|
PR OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23630
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$1,087.13 |
| Rate for Payer: Aetna Commercial |
$1,011.63
|
| Rate for Payer: Aetna Medicare |
$785.15
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$754.95
|
| Rate for Payer: BCN Medicare Advantage |
$754.95
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$1,087.13
|
| Rate for Payer: Cofinity Commercial |
$1,011.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$754.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$792.70
|
| Rate for Payer: Nomi Health Commercial |
$905.94
|
| Rate for Payer: PACE SWMI |
$754.95
|
| Rate for Payer: PHP Medicare Advantage |
$754.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$762.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$754.95
|
| Rate for Payer: UHC Exchange |
$754.95
|
| Rate for Payer: UHC Medicare Advantage |
$754.95
|
|
|
PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD
|
Professional
|
Both
|
$3,546.00
|
|
|
Service Code
|
HCPCS 27254
|
| Min. Negotiated Rate |
$1,224.39 |
| Max. Negotiated Rate |
$2,304.90 |
| Rate for Payer: Aetna Commercial |
$1,640.68
|
| Rate for Payer: Aetna Medicare |
$1,273.37
|
| Rate for Payer: BCBS Complete |
$1,418.40
|
| Rate for Payer: BCBS MAPPO |
$1,224.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,224.39
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cofinity Commercial |
$1,763.12
|
| Rate for Payer: Cofinity Commercial |
$1,640.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,224.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,285.61
|
| Rate for Payer: Nomi Health Commercial |
$1,469.27
|
| Rate for Payer: PACE SWMI |
$1,224.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,224.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.90
|
| Rate for Payer: Priority Health Medicare |
$1,236.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,224.39
|
| Rate for Payer: UHC Exchange |
$1,224.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,224.39
|
|
|
PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27253
|
| Min. Negotiated Rate |
$906.31 |
| Max. Negotiated Rate |
$1,528.15 |
| Rate for Payer: Aetna Commercial |
$1,214.46
|
| Rate for Payer: Aetna Medicare |
$942.56
|
| Rate for Payer: BCBS Complete |
$940.40
|
| Rate for Payer: BCBS MAPPO |
$906.31
|
| Rate for Payer: BCN Medicare Advantage |
$906.31
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cofinity Commercial |
$1,305.09
|
| Rate for Payer: Cofinity Commercial |
$1,214.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$906.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$951.63
|
| Rate for Payer: Nomi Health Commercial |
$1,087.57
|
| Rate for Payer: PACE SWMI |
$906.31
|
| Rate for Payer: PHP Medicare Advantage |
$906.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health Medicare |
$915.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$906.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$906.31
|
| Rate for Payer: UHC Exchange |
$906.31
|
| Rate for Payer: UHC Medicare Advantage |
$906.31
|
|
|
PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$3,092.00
|
|
|
Service Code
|
HCPCS 24515
|
| Min. Negotiated Rate |
$849.17 |
| Max. Negotiated Rate |
$2,009.80 |
| Rate for Payer: Aetna Commercial |
$1,137.89
|
| Rate for Payer: Aetna Medicare |
$883.14
|
| Rate for Payer: BCBS Complete |
$1,236.80
|
| Rate for Payer: BCBS MAPPO |
$849.17
|
| Rate for Payer: BCN Medicare Advantage |
$849.17
|
| Rate for Payer: Cash Price |
$2,473.60
|
| Rate for Payer: Cash Price |
$2,473.60
|
| Rate for Payer: Cofinity Commercial |
$1,222.80
|
| Rate for Payer: Cofinity Commercial |
$1,137.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.63
|
| Rate for Payer: Nomi Health Commercial |
$1,019.00
|
| Rate for Payer: PACE SWMI |
$849.17
|
| Rate for Payer: PHP Medicare Advantage |
$849.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.80
|
| Rate for Payer: Priority Health Medicare |
$857.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.17
|
| Rate for Payer: UHC Exchange |
$849.17
|
| Rate for Payer: UHC Medicare Advantage |
$849.17
|
|
|
PR OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS 27215
|
| Min. Negotiated Rate |
$1,053.60 |
| Max. Negotiated Rate |
$1,712.10 |
| Rate for Payer: Aetna Medicare |
$1,317.00
|
| Rate for Payer: BCBS Complete |
$1,053.60
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.10
|
|
|
PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN
|
Professional
|
Both
|
$2,054.00
|
|
|
Service Code
|
HCPCS 21347
|
| Min. Negotiated Rate |
$821.60 |
| Max. Negotiated Rate |
$1,410.72 |
| Rate for Payer: Aetna Commercial |
$1,312.76
|
| Rate for Payer: Aetna Medicare |
$1,018.86
|
| Rate for Payer: BCBS Complete |
$821.60
|
| Rate for Payer: BCBS MAPPO |
$979.67
|
| Rate for Payer: BCN Medicare Advantage |
$979.67
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Cofinity Commercial |
$1,410.72
|
| Rate for Payer: Cofinity Commercial |
$1,312.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.65
|
| Rate for Payer: Nomi Health Commercial |
