|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Facility
|
IP
|
$2,343.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
24685
|
| Min. Negotiated Rate |
$1,522.95 |
| Max. Negotiated Rate |
$2,108.70 |
| Rate for Payer: Aetna Commercial |
$1,991.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,912.59
|
| Rate for Payer: BCN Commercial |
$1,810.67
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cofinity Commercial |
$2,014.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.40
|
| Rate for Payer: Healthscope Commercial |
$2,108.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.55
|
| Rate for Payer: Nomi Health Commercial |
$1,921.26
|
| Rate for Payer: PHP Commercial |
$1,991.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,038.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,569.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,061.84
|
| Rate for Payer: UHC Core |
$1,956.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.25
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Facility
|
OP
|
$2,343.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
24685
|
| Min. Negotiated Rate |
$556.46 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$1,991.55
|
| Rate for Payer: Aetna Medicare |
$609.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$732.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$732.19
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$585.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.18
|
| Rate for Payer: BCN Commercial |
$1,821.68
|
| Rate for Payer: BCN Medicare Advantage |
$585.75
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cash Price |
$1,874.40
|
| Rate for Payer: Cofinity Commercial |
$2,014.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,874.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.75
|
| Rate for Payer: Healthscope Commercial |
$2,108.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.25
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.04
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$673.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.55
|
| Rate for Payer: Nomi Health Commercial |
$1,921.26
|
| Rate for Payer: PACE Senior Care Partners |
$556.46
|
| Rate for Payer: PACE SWMI |
$585.75
|
| Rate for Payer: PHP Commercial |
$1,991.55
|
| Rate for Payer: PHP Medicare Advantage |
$585.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,038.41
|
| Rate for Payer: Priority Health Medicare |
$591.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,569.81
|
| Rate for Payer: Railroad Medicare Medicare |
$585.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,061.84
|
| Rate for Payer: UHC Core |
$1,956.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$585.75
|
| Rate for Payer: UHC Exchange |
$585.75
|
| Rate for Payer: UHC Medicare Advantage |
$585.75
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$585.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.25
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Professional
|
Both
|
$2,343.00
|
|
|
Service Code
|
HCPCS 24685
|
| Hospital Charge Code |
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
|
|
|
PR OPEN TREATMENT ULNAR SHAFT FRACTURE W/INT FIXJ
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25545
|
| Min. Negotiated Rate |
$605.31 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$811.12
|
| Rate for Payer: Aetna Medicare |
$629.52
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$605.31
|
| Rate for Payer: BCN Medicare Advantage |
$605.31
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$871.65
|
| Rate for Payer: Cofinity Commercial |
$811.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$635.58
|
| Rate for Payer: Nomi Health Commercial |
$726.37
|
| Rate for Payer: PACE SWMI |
$605.31
|
| Rate for Payer: PHP Medicare Advantage |
$605.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$611.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.31
|
