|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$984.90
|
| Rate for Payer: Aetna Medicare |
$764.40
|
| Rate for Payer: BCBS Complete |
$1,202.00
|
| Rate for Payer: BCBS MAPPO |
$735.00
|
| Rate for Payer: BCN Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$984.90
|
| Rate for Payer: Cofinity Commercial |
$1,058.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$771.75
|
| Rate for Payer: Nomi Health Commercial |
$882.00
|
| Rate for Payer: PACE SWMI |
$735.00
|
| Rate for Payer: PHP Medicare Advantage |
$735.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health Medicare |
$742.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.00
|
| Rate for Payer: UHC Exchange |
$735.00
|
| Rate for Payer: UHC Medicare Advantage |
$735.00
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Facility
|
OP
|
$3,005.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$713.69 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$2,554.25
|
| Rate for Payer: Aetna Medicare |
$781.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$939.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$939.06
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$751.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,470.41
|
| Rate for Payer: BCN Commercial |
$2,336.39
|
| Rate for Payer: BCN Medicare Advantage |
$751.25
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$2,584.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,404.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.25
|
| Rate for Payer: Healthscope Commercial |
$2,704.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,253.75
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.81
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$863.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,554.25
|
| Rate for Payer: Nomi Health Commercial |
$2,464.10
|
| Rate for Payer: PACE Senior Care Partners |
$713.69
|
| Rate for Payer: PACE SWMI |
$751.25
|
| Rate for Payer: PHP Commercial |
$2,554.25
|
| Rate for Payer: PHP Medicare Advantage |
$751.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,614.35
|
| Rate for Payer: Priority Health Medicare |
$758.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,013.35
|
| Rate for Payer: Railroad Medicare Medicare |
$751.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,644.40
|
| Rate for Payer: UHC Core |
$2,509.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.25
|
| Rate for Payer: UHC Exchange |
$751.25
|
| Rate for Payer: UHC Medicare Advantage |
$751.25
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$751.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,253.75
|
|
|
PR OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$3,366.00
|
|
|
Service Code
|
HCPCS 28415
|
| Min. Negotiated Rate |
$1,072.44 |
| Max. Negotiated Rate |
$2,187.90 |
| Rate for Payer: Aetna Commercial |
$1,437.07
|
| Rate for Payer: Aetna Medicare |
$1,115.34
|
| Rate for Payer: BCBS Complete |
$1,346.40
|
| Rate for Payer: BCBS MAPPO |
$1,072.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,072.44
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cofinity Commercial |
$1,544.31
|
| Rate for Payer: Cofinity Commercial |
$1,437.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,072.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,126.06
|
| Rate for Payer: Nomi Health Commercial |
$1,286.93
|
| Rate for Payer: PACE SWMI |
$1,072.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,072.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.90
|
| Rate for Payer: Priority Health Medicare |
$1,083.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,072.44
|
| Rate for Payer: UHC Exchange |
$1,072.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,072.44
|
|
|
PR OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT
|
Professional
|
Both
|
$2,224.00
|
|
|
Service Code
|
HCPCS 28420
|
| Min. Negotiated Rate |
$889.60 |
| Max. Negotiated Rate |
$1,788.93 |
| Rate for Payer: Aetna Commercial |
$1,664.70
|
| Rate for Payer: Aetna Medicare |
$1,292.00
|
| Rate for Payer: BCBS Complete |
$889.60
|
| Rate for Payer: BCBS MAPPO |
$1,242.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,242.31
|
| Rate for Payer: Cash Price |
$1,779.20
|
| Rate for Payer: Cash Price |
$1,779.20
|
| Rate for Payer: Cofinity Commercial |
$1,788.93
|
| Rate for Payer: Cofinity Commercial |