$1,175.60
|
| Rate for Payer: PACE SWMI |
$979.67
|
| Rate for Payer: PHP Medicare Advantage |
$979.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.10
|
| Rate for Payer: Priority Health Medicare |
$989.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.67
|
| Rate for Payer: UHC Exchange |
$979.67
|
| Rate for Payer: UHC Medicare Advantage |
$979.67
|
|
|
PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 21390
|
| Min. Negotiated Rate |
$645.20 |
| Max. Negotiated Rate |
$1,088.16 |
| Rate for Payer: Aetna Commercial |
$1,012.60
|
| Rate for Payer: Aetna Medicare |
$785.90
|
| Rate for Payer: BCBS Complete |
$645.20
|
| Rate for Payer: BCBS MAPPO |
$755.67
|
| Rate for Payer: BCN Medicare Advantage |
$755.67
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cofinity Commercial |
$1,088.16
|
| Rate for Payer: Cofinity Commercial |
$1,012.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$755.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$793.45
|
| Rate for Payer: Nomi Health Commercial |
$906.80
|
| Rate for Payer: PACE SWMI |
$755.67
|
| Rate for Payer: PHP Medicare Advantage |
$755.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,048.45
|
| Rate for Payer: Priority Health Medicare |
$763.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$755.67
|
| Rate for Payer: UHC Exchange |
$755.67
|
| Rate for Payer: UHC Medicare Advantage |
$755.67
|
|
|
PR OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
HCPCS 27566
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: Aetna Commercial |
$1,155.75
|
| Rate for Payer: Aetna Medicare |
$897.00
|
| Rate for Payer: BCBS Complete |
$638.00
|
| Rate for Payer: BCBS MAPPO |
$862.50
|
| Rate for Payer: BCN Medicare Advantage |
$862.50
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cofinity Commercial |
$1,242.00
|
| Rate for Payer: Cofinity Commercial |
$1,155.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.62
|
| Rate for Payer: Nomi Health Commercial |
$1,035.00
|
| Rate for Payer: PACE SWMI |
$862.50
|
| Rate for Payer: PHP Medicare Advantage |
$862.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,036.75
|
| Rate for Payer: Priority Health Medicare |
$871.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$862.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.50
|
| Rate for Payer: UHC Exchange |
$862.50
|
| Rate for Payer: UHC Medicare Advantage |
$862.50
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 27524
|
| Min. Negotiated Rate |
$728.06 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Medicare |
$757.18
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$728.06
|
| Rate for Payer: BCN Medicare Advantage |
$728.06
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$975.60
|
| Rate for Payer: Cofinity Commercial |
$1,048.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.46
|
| Rate for Payer: Nomi Health Commercial |
$873.67
|
| Rate for Payer: PACE SWMI |
$728.06
|
| Rate for Payer: PHP Medicare Advantage |
$728.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$735.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Exchange |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Facility
|
IP
|
$2,509.00
|
|
|
Service Code
|
CPT 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$1,630.85 |
| Max. Negotiated Rate |
$2,258.10 |
| Rate for Payer: Aetna Commercial |
$2,132.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.10
|
| Rate for Payer: BCN Commercial |
$1,938.96
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$2,157.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.20
|
| Rate for Payer: Healthscope Commercial |
$2,258.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,881.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.65
|
| Rate for Payer: Nomi Health Commercial |
$2,057.38
|
| Rate for Payer: PHP Commercial |
$2,132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,182.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,681.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,207.92
|
| Rate for Payer: UHC Core |
$2,095.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,881.75
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$728.06 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Medicare |
$757.18
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$728.06
|
| Rate for Payer: BCN Medicare Advantage |
$728.06
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$975.60
|
| Rate for Payer: Cofinity Commercial |
$1,048.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.46
|
| Rate for Payer: Nomi Health Commercial |
$873.67
|
| Rate for Payer: PACE SWMI |
$728.06
|
| Rate for Payer: PHP Medicare Advantage |
$728.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$735.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Exchange |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Facility
|
OP
|
$2,509.00
|
|
|
Service Code
|
CPT 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$595.89 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$2,132.65
|
| Rate for Payer: Aetna Medicare |