| Rate for Payer: UHC Exchange |
$605.31
|
| Rate for Payer: UHC Medicare Advantage |
$605.31
|
|
|
PR OPEN TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 25652
|
| Min. Negotiated Rate |
$604.86 |
| Max. Negotiated Rate |
$1,083.55 |
| Rate for Payer: Aetna Commercial |
$810.51
|
| Rate for Payer: Aetna Medicare |
$629.05
|
| Rate for Payer: BCBS Complete |
$666.80
|
| Rate for Payer: BCBS MAPPO |
$604.86
|
| Rate for Payer: BCN Medicare Advantage |
$604.86
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cofinity Commercial |
$810.51
|
| Rate for Payer: Cofinity Commercial |
$871.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$635.10
|
| Rate for Payer: Nomi Health Commercial |
$725.83
|
| Rate for Payer: PACE SWMI |
$604.86
|
| Rate for Payer: PHP Medicare Advantage |
$604.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.55
|
| Rate for Payer: Priority Health Medicare |
$610.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.86
|
| Rate for Payer: UHC Exchange |
$604.86
|
| Rate for Payer: UHC Medicare Advantage |
$604.86
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 1-2 RIBS
|
Professional
|
Both
|
$3,348.00
|
|
|
Service Code
|
HCPCS 0245T
|
| Min. Negotiated Rate |
$1,339.20 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Aetna Medicare |
$1,674.00
|
| Rate for Payer: BCBS Complete |
$1,339.20
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.20
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 3-4 RIBS
|
Professional
|
Both
|
$3,689.00
|
|
|
Service Code
|
HCPCS 0246T
|
| Min. Negotiated Rate |
$1,475.60 |
| Max. Negotiated Rate |
$2,397.85 |
| Rate for Payer: Aetna Medicare |
$1,844.50
|
| Rate for Payer: BCBS Complete |
$1,475.60
|
| Rate for Payer: Cash Price |
$2,951.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,397.85
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 5-6 RIBS
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 0247T
|
| Min. Negotiated Rate |
$1,632.00 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Aetna Medicare |
$2,040.00
|
| Rate for Payer: BCBS Complete |
$1,632.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 7+ RIBS
|
Professional
|
Both
|
$4,709.00
|
|
|
Service Code
|
HCPCS 0248T
|
| Min. Negotiated Rate |
$1,883.60 |
| Max. Negotiated Rate |
$3,060.85 |
| Rate for Payer: Aetna Medicare |
$2,354.50
|
| Rate for Payer: BCBS Complete |
$1,883.60
|
| Rate for Payer: Cash Price |
$3,767.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,060.85
|
|
|
PR OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,743.00
|
|
|
Service Code
|
HCPCS 23550
|
| Min. Negotiated Rate |
$552.64 |
| Max. Negotiated Rate |
$1,782.95 |
| Rate for Payer: Aetna Commercial |
$740.54
|
| Rate for Payer: Aetna Medicare |
$574.75
|
| Rate for Payer: BCBS Complete |
$1,097.20
|
| Rate for Payer: BCBS MAPPO |
$552.64
|
| Rate for Payer: BCN Medicare Advantage |
$552.64
|
| Rate for Payer: Cash Price |
$2,194.40
|
| Rate for Payer: Cash Price |
$2,194.40
|
| Rate for Payer: Cofinity Commercial |
$795.80
|
| Rate for Payer: Cofinity Commercial |
$740.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.27
|
| Rate for Payer: Nomi Health Commercial |
$663.17
|
| Rate for Payer: PACE SWMI |
$552.64
|
| Rate for Payer: PHP Medicare Advantage |
$552.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,782.95
|
| Rate for Payer: Priority Health Medicare |
$558.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.64
|
| Rate for Payer: UHC Exchange |
$552.64
|
| Rate for Payer: UHC Medicare Advantage |
$552.64
|
|
|
PR OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 24615
|
| Min. Negotiated Rate |
$690.17 |
| Max. Negotiated Rate |
$1,675.05 |
| Rate for Payer: Aetna Commercial |
$924.83
|
| Rate for Payer: Aetna Medicare |
$717.78
|
| Rate for Payer: BCBS Complete |
$1,030.80
|
| Rate for Payer: BCBS MAPPO |
$690.17
|
| Rate for Payer: BCN Medicare Advantage |
$690.17
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cofinity Commercial |