$1,664.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,242.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,304.43
|
| Rate for Payer: Nomi Health Commercial |
$1,490.77
|
| Rate for Payer: PACE SWMI |
$1,242.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,242.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.60
|
| Rate for Payer: Priority Health Medicare |
$1,254.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,242.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,242.31
|
| Rate for Payer: UHC Exchange |
$1,242.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,242.31
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA
|
Professional
|
Both
|
$4,603.00
|
|
|
Service Code
|
HCPCS 27828
|
| Min. Negotiated Rate |
$1,266.86 |
| Max. Negotiated Rate |
$2,991.95 |
| Rate for Payer: Aetna Commercial |
$1,697.59
|
| Rate for Payer: Aetna Medicare |
$1,317.53
|
| Rate for Payer: BCBS Complete |
$1,841.20
|
| Rate for Payer: BCBS MAPPO |
$1,266.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.86
|
| Rate for Payer: Cash Price |
$3,682.40
|
| Rate for Payer: Cash Price |
$3,682.40
|
| Rate for Payer: Cofinity Commercial |
$1,824.28
|
| Rate for Payer: Cofinity Commercial |
$1,697.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,330.20
|
| Rate for Payer: Nomi Health Commercial |
$1,520.23
|
| Rate for Payer: PACE SWMI |
$1,266.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.95
|
| Rate for Payer: Priority Health Medicare |
$1,279.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,266.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,266.86
|
| Rate for Payer: UHC Exchange |
$1,266.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.86
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA
|
Professional
|
Both
|
$3,101.00
|
|
|
Service Code
|
HCPCS 27826
|
| Min. Negotiated Rate |
$813.21 |
| Max. Negotiated Rate |
$2,015.65 |
| Rate for Payer: Aetna Commercial |
$1,089.70
|
| Rate for Payer: Aetna Medicare |
$845.74
|
| Rate for Payer: BCBS Complete |
$1,240.40
|
| Rate for Payer: BCBS MAPPO |
$813.21
|
| Rate for Payer: BCN Medicare Advantage |
$813.21
|
| Rate for Payer: Cash Price |
$2,480.80
|
| Rate for Payer: Cash Price |
$2,480.80
|
| Rate for Payer: Cofinity Commercial |
$1,171.02
|
| Rate for Payer: Cofinity Commercial |
$1,089.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$853.87
|
| Rate for Payer: Nomi Health Commercial |
$975.85
|
| Rate for Payer: PACE SWMI |
$813.21
|
| Rate for Payer: PHP Medicare Advantage |
$813.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,015.65
|
| Rate for Payer: Priority Health Medicare |
$821.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$813.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.21
|
| Rate for Payer: UHC Exchange |
$813.21
|
| Rate for Payer: UHC Medicare Advantage |
$813.21
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY
|
Professional
|
Both
|
$4,362.00
|
|
|
Service Code
|
HCPCS 27827
|
| Min. Negotiated Rate |
$1,071.12 |
| Max. Negotiated Rate |
$2,835.30 |
| Rate for Payer: Aetna Commercial |
$1,435.30
|
| Rate for Payer: Aetna Medicare |
$1,113.96
|
| Rate for Payer: BCBS Complete |
$1,744.80
|
| Rate for Payer: BCBS MAPPO |
$1,071.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.12
|
| Rate for Payer: Cash Price |
$3,489.60
|
| Rate for Payer: Cash Price |
$3,489.60
|
| Rate for Payer: Cofinity Commercial |
$1,542.41
|
| Rate for Payer: Cofinity Commercial |
$1,435.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.68
|
| Rate for Payer: Nomi Health Commercial |
$1,285.34
|
| Rate for Payer: PACE SWMI |
$1,071.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,835.30
|
| Rate for Payer: Priority Health Medicare |
$1,081.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,071.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.12
|
| Rate for Payer: UHC Exchange |
$1,071.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.12
|
|
|
PR OPEN TREATMENT GREATER TROCHANTERIC FRACTURE
|
Professional
|
Both
|
$2,016.00
|
|
|
Service Code
|
HCPCS 27248
|
| Min. Negotiated Rate |
$719.01 |
| Max. Negotiated Rate |
$1,310.40 |
| Rate for Payer: Aetna Commercial |
$963.47
|
| Rate for Payer: Aetna Medicare |
$747.77
|
| Rate for Payer: BCBS Complete |
$806.40
|
| Rate for Payer: BCBS MAPPO |
$719.01
|
| Rate for Payer: BCN Medicare Advantage |
$719.01
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cofinity Commercial |
