|
| Rate for Payer: Nomi Health Commercial |
$464.02
|
| Rate for Payer: PACE SWMI |
$386.68
|
| Rate for Payer: PHP Medicare Advantage |
$386.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.70
|
| Rate for Payer: Priority Health Medicare |
$390.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.68
|
| Rate for Payer: UHC Exchange |
$386.68
|
| Rate for Payer: UHC Medicare Advantage |
$386.68
|
|
|
PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 26670
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$449.01 |
| Rate for Payer: Aetna Commercial |
$417.83
|
| Rate for Payer: Aetna Medicare |
$324.28
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$311.81
|
| Rate for Payer: BCN Medicare Advantage |
$311.81
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$449.01
|
| Rate for Payer: Cofinity Commercial |
$417.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$327.40
|
| Rate for Payer: Nomi Health Commercial |
$374.17
|
| Rate for Payer: PACE SWMI |
$311.81
|
| Rate for Payer: PHP Medicare Advantage |
$311.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$314.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.81
|
| Rate for Payer: UHC Exchange |
$311.81
|
| Rate for Payer: UHC Medicare Advantage |
$311.81
|
|
|
PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$413.33 |
| Max. Negotiated Rate |
$822.25 |
| Rate for Payer: Aetna Commercial |
$553.86
|
| Rate for Payer: Aetna Medicare |
$429.86
|
| Rate for Payer: BCBS Complete |
$506.00
|
| Rate for Payer: BCBS MAPPO |
$413.33
|
| Rate for Payer: BCN Medicare Advantage |
$413.33
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cofinity Commercial |
$595.20
|
| Rate for Payer: Cofinity Commercial |
$553.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.00
|
| Rate for Payer: Nomi Health Commercial |
$496.00
|
| Rate for Payer: PACE SWMI |
$413.33
|
| Rate for Payer: PHP Medicare Advantage |
$413.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.25
|
| Rate for Payer: Priority Health Medicare |
$417.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.33
|
| Rate for Payer: UHC Exchange |
$413.33
|
| Rate for Payer: UHC Medicare Advantage |
$413.33
|
|
|
PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 27516
|
| Min. Negotiated Rate |
$472.57 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$633.24
|
| Rate for Payer: Aetna Medicare |
$491.47
|
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: BCBS MAPPO |
$472.57
|
| Rate for Payer: BCN Medicare Advantage |
$472.57
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$633.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.20
|
| Rate for Payer: Nomi Health Commercial |
$567.08
|
| Rate for Payer: PACE SWMI |
$472.57
|
| Rate for Payer: PHP Medicare Advantage |
$472.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health Medicare |
$477.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.57
|
| Rate for Payer: UHC Exchange |
$472.57
|
| Rate for Payer: UHC Medicare Advantage |
$472.57
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 27788
|
| Min. Negotiated Rate |
$375.69 |
| Max. Negotiated Rate |
$882.05 |
| Rate for Payer: Aetna Commercial |
$503.42
|
| Rate for Payer: Aetna Medicare |
$390.72
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS MAPPO |
$375.69
|
| Rate for Payer: BCN Medicare Advantage |
$375.69
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Commercial |
$540.99
|
| Rate for Payer: Cofinity Commercial |
$503.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$394.47
|
| Rate for Payer: Nomi Health Commercial |
$450.83
|
| Rate for Payer: PACE SWMI |
$375.69
|
| Rate for Payer: PHP Medicare Advantage |
$375.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.05
|
| Rate for Payer: Priority Health Medicare |
$379.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.69
|
| Rate for Payer: UHC Exchange |
$375.69
|
| Rate for Payer: UHC Medicare Advantage |
$375.69
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27786
|
| Min. Negotiated Rate |
$279.28 |
| Max. Negotiated Rate |
$503.75 |
| Rate for Payer: Aetna Commercial |
$374.24
|
| Rate for Payer: Aetna Medicare |
$290.45
|
| Rate for Payer: BCBS Complete |
$310.00
|
| Rate for Payer: BCBS MAPPO |
$279.28
|
| Rate for Payer: BCN Medicare Advantage |
$279.28
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cofinity Commercial |
$402.16
|
| Rate for Payer: Cofinity Commercial |
$374.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.24
|
| Rate for Payer: Nomi Health Commercial |
$335.14
|
| Rate for Payer: PACE SWMI |
$279.28
|
| Rate for Payer: PHP Medicare Advantage |
$279.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.75
|
| Rate for Payer: Priority Health Medicare |
$282.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.28
|
| Rate for Payer: UHC Exchange |
$279.28
|
| Rate for Payer: UHC Medicare Advantage |
$279.28
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 26755
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$391.65 |
| Rate for Payer: Aetna Commercial |
$364.45
|
| Rate for Payer: Aetna Medicare |
$282.86
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS MAPPO |
$271.98
|
| Rate for Payer: BCN Medicare Advantage |
$271.98
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$391.65
|
| Rate for Payer: Cofinity Commercial |
$364.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.58
|
| Rate for Payer: Nomi Health Commercial |
$326.38
|
| Rate for Payer: PACE SWMI |
$271.98
|
| Rate for Payer: PHP Medicare Advantage |