$924.83
|
| Rate for Payer: Cofinity Commercial |
$993.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.68
|
| Rate for Payer: Nomi Health Commercial |
$828.20
|
| Rate for Payer: PACE SWMI |
$690.17
|
| Rate for Payer: PHP Medicare Advantage |
$690.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.05
|
| Rate for Payer: Priority Health Medicare |
$697.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$690.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$690.17
|
| Rate for Payer: UHC Exchange |
$690.17
|
| Rate for Payer: UHC Medicare Advantage |
$690.17
|
|
|
PR OPEN TX ACUTE SHOULDER DISLOCATION
|
Professional
|
Both
|
$2,720.00
|
|
|
Service Code
|
HCPCS 23660
|
| Min. Negotiated Rate |
$566.24 |
| Max. Negotiated Rate |
$1,768.00 |
| Rate for Payer: Aetna Commercial |
$758.76
|
| Rate for Payer: Aetna Medicare |
$588.89
|
| Rate for Payer: BCBS Complete |
$1,088.00
|
| Rate for Payer: BCBS MAPPO |
$566.24
|
| Rate for Payer: BCN Medicare Advantage |
$566.24
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cofinity Commercial |
$815.39
|
| Rate for Payer: Cofinity Commercial |
$758.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$594.55
|
| Rate for Payer: Nomi Health Commercial |
$679.49
|
| Rate for Payer: PACE SWMI |
$566.24
|
| Rate for Payer: PHP Medicare Advantage |
$566.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.00
|
| Rate for Payer: Priority Health Medicare |
$571.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$566.24
|
| Rate for Payer: UHC Exchange |
$566.24
|
| Rate for Payer: UHC Medicare Advantage |
$566.24
|
|
|
PR OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA
|
Professional
|
Both
|
$2,530.00
|
|
|
Service Code
|
HCPCS 26746
|
| Min. Negotiated Rate |
$716.55 |
| Max. Negotiated Rate |
$1,644.50 |
| Rate for Payer: Aetna Commercial |
$960.18
|
| Rate for Payer: Aetna Medicare |
$745.21
|
| Rate for Payer: BCBS Complete |
$1,012.00
|
| Rate for Payer: BCBS MAPPO |
$716.55
|
| Rate for Payer: BCN Medicare Advantage |
$716.55
|
| Rate for Payer: Cash Price |
$2,024.00
|
| Rate for Payer: Cash Price |
$2,024.00
|
| Rate for Payer: Cofinity Commercial |
$960.18
|
| Rate for Payer: Cofinity Commercial |
$1,031.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.38
|
| Rate for Payer: Nomi Health Commercial |
$859.86
|
| Rate for Payer: PACE SWMI |
$716.55
|
| Rate for Payer: PHP Medicare Advantage |
$716.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,644.50
|
| Rate for Payer: Priority Health Medicare |
$723.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.55
|
| Rate for Payer: UHC Exchange |
$716.55
|
| Rate for Payer: UHC Medicare Advantage |
$716.55
|
|
|
PR OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA
|
Professional
|
Both
|
$1,508.00
|
|
|
Service Code
|
HCPCS 25645
|
| Min. Negotiated Rate |
$554.35 |
| Max. Negotiated Rate |
$980.20 |
| Rate for Payer: Aetna Commercial |
$742.83
|
| Rate for Payer: Aetna Medicare |
$576.52
|
| Rate for Payer: BCBS Complete |
$603.20
|
| Rate for Payer: BCBS MAPPO |
$554.35
|
| Rate for Payer: BCN Medicare Advantage |
$554.35
|
| Rate for Payer: Cash Price |
$1,206.40
|
| Rate for Payer: Cash Price |
$1,206.40
|
| Rate for Payer: Cofinity Commercial |
$798.26
|
| Rate for Payer: Cofinity Commercial |
$742.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.07
|
| Rate for Payer: Nomi Health Commercial |
$665.22
|
| Rate for Payer: PACE SWMI |
$554.35
|
| Rate for Payer: PHP Medicare Advantage |
$554.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.20
|
| Rate for Payer: Priority Health Medicare |
$559.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.35
|
| Rate for Payer: UHC Exchange |
$554.35
|
| Rate for Payer: UHC Medicare Advantage |
$554.35
|
|
|
PR OPEN TX CARPAL SCAPHOID NAVICULAR FX W/INT FIXJ
|
Professional
|
Both
|
$2,024.00
|
|
|
Service Code
|
HCPCS 25628
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$932.37