$963.47
|
| Rate for Payer: Cofinity Commercial |
$1,035.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.96
|
| Rate for Payer: Nomi Health Commercial |
$862.81
|
| Rate for Payer: PACE SWMI |
$719.01
|
| Rate for Payer: PHP Medicare Advantage |
$719.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.40
|
| Rate for Payer: Priority Health Medicare |
$726.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.01
|
| Rate for Payer: UHC Exchange |
$719.01
|
| Rate for Payer: UHC Medicare Advantage |
$719.01
|
|
|
PR OPEN TREATMENT HUMERAL CONDYLAR FRACTURE
|
Professional
|
Both
|
$2,858.00
|
|
|
Service Code
|
HCPCS 24579
|
| Min. Negotiated Rate |
$807.26 |
| Max. Negotiated Rate |
$1,857.70 |
| Rate for Payer: Aetna Commercial |
$1,081.73
|
| Rate for Payer: Aetna Medicare |
$839.55
|
| Rate for Payer: BCBS Complete |
$1,143.20
|
| Rate for Payer: BCBS MAPPO |
$807.26
|
| Rate for Payer: BCN Medicare Advantage |
$807.26
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Cofinity Commercial |
$1,162.45
|
| Rate for Payer: Cofinity Commercial |
$1,081.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$807.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$847.62
|
| Rate for Payer: Nomi Health Commercial |
$968.71
|
| Rate for Payer: PACE SWMI |
$807.26
|
| Rate for Payer: PHP Medicare Advantage |
$807.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,857.70
|
| Rate for Payer: Priority Health Medicare |
$815.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$807.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$807.26
|
| Rate for Payer: UHC Exchange |
$807.26
|
| Rate for Payer: UHC Medicare Advantage |
$807.26
|
|
|
PR OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$979.00
|
|
|
Service Code
|
HCPCS 28675
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$636.35 |
| Rate for Payer: Aetna Commercial |
$529.88
|
| Rate for Payer: Aetna Medicare |
$411.25
|
| Rate for Payer: BCBS Complete |
$391.60
|
| Rate for Payer: BCBS MAPPO |
$395.43
|
| Rate for Payer: BCN Medicare Advantage |
$395.43
|
| Rate for Payer: Cash Price |
$783.20
|
| Rate for Payer: Cash Price |
$783.20
|
| Rate for Payer: Cofinity Commercial |
$569.42
|
| Rate for Payer: Cofinity Commercial |
$529.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.20
|
| Rate for Payer: Nomi Health Commercial |
$474.52
|
| Rate for Payer: PACE SWMI |
$395.43
|
| Rate for Payer: PHP Medicare Advantage |
$395.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.35
|
| Rate for Payer: Priority Health Medicare |
$399.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.43
|
| Rate for Payer: UHC Exchange |
$395.43
|
| Rate for Payer: UHC Medicare Advantage |
$395.43
|
|
|
PR OPEN TREATMENT LUNATE DISLOCATION
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS 25695
|
| Min. Negotiated Rate |
$615.04 |
| Max. Negotiated Rate |
$1,237.60 |
| Rate for Payer: Aetna Commercial |
$824.15
|
| Rate for Payer: Aetna Medicare |
$639.64
|
| Rate for Payer: BCBS Complete |
$761.60
|
| Rate for Payer: BCBS MAPPO |
$615.04
|
| Rate for Payer: BCN Medicare Advantage |
$615.04
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cofinity Commercial |
$885.66
|
| Rate for Payer: Cofinity Commercial |
$824.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.79
|
| Rate for Payer: Nomi Health Commercial |
$738.05
|
| Rate for Payer: PACE SWMI |
$615.04
|
| Rate for Payer: PHP Medicare Advantage |
$615.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.60
|
| Rate for Payer: Priority Health Medicare |
$621.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$615.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.04
|
| Rate for Payer: UHC Exchange |
$615.04
|
| Rate for Payer: UHC Medicare Advantage |
$615.04
|
|
|
PR OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE
|
Professional
|
Both
|
$1,713.00
|
|
|
Service Code
|
HCPCS 21465
|
| Min. Negotiated Rate |
$685.20 |
| Max. Negotiated Rate |
$1,113.45 |
| Rate for Payer: Aetna Commercial |
$1,030.37
|
| Rate for Payer: Aetna Medicare |
$799.69
|
| Rate for Payer: BCBS Complete |
$685.20
|
| Rate for Payer: BCBS MAPPO |
$768.93
|
| Rate for Payer: BCN Medicare Advantage |
$768.93
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cofinity Commercial |
$1,107.26
|
| Rate for Payer: Cofinity Commercial |
$1,030.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$807.38
|