$271.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health Medicare |
$274.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.98
|
| Rate for Payer: UHC Exchange |
$271.98
|
| Rate for Payer: UHC Medicare Advantage |
$271.98
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 26750
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$270.71 |
| Rate for Payer: Aetna Commercial |
$251.91
|
| Rate for Payer: Aetna Medicare |
$195.51
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$187.99
|
| Rate for Payer: BCN Medicare Advantage |
$187.99
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$270.71
|
| Rate for Payer: Cofinity Commercial |
$251.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.39
|
| Rate for Payer: Nomi Health Commercial |
$225.59
|
| Rate for Payer: PACE SWMI |
$187.99
|
| Rate for Payer: PHP Medicare Advantage |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$189.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.99
|
| Rate for Payer: UHC Exchange |
$187.99
|
| Rate for Payer: UHC Medicare Advantage |
$187.99
|
|
|
PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 25600
|
| Min. Negotiated Rate |
$301.60 |
| Max. Negotiated Rate |
$490.10 |
| Rate for Payer: Aetna Commercial |
$424.75
|
| Rate for Payer: Aetna Medicare |
$329.66
|
| Rate for Payer: BCBS Complete |
$301.60
|
| Rate for Payer: BCBS MAPPO |
$316.98
|
| Rate for Payer: BCN Medicare Advantage |
$316.98
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$456.45
|
| Rate for Payer: Cofinity Commercial |
$424.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.83
|
| Rate for Payer: Nomi Health Commercial |
$380.38
|
| Rate for Payer: PACE SWMI |
$316.98
|
| Rate for Payer: PHP Medicare Advantage |
$316.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health Medicare |
$320.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.98
|
| Rate for Payer: UHC Exchange |
$316.98
|
| Rate for Payer: UHC Medicare Advantage |
$316.98
|
|
|
PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MNPJ
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 25605
|
| Min. Negotiated Rate |
$498.18 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$667.56
|
| Rate for Payer: Aetna Medicare |
$518.11
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$498.18
|
| Rate for Payer: BCN Medicare Advantage |
$498.18
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$717.38
|
| Rate for Payer: Cofinity Commercial |
$667.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.09
|
| Rate for Payer: Nomi Health Commercial |
$597.82
|
| Rate for Payer: PACE SWMI |
$498.18
|
| Rate for Payer: PHP Medicare Advantage |
$498.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$503.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.18
|
| Rate for Payer: UHC Exchange |
$498.18
|
| Rate for Payer: UHC Medicare Advantage |
$498.18
|
|
|
PR CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
HCPCS 26432
|
| Min. Negotiated Rate |
$418.80 |
| Max. Negotiated Rate |
$728.01 |
| Rate for Payer: Aetna Commercial |
$677.45
|
| Rate for Payer: Aetna Medicare |
$525.78
|
| Rate for Payer: BCBS Complete |
$418.80
|
| Rate for Payer: BCBS MAPPO |
$505.56
|
| Rate for Payer: BCN Medicare Advantage |
$505.56
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cofinity Commercial |
$728.01
|
| Rate for Payer: Cofinity Commercial |
$677.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$530.84
|
| Rate for Payer: Nomi Health Commercial |
$606.67
|
| Rate for Payer: PACE SWMI |
$505.56
|
| Rate for Payer: PHP Medicare Advantage |
$505.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.55
|
| Rate for Payer: Priority Health Medicare |
$510.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.56
|
| Rate for Payer: UHC Exchange |
$505.56
|
| Rate for Payer: UHC Medicare Advantage |
$505.56
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 27510
|
| Min. Negotiated Rate |
$566.80 |
| Max. Negotiated Rate |
$950.01 |
| Rate for Payer: Aetna Commercial |
$884.04
|
| Rate for Payer: Aetna Medicare |
$686.12
|
| Rate for Payer: BCBS Complete |
$566.80
|
| Rate for Payer: BCBS MAPPO |
$659.73
|
| Rate for Payer: BCN Medicare Advantage |
$659.73
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cofinity Commercial |
$950.01
|
| Rate for Payer: Cofinity Commercial |
$884.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.72
|
| Rate for Payer: Nomi Health Commercial |
$791.68
|
| Rate for Payer: PACE SWMI |
$659.73
|
| Rate for Payer: PHP Medicare Advantage |
$659.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.05
|
| Rate for Payer: Priority Health Medicare |
$666.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$659.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$659.73
|
| Rate for Payer: UHC Exchange |
$659.73
|
| Rate for Payer: UHC Medicare Advantage |
$659.73
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27508
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna Medicare |
$503.68
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: BCBS MAPPO |
$484.31
|
| Rate for Payer: BCN Medicare Advantage |
$484.31
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$697.41
|
| Rate for Payer: Cofinity Commercial |
$648.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.53
|
| Rate for Payer: Nomi Health Commercial |
$581.17
|
| Rate for Payer: PACE SWMI |
$484.31
|
| Rate for Payer: PHP Medicare Advantage |
$484.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health Medicare |
$489.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.31
|