|
| Rate for Payer: Aetna Medicare |
$723.63
|
| Rate for Payer: BCBS Complete |
$809.60
|
| Rate for Payer: BCBS MAPPO |
$695.80
|
| Rate for Payer: BCN Medicare Advantage |
$695.80
|
| Rate for Payer: Cash Price |
$1,619.20
|
| Rate for Payer: Cash Price |
$1,619.20
|
| Rate for Payer: Cofinity Commercial |
$932.37
|
| Rate for Payer: Cofinity Commercial |
$1,001.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.59
|
| Rate for Payer: Nomi Health Commercial |
$834.96
|
| Rate for Payer: PACE SWMI |
$695.80
|
| Rate for Payer: PHP Medicare Advantage |
$695.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,315.60
|
| Rate for Payer: Priority Health Medicare |
$702.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.80
|
| Rate for Payer: UHC Exchange |
$695.80
|
| Rate for Payer: UHC Medicare Advantage |
$695.80
|
|
|
PR OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB
|
Professional
|
Both
|
$2,255.00
|
|
|
Service Code
|
HCPCS 26685
|
| Min. Negotiated Rate |
$557.66 |
| Max. Negotiated Rate |
$1,465.75 |
| Rate for Payer: Aetna Commercial |
$747.26
|
| Rate for Payer: Aetna Medicare |
$579.97
|
| Rate for Payer: BCBS Complete |
$902.00
|
| Rate for Payer: BCBS MAPPO |
$557.66
|
| Rate for Payer: BCN Medicare Advantage |
$557.66
|
| Rate for Payer: Cash Price |
$1,804.00
|
| Rate for Payer: Cash Price |
$1,804.00
|
| Rate for Payer: Cofinity Commercial |
$803.03
|
| Rate for Payer: Cofinity Commercial |
$747.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.54
|
| Rate for Payer: Nomi Health Commercial |
$669.19
|
| Rate for Payer: PACE SWMI |
$557.66
|
| Rate for Payer: PHP Medicare Advantage |
$557.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.75
|
| Rate for Payer: Priority Health Medicare |
$563.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.66
|
| Rate for Payer: UHC Exchange |
$557.66
|
| Rate for Payer: UHC Medicare Advantage |
$557.66
|
|
|
PR OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB
|
Professional
|
Both
|
$2,888.00
|
|
|
Service Code
|
HCPCS 26665
|
| Min. Negotiated Rate |
$606.14 |
| Max. Negotiated Rate |
$1,877.20 |
| Rate for Payer: Aetna Commercial |
$812.23
|
| Rate for Payer: Aetna Medicare |
$630.39
|
| Rate for Payer: BCBS Complete |
$1,155.20
|
| Rate for Payer: BCBS MAPPO |
$606.14
|
| Rate for Payer: BCN Medicare Advantage |
$606.14
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cofinity Commercial |
$872.84
|
| Rate for Payer: Cofinity Commercial |
$812.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.45
|
| Rate for Payer: Nomi Health Commercial |
$727.37
|
| Rate for Payer: PACE SWMI |
$606.14
|
| Rate for Payer: PHP Medicare Advantage |
$606.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,877.20
|
| Rate for Payer: Priority Health Medicare |
$612.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.14
|
| Rate for Payer: UHC Exchange |
$606.14
|
| Rate for Payer: UHC Medicare Advantage |
$606.14
|
|
|
PR OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION
|
Professional
|
Both
|
$2,455.00
|
|
|
Service Code
|
HCPCS 23515
|
| Min. Negotiated Rate |
$695.61 |
| Max. Negotiated Rate |
$1,595.75 |
| Rate for Payer: Aetna Commercial |
$932.12
|
| Rate for Payer: Aetna Medicare |
$723.43
|
| Rate for Payer: BCBS Complete |
$982.00
|
| Rate for Payer: BCBS MAPPO |
$695.61
|
| Rate for Payer: BCN Medicare Advantage |
$695.61
|
| Rate for Payer: Cash Price |
$1,964.00
|
| Rate for Payer: Cash Price |
$1,964.00
|
| Rate for Payer: Cofinity Commercial |
$932.12
|
| Rate for Payer: Cofinity Commercial |
$1,001.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.39
|
| Rate for Payer: Nomi Health Commercial |
$834.73
|
| Rate for Payer: PACE SWMI |
$695.61
|
| Rate for Payer: PHP Medicare Advantage |
$695.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,595.75
|
| Rate for Payer: Priority Health Medicare |
$702.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.61
|