| Rate for Payer: Nomi Health Commercial |
$922.72
|
| Rate for Payer: PACE SWMI |
$768.93
|
| Rate for Payer: PHP Medicare Advantage |
$768.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.45
|
| Rate for Payer: Priority Health Medicare |
$776.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$768.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$768.93
|
| Rate for Payer: UHC Exchange |
$768.93
|
| Rate for Payer: UHC Medicare Advantage |
$768.93
|
|
|
PR OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 27766
|
| Min. Negotiated Rate |
$583.27 |
| Max. Negotiated Rate |
$1,417.65 |
| Rate for Payer: Aetna Commercial |
$781.58
|
| Rate for Payer: Aetna Medicare |
$606.60
|
| Rate for Payer: BCBS Complete |
$872.40
|
| Rate for Payer: BCBS MAPPO |
$583.27
|
| Rate for Payer: BCN Medicare Advantage |
$583.27
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cofinity Commercial |
$839.91
|
| Rate for Payer: Cofinity Commercial |
$781.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$612.43
|
| Rate for Payer: Nomi Health Commercial |
$699.92
|
| Rate for Payer: PACE SWMI |
$583.27
|
| Rate for Payer: PHP Medicare Advantage |
$583.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.65
|
| Rate for Payer: Priority Health Medicare |
$589.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$583.27
|
| Rate for Payer: UHC Exchange |
$583.27
|
| Rate for Payer: UHC Medicare Advantage |
$583.27
|
|
|
PR OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
HCPCS 26715
|
| Min. Negotiated Rate |
$555.11 |
| Max. Negotiated Rate |
$1,251.25 |
| Rate for Payer: Aetna Commercial |
$743.85
|
| Rate for Payer: Aetna Medicare |
$577.31
|
| Rate for Payer: BCBS Complete |
$770.00
|
| Rate for Payer: BCBS MAPPO |
$555.11
|
| Rate for Payer: BCN Medicare Advantage |
$555.11
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cofinity Commercial |
$799.36
|
| Rate for Payer: Cofinity Commercial |
$743.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.87
|
| Rate for Payer: Nomi Health Commercial |
$666.13
|
| Rate for Payer: PACE SWMI |
$555.11
|
| Rate for Payer: PHP Medicare Advantage |
$555.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.25
|
| Rate for Payer: Priority Health Medicare |
$560.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.11
|
| Rate for Payer: UHC Exchange |
$555.11
|
| Rate for Payer: UHC Medicare Advantage |
$555.11
|
|
|
PR OPEN TREATMENT METATARSAL FRACTURE EACH
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28485
|
| Min. Negotiated Rate |
$536.19 |
| Max. Negotiated Rate |
$874.90 |
| Rate for Payer: Aetna Commercial |
$718.49
|
| Rate for Payer: Aetna Medicare |
$557.64
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS MAPPO |
$536.19
|
| Rate for Payer: BCN Medicare Advantage |
$536.19
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$772.11
|
| Rate for Payer: Cofinity Commercial |
$718.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.00
|
| Rate for Payer: Nomi Health Commercial |
$643.43
|
| Rate for Payer: PACE SWMI |
$536.19
|
| Rate for Payer: PHP Medicare Advantage |
$536.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health Medicare |
$541.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$536.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.19
|
| Rate for Payer: UHC Exchange |
$536.19
|
| Rate for Payer: UHC Medicare Advantage |
$536.19
|
|
|
PR OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 21325
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$594.10 |
| Rate for Payer: Aetna Commercial |
$552.84
|
| Rate for Payer: Aetna Medicare |
$429.07
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: BCBS MAPPO |
$412.57
|
| Rate for Payer: BCN Medicare Advantage |
$412.57
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cofinity Commercial |
$594.10
|
| Rate for Payer: Cofinity Commercial |
$552.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.20
|
| Rate for Payer: Nomi Health Commercial |
$495.08
|
| Rate for Payer: PACE SWMI |
$412.57
|
| Rate for Payer: PHP Medicare Advantage |
$412.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health Medicare |
$416.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$412.57
|
| Rate for Payer: UHC Exchange |
$412.57
|
| Rate for Payer: UHC Medicare Advantage |
$412.57
|
|
|
PR OPEN TREATMENT PALATAL/MAXILLARY FRACTURE
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 21422
|