$652.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$784.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$784.06
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$627.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,062.65
|
| Rate for Payer: BCN Commercial |
$1,950.75
|
| Rate for Payer: BCN Medicare Advantage |
$627.25
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$2,157.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.25
|
| Rate for Payer: Healthscope Commercial |
$2,258.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,881.75
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.61
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.65
|
| Rate for Payer: Nomi Health Commercial |
$2,057.38
|
| Rate for Payer: PACE Senior Care Partners |
$595.89
|
| Rate for Payer: PACE SWMI |
$627.25
|
| Rate for Payer: PHP Commercial |
$2,132.65
|
| Rate for Payer: PHP Medicare Advantage |
$627.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,182.83
|
| Rate for Payer: Priority Health Medicare |
$633.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,681.03
|
| Rate for Payer: Railroad Medicare Medicare |
$627.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,207.92
|
| Rate for Payer: UHC Core |
$2,095.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$627.25
|
| Rate for Payer: UHC Exchange |
$627.25
|
| Rate for Payer: UHC Medicare Advantage |
$627.25
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$627.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,881.75
|
|
|
PR OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO
|
Professional
|
Both
|
$1,947.00
|
|
|
Service Code
|
HCPCS 24586
|
| Min. Negotiated Rate |
$778.80 |
| Max. Negotiated Rate |
$1,502.88 |
| Rate for Payer: Aetna Commercial |
$1,398.52
|
| Rate for Payer: Aetna Medicare |
$1,085.42
|
| Rate for Payer: BCBS Complete |
$778.80
|
| Rate for Payer: BCBS MAPPO |
$1,043.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,043.67
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cofinity Commercial |
$1,502.88
|
| Rate for Payer: Cofinity Commercial |
$1,398.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,043.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,095.85
|
| Rate for Payer: Nomi Health Commercial |
$1,252.40
|
| Rate for Payer: PACE SWMI |
$1,043.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,043.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.55
|
| Rate for Payer: Priority Health Medicare |
$1,054.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,043.67
|
| Rate for Payer: UHC Exchange |
$1,043.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,043.67
|
|
|
PR OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD
|
Professional
|
Both
|
$3,919.00
|
|
|
Service Code
|
HCPCS 27218
|
| Min. Negotiated Rate |
$1,567.60 |
| Max. Negotiated Rate |
$2,547.35 |
| Rate for Payer: Aetna Medicare |
$1,959.50
|
| Rate for Payer: BCBS Complete |
$1,567.60
|
| Rate for Payer: Cash Price |
$3,135.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,547.35
|
|
|
PR OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 24587
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,510.44 |
| Rate for Payer: Aetna Commercial |
$1,405.55
|
| Rate for Payer: Aetna Medicare |
$1,090.88
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$1,048.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.92
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,510.44
|
| Rate for Payer: Cofinity Commercial |
$1,405.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,101.37
|
| Rate for Payer: Nomi Health Commercial |
$1,258.70
|
| Rate for Payer: PACE SWMI |
$1,048.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$1,059.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.92
|
| Rate for Payer: UHC Exchange |
$1,048.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.92
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$758.10 |
| Max. Negotiated Rate |
$9,768.49 |
| Rate for Payer: Aetna Commercial |
$2,713.20
|
| Rate for Payer: Aetna Medicare |
$829.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$997.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$997.50
|
| Rate for Payer: BCBS Complete |
$9,768.49
|
| Rate for Payer: BCBS MAPPO |
$798.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,624.14
|
| Rate for Payer: BCN Commercial |
$2,481.78
|
| Rate for Payer: BCN Medicare Advantage |
$798.00
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.00
|
| Rate for Payer: Healthscope Commercial |
$2,872.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,394.00
|
| Rate for Payer: Mclaren Medicaid |
$9,302.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$837.90
|
| Rate for Payer: Meridian Medicaid |
$9,768.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$917.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: Nomi Health Commercial |
$2,617.44
|
| Rate for Payer: PACE Senior Care Partners |
$758.10
|
| Rate for Payer: PACE SWMI |
$798.00
|
| Rate for Payer: PHP Commercial |
$2,713.20
|
| Rate for Payer: PHP Medicare Advantage |
$798.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,302.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,777.04