| Rate for Payer: UHC Exchange |
$695.61
|
| Rate for Payer: UHC Medicare Advantage |
$695.61
|
|
|
PR OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG
|
Professional
|
Both
|
$2,018.00
|
|
|
Service Code
|
HCPCS 21365
|
| Min. Negotiated Rate |
$807.20 |
| Max. Negotiated Rate |
$1,490.82 |
| Rate for Payer: Aetna Commercial |
$1,387.29
|
| Rate for Payer: Aetna Medicare |
$1,076.70
|
| Rate for Payer: BCBS Complete |
$807.20
|
| Rate for Payer: BCBS MAPPO |
$1,035.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.29
|
| Rate for Payer: Cash Price |
$1,614.40
|
| Rate for Payer: Cash Price |
$1,614.40
|
| Rate for Payer: Cofinity Commercial |
$1,490.82
|
| Rate for Payer: Cofinity Commercial |
$1,387.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,035.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,087.05
|
| Rate for Payer: Nomi Health Commercial |
$1,242.35
|
| Rate for Payer: PACE SWMI |
$1,035.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,035.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,311.70
|
| Rate for Payer: Priority Health Medicare |
$1,045.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,035.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,035.29
|
| Rate for Payer: UHC Exchange |
$1,035.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,035.29
|
|
|
PR OPEN TX COMPLICATED FRONTAL SINUS FRACTURE
|
Professional
|
Both
|
$3,475.00
|
|
|
Service Code
|
HCPCS 21344
|
| Min. Negotiated Rate |
$1,324.03 |
| Max. Negotiated Rate |
$2,258.75 |
| Rate for Payer: Aetna Commercial |
$1,774.20
|
| Rate for Payer: Aetna Medicare |
$1,376.99
|
| Rate for Payer: BCBS Complete |
$1,390.00
|
| Rate for Payer: BCBS MAPPO |
$1,324.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,324.03
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cofinity Commercial |
$1,906.60
|
| Rate for Payer: Cofinity Commercial |
$1,774.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,324.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,390.23
|
| Rate for Payer: Nomi Health Commercial |
$1,588.84
|
| Rate for Payer: PACE SWMI |
$1,324.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,324.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,258.75
|
| Rate for Payer: Priority Health Medicare |
$1,337.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,324.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,324.03
|
| Rate for Payer: UHC Exchange |
$1,324.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,324.03
|
|
|
PR OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR
|
Professional
|
Both
|
$3,013.00
|
|
|
Service Code
|
HCPCS 21433
|
| Min. Negotiated Rate |
$1,205.20 |
| Max. Negotiated Rate |
$2,388.36 |
| Rate for Payer: Aetna Commercial |
$2,222.50
|
| Rate for Payer: Aetna Medicare |
$1,724.92
|
| Rate for Payer: BCBS Complete |
$1,205.20
|
| Rate for Payer: BCBS MAPPO |
$1,658.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,658.58
|
| Rate for Payer: Cash Price |
$2,410.40
|
| Rate for Payer: Cash Price |
$2,410.40
|
| Rate for Payer: Cofinity Commercial |
$2,388.36
|
| Rate for Payer: Cofinity Commercial |
$2,222.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,658.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,741.51
|
| Rate for Payer: Nomi Health Commercial |
$1,990.30
|
| Rate for Payer: PACE SWMI |
$1,658.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,658.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,958.45
|
| Rate for Payer: Priority Health Medicare |
$1,675.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,658.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,658.58
|
| Rate for Payer: UHC Exchange |
$1,658.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,658.58
|
|
|
PR OPEN TX DEPRESSED FRONTAL SINUS FRACTURE
|
Professional
|
Both
|
$2,453.00
|
|
|
Service Code
|
HCPCS 21343
|
| Min. Negotiated Rate |
$981.20 |
| Max. Negotiated Rate |
$1,594.45 |
| Rate for Payer: Aetna Commercial |