| Min. Negotiated Rate |
$537.20 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Aetna Commercial |
$804.95
|
| Rate for Payer: Aetna Medicare |
$624.74
|
| Rate for Payer: BCBS Complete |
$537.20
|
| Rate for Payer: BCBS MAPPO |
$600.71
|
| Rate for Payer: BCN Medicare Advantage |
$600.71
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$865.02
|
| Rate for Payer: Cofinity Commercial |
$804.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.75
|
| Rate for Payer: Nomi Health Commercial |
$720.85
|
| Rate for Payer: PACE SWMI |
$600.71
|
| Rate for Payer: PHP Medicare Advantage |
$600.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health Medicare |
$606.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$600.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.71
|
| Rate for Payer: UHC Exchange |
$600.71
|
| Rate for Payer: UHC Medicare Advantage |
$600.71
|
|
|
PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 27769
|
| Min. Negotiated Rate |
$518.80 |
| Max. Negotiated Rate |
$1,009.25 |
| Rate for Payer: Aetna Commercial |
$939.17
|
| Rate for Payer: Aetna Medicare |
$728.90
|
| Rate for Payer: BCBS Complete |
$518.80
|
| Rate for Payer: BCBS MAPPO |
$700.87
|
| Rate for Payer: BCN Medicare Advantage |
$700.87
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$939.17
|
| Rate for Payer: Cofinity Commercial |
$1,009.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.91
|
| Rate for Payer: Nomi Health Commercial |
$841.04
|
| Rate for Payer: PACE SWMI |
$700.87
|
| Rate for Payer: PHP Medicare Advantage |
$700.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health Medicare |
$707.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.87
|
| Rate for Payer: UHC Exchange |
$700.87
|
| Rate for Payer: UHC Medicare Advantage |
$700.87
|
|
|
PR OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 27784
|
| Min. Negotiated Rate |
$684.90 |
| Max. Negotiated Rate |
$1,480.70 |
| Rate for Payer: Aetna Commercial |
$917.77
|
| Rate for Payer: Aetna Medicare |
$712.30
|
| Rate for Payer: BCBS Complete |
$911.20
|
| Rate for Payer: BCBS MAPPO |
$684.90
|
| Rate for Payer: BCN Medicare Advantage |
$684.90
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cofinity Commercial |
$986.26
|
| Rate for Payer: Cofinity Commercial |
$917.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.14
|
| Rate for Payer: Nomi Health Commercial |
$821.88
|
| Rate for Payer: PACE SWMI |
$684.90
|
| Rate for Payer: PHP Medicare Advantage |
$684.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health Medicare |
$691.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.90
|
| Rate for Payer: UHC Exchange |
$684.90
|
| Rate for Payer: UHC Medicare Advantage |
$684.90
|
|
|
PR OPEN TREATMENT RADIAL SHAFT FRACTURE W/INT FIXJ
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 25515
|
| Min. Negotiated Rate |
$649.01 |
| Max. Negotiated Rate |
$1,340.95 |
| Rate for Payer: Aetna Commercial |
$869.67
|
| Rate for Payer: Aetna Medicare |
$674.97
|
| Rate for Payer: BCBS Complete |
$825.20
|
| Rate for Payer: BCBS MAPPO |
$649.01
|
| Rate for Payer: BCN Medicare Advantage |
$649.01
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$934.57
|
| Rate for Payer: Cofinity Commercial |
$869.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$681.46
|
| Rate for Payer: Nomi Health Commercial |
$778.81
|
| Rate for Payer: PACE SWMI |
$649.01
|
| Rate for Payer: PHP Medicare Advantage |
$649.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.95
|
| Rate for Payer: Priority Health Medicare |
$655.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$649.01
|
| Rate for Payer: UHC Exchange |
$649.01
|
| Rate for Payer: UHC Medicare Advantage |
$649.01
|
|
|
PR OPEN TREATMENT TALOTARSAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 28585
|
| Min. Negotiated Rate |
$685.67 |
| Max. Negotiated Rate |
$1,297.40 |
| Rate for Payer: Aetna Commercial |
$918.80
|
| Rate for Payer: Aetna Medicare |
$713.10
|
| Rate for Payer: BCBS Complete |
$798.40
|
| Rate for Payer: BCBS MAPPO |
$685.67
|
| Rate for Payer: BCN Medicare Advantage |
$685.67
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cofinity Commercial |
$987.36
|
| Rate for Payer: Cofinity Commercial |
$918.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.95
|
| Rate for Payer: Nomi Health Commercial |
$822.80
|
| Rate for Payer: PACE SWMI |
$685.67
|
| Rate for Payer: PHP Medicare Advantage |