| Rate for Payer: UHC Exchange |
$484.31
|
| Rate for Payer: UHC Medicare Advantage |
$484.31
|
|
|
PR CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 27232
|
| Min. Negotiated Rate |
$549.20 |
| Max. Negotiated Rate |
$1,021.29 |
| Rate for Payer: Aetna Commercial |
$950.37
|
| Rate for Payer: Aetna Medicare |
$737.60
|
| Rate for Payer: BCBS Complete |
$549.20
|
| Rate for Payer: BCBS MAPPO |
$709.23
|
| Rate for Payer: BCN Medicare Advantage |
$709.23
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$950.37
|
| Rate for Payer: Cofinity Commercial |
$1,021.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.69
|
| Rate for Payer: Nomi Health Commercial |
$851.08
|
| Rate for Payer: PACE SWMI |
$709.23
|
| Rate for Payer: PHP Medicare Advantage |
$709.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Medicare |
$716.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.23
|
| Rate for Payer: UHC Exchange |
$709.23
|
| Rate for Payer: UHC Medicare Advantage |
$709.23
|
|
|
PR CLTX FEM FX PROX END NCK W/O MANJ
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
HCPCS 27230
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$667.22 |
| Rate for Payer: Aetna Commercial |
$620.89
|
| Rate for Payer: Aetna Medicare |
$481.88
|
| Rate for Payer: BCBS Complete |
$399.60
|
| Rate for Payer: BCBS MAPPO |
$463.35
|
| Rate for Payer: BCN Medicare Advantage |
$463.35
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cofinity Commercial |
$667.22
|
| Rate for Payer: Cofinity Commercial |
$620.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$486.52
|
| Rate for Payer: Nomi Health Commercial |
$556.02
|
| Rate for Payer: PACE SWMI |
$463.35
|
| Rate for Payer: PHP Medicare Advantage |
$463.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.35
|
| Rate for Payer: Priority Health Medicare |
$467.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$463.35
|
| Rate for Payer: UHC Exchange |
$463.35
|
| Rate for Payer: UHC Medicare Advantage |
$463.35
|
|
|
PR CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ
|
Professional
|
Both
|
$1,832.00
|
|
|
Service Code
|
HCPCS 27502
|
| Min. Negotiated Rate |
$731.09 |
| Max. Negotiated Rate |
$1,190.80 |
| Rate for Payer: Aetna Commercial |
$979.66
|
| Rate for Payer: Aetna Medicare |
$760.33
|
| Rate for Payer: BCBS Complete |
$732.80
|
| Rate for Payer: BCBS MAPPO |
$731.09
|
| Rate for Payer: BCN Medicare Advantage |
$731.09
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Cofinity Commercial |
$979.66
|
| Rate for Payer: Cofinity Commercial |
$1,052.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$767.64
|
| Rate for Payer: Nomi Health Commercial |
$877.31
|
| Rate for Payer: PACE SWMI |
$731.09
|
| Rate for Payer: PHP Medicare Advantage |
$731.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.80
|
| Rate for Payer: Priority Health Medicare |
$738.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$731.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$731.09
|
| Rate for Payer: UHC Exchange |
$731.09
|
| Rate for Payer: UHC Medicare Advantage |
$731.09
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 28495
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$208.60 |
| Rate for Payer: Aetna Commercial |
$194.11
|
| Rate for Payer: Aetna Medicare |
$150.65
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$144.86
|
| Rate for Payer: BCN Medicare Advantage |
$144.86
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$208.60
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.10
|
| Rate for Payer: Nomi Health Commercial |
$173.83
|
| Rate for Payer: PACE SWMI |
$144.86
|
| Rate for Payer: PHP Medicare Advantage |
$144.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health Medicare |
$146.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.86
|
| Rate for Payer: UHC Exchange |
$144.86
|
| Rate for Payer: UHC Medicare Advantage |
$144.86
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
28490
|
| Min. Negotiated Rate |
$71.96 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Aetna Commercial |
$257.55
|
| Rate for Payer: Aetna Medicare |
$78.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.69
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$75.75
|
| Rate for Payer: BCBS Trust/PPO |
$249.10
|
| Rate for Payer: BCN Commercial |
$235.58
|
| Rate for Payer: BCN Medicare Advantage |
$75.75
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$260.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.75
|
| Rate for Payer: Healthscope Commercial |
$272.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.25
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.54
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.55
|
| Rate for Payer: Nomi Health Commercial |
$248.46
|
| Rate for Payer: PACE Senior Care Partners |
$71.96
|
| Rate for Payer: PACE SWMI |
$75.75
|
| Rate for Payer: PHP Commercial |
$257.55
|
| Rate for Payer: PHP Medicare Advantage |
$75.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health HMO/PPO |
$263.61
|
| Rate for Payer: Priority Health Medicare |
$76.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.01
|
| Rate for Payer: Railroad Medicare Medicare |
$75.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.64
|
| Rate for Payer: UHC Core |
$253.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.75
|
| Rate for Payer: UHC Exchange |
$75.75
|
| Rate for Payer: UHC Medicare Advantage |
$75.75
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$75.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.25
|
|