$1,374.30
|
| Rate for Payer: Aetna Medicare |
$1,066.62
|
| Rate for Payer: BCBS Complete |
$981.20
|
| Rate for Payer: BCBS MAPPO |
$1,025.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,962.40
|
| Rate for Payer: Cash Price |
$1,962.40
|
| Rate for Payer: Cofinity Commercial |
$1,476.86
|
| Rate for Payer: Cofinity Commercial |
$1,374.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,076.88
|
| Rate for Payer: Nomi Health Commercial |
$1,230.72
|
| Rate for Payer: PACE SWMI |
$1,025.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,594.45
|
| Rate for Payer: Priority Health Medicare |
$1,035.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,025.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,025.60
|
| Rate for Payer: UHC Exchange |
$1,025.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.60
|
|
|
PR OPEN TX DEPRESSED MALAR FRACTURE
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 21360
|
| Min. Negotiated Rate |
$414.80 |
| Max. Negotiated Rate |
$720.16 |
| Rate for Payer: Aetna Commercial |
$670.15
|
| Rate for Payer: Aetna Medicare |
$520.11
|
| Rate for Payer: BCBS Complete |
$414.80
|
| Rate for Payer: BCBS MAPPO |
$500.11
|
| Rate for Payer: BCN Medicare Advantage |
$500.11
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cofinity Commercial |
$720.16
|
| Rate for Payer: Cofinity Commercial |
$670.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.12
|
| Rate for Payer: Nomi Health Commercial |
$600.13
|
| Rate for Payer: PACE SWMI |
$500.11
|
| Rate for Payer: PHP Medicare Advantage |
$500.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.05
|
| Rate for Payer: Priority Health Medicare |
$505.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$500.11
|
| Rate for Payer: UHC Exchange |
$500.11
|
| Rate for Payer: UHC Medicare Advantage |
$500.11
|
|
|
PR OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE
|
Professional
|
Both
|
$824.00
|
|
|
Service Code
|
HCPCS 21356
|
| Min. Negotiated Rate |
$329.60 |
| Max. Negotiated Rate |
$551.85 |
| Rate for Payer: Aetna Commercial |
$513.53
|
| Rate for Payer: Aetna Medicare |
$398.56
|
| Rate for Payer: BCBS Complete |
$329.60
|
| Rate for Payer: BCBS MAPPO |
$383.23
|
| Rate for Payer: BCN Medicare Advantage |
$383.23
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cofinity Commercial |
$551.85
|
| Rate for Payer: Cofinity Commercial |
$513.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$402.39
|
| Rate for Payer: Nomi Health Commercial |
$459.88
|
| Rate for Payer: PACE SWMI |
$383.23
|
| Rate for Payer: PHP Medicare Advantage |
$383.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.60
|
| Rate for Payer: Priority Health Medicare |
$387.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$383.23
|
| Rate for Payer: UHC Exchange |
$383.23
|
| Rate for Payer: UHC Medicare Advantage |
$383.23
|
|
|
PR OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 27792
|
| Hospital Charge Code |
27792
|
| Min. Negotiated Rate |
$1,606.15 |
| Max. Negotiated Rate |
$2,223.90 |
| Rate for Payer: Aetna Commercial |
$2,100.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,017.08
|
| Rate for Payer: BCN Commercial |
$1,909.59
|
| Rate for Payer: Cash Price |
$1,976.80
|
| Rate for Payer: Cofinity Commercial |
$2,125.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,976.80
|
| Rate for Payer: Healthscope Commercial |
$2,223.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,853.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,100.35
|
| Rate for Payer: Nomi Health Commercial |
$2,026.22
|
| Rate for Payer: PHP Commercial |
$2,100.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,606.15
|
| Rate for Payer: Priority Health HMO/PPO |
$2,149.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,655.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,174.48
|
| Rate for Payer: UHC Core |
$2,063.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,853.25
|
|