$685.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.40
|
| Rate for Payer: Priority Health Medicare |
$692.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.67
|
| Rate for Payer: UHC Exchange |
$685.67
|
| Rate for Payer: UHC Medicare Advantage |
$685.67
|
|
|
PR OPEN TREATMENT TALUS FRACTURE
|
Professional
|
Both
|
$3,142.00
|
|
|
Service Code
|
HCPCS 28445
|
| Min. Negotiated Rate |
$1,005.36 |
| Max. Negotiated Rate |
$2,042.30 |
| Rate for Payer: Aetna Commercial |
$1,347.18
|
| Rate for Payer: Aetna Medicare |
$1,045.57
|
| Rate for Payer: BCBS Complete |
$1,256.80
|
| Rate for Payer: BCBS MAPPO |
$1,005.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.36
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cofinity Commercial |
$1,447.72
|
| Rate for Payer: Cofinity Commercial |
$1,347.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,055.63
|
| Rate for Payer: Nomi Health Commercial |
$1,206.43
|
| Rate for Payer: PACE SWMI |
$1,005.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,042.30
|
| Rate for Payer: Priority Health Medicare |
$1,015.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,005.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,005.36
|
| Rate for Payer: UHC Exchange |
$1,005.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,005.36
|
|
|
PR OPEN TREATMENT TARSAL BONE DISLOCATION
|
Professional
|
Both
|
$1,728.00
|
|
|
Service Code
|
HCPCS 28555
|
| Min. Negotiated Rate |
$624.71 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$837.11
|
| Rate for Payer: Aetna Medicare |
$649.70
|
| Rate for Payer: BCBS Complete |
$691.20
|
| Rate for Payer: BCBS MAPPO |
$624.71
|
| Rate for Payer: BCN Medicare Advantage |
$624.71
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cofinity Commercial |
$899.58
|
| Rate for Payer: Cofinity Commercial |
$837.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.95
|
| Rate for Payer: Nomi Health Commercial |
$749.65
|
| Rate for Payer: PACE SWMI |
$624.71
|
| Rate for Payer: PHP Medicare Advantage |
$624.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.20
|
| Rate for Payer: Priority Health Medicare |
$630.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.71
|
| Rate for Payer: UHC Exchange |
$624.71
|
| Rate for Payer: UHC Medicare Advantage |
$624.71
|
|
|
PR OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,795.00
|
|
|
Service Code
|
HCPCS 28615
|
| Min. Negotiated Rate |
$718.00 |
| Max. Negotiated Rate |
$1,166.75 |
| Rate for Payer: Aetna Commercial |
$1,058.81
|
| Rate for Payer: Aetna Medicare |
$821.77
|
| Rate for Payer: BCBS Complete |
$718.00
|
| Rate for Payer: BCBS MAPPO |
$790.16
|
| Rate for Payer: BCN Medicare Advantage |
$790.16
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Cofinity Commercial |
$1,137.83
|
| Rate for Payer: Cofinity Commercial |
$1,058.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$829.67
|
| Rate for Payer: Nomi Health Commercial |
$948.19
|
| Rate for Payer: PACE SWMI |
$790.16
|
| Rate for Payer: PHP Medicare Advantage |
$790.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,166.75
|
| Rate for Payer: Priority Health Medicare |
$798.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$790.16
|
| Rate for Payer: UHC Exchange |
$790.16
|
| Rate for Payer: UHC Medicare Advantage |
$790.16
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Professional
|
Both
|
$2,343.00
|
|
|
Service Code
|
HCPCS 24685
|
| Min. Negotiated Rate |
$631.56 |
| Max. Negotiated Rate |
$1,522.95 |
| Rate for Payer: Aetna Commercial |
$846.29
|
| Rate for Payer: Aetna Medicare |
$656.82
|
| Rate for Payer: BCBS Complete |
$937.20
|
| Rate for Payer: BCBS MAPPO |
$631.56
|
| Rate for Payer: BCN Medicare Advantage |
$631.56
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cofinity Commercial |
$909.45
|
| Rate for Payer: Cofinity Commercial |
$846.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$631.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$663.14
|
| Rate for Payer: Nomi Health Commercial |
$757.87
|
| Rate for Payer: PACE SWMI |
$631.56
|
| Rate for Payer: PHP Medicare Advantage |
$631.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.95
|
| Rate for Payer: Priority Health Medicare |
$637.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$631.56
|
| Rate for Payer: UHC Exchange |
$631.56
|
| Rate for Payer: UHC Medicare Advantage |
$631.56
|
|