|
| Rate for Payer: Priority Health Medicare |
$805.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,138.64
|
| Rate for Payer: Railroad Medicare Medicare |
$798.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,808.96
|
| Rate for Payer: UHC Core |
$2,665.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.00
|
| Rate for Payer: UHC Exchange |
$798.00
|
| Rate for Payer: UHC Medicare Advantage |
$798.00
|
| Rate for Payer: UHCCP Medicaid |
$9,302.71
|
| Rate for Payer: VA VA |
$798.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,394.00
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$886.39
|
| Rate for Payer: BCBS Complete |
$1,276.80
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.91
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$860.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Exchange |
$852.30
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$2,074.80 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Aetna Commercial |
$2,713.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,605.63
|
| Rate for Payer: BCN Commercial |
$2,466.78
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Healthscope Commercial |
$2,872.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,394.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: Nomi Health Commercial |
$2,617.44
|
| Rate for Payer: PHP Commercial |
$2,713.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,777.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,138.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,808.96
|
| Rate for Payer: UHC Core |
$2,665.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,394.00
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$886.39
|
| Rate for Payer: BCBS Complete |
$1,276.80
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.91
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$860.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Exchange |
$852.30
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
|
|
PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT
|
Professional
|
Both
|
$2,377.00
|
|
|
Service Code
|
HCPCS 23616
|
| Min. Negotiated Rate |
$950.80 |
| Max. Negotiated Rate |
$1,711.53 |
| Rate for Payer: Aetna Commercial |
$1,592.67
|
| Rate for Payer: Aetna Medicare |
$1,236.10
|
| Rate for Payer: BCBS Complete |
$950.80
|
| Rate for Payer: BCBS MAPPO |
$1,188.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,188.56
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cofinity Commercial |
$1,711.53
|
| Rate for Payer: Cofinity Commercial |
$1,592.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,188.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.99
|
| Rate for Payer: Nomi Health Commercial |
$1,426.27
|
| Rate for Payer: PACE SWMI |
$1,188.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,188.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,545.05
|
| Rate for Payer: Priority Health Medicare |
$1,200.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,188.56
|
| Rate for Payer: UHC Exchange |
$1,188.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,188.56
|
|
|
PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ
|
Professional
|
Both
|
$3,098.00
|
|
|
Service Code
|
HCPCS 27226
|
| Min. Negotiated Rate |
$1,015.24 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,360.42
|
| Rate for Payer: Aetna Medicare |
$1,055.85
|
| Rate for Payer: BCBS Complete |
$1,239.20
|
| Rate for Payer: BCBS MAPPO |
$1,015.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,015.24
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cofinity Commercial |
$1,461.95
|
| Rate for Payer: Cofinity Commercial |
$1,360.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,015.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.00
|
| Rate for Payer: Nomi Health Commercial |
$1,218.29
|
| Rate for Payer: PACE SWMI |
$1,015.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,015.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.70
|
| Rate for Payer: Priority Health Medicare |
$1,025.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,015.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,015.24
|
| Rate for Payer: UHC Exchange |
$1,015.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,015.24
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$2,540.00
|
|
|
Service Code
|
HCPCS 25575
|
| Min. Negotiated Rate |
$873.49 |
| Max. Negotiated Rate |
$1,651.00 |
| Rate for Payer: Aetna Commercial |
$1,170.48
|
| Rate for Payer: Aetna Medicare |
$908.43
|
| Rate for Payer: BCBS Complete |
$1,016.00
|
| Rate for Payer: BCBS MAPPO |
$873.49
|
| Rate for Payer: BCN Medicare Advantage |
$873.49
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cofinity Commercial |
$1,257.83
|
| Rate for Payer: Cofinity Commercial |
$1,170.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.16
|
| Rate for Payer: Nomi Health Commercial |
$1,048.19
|
| Rate for Payer: PACE SWMI |
$873.49
|
| Rate for Payer: PHP Medicare Advantage |
$873.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.00
|
| Rate for Payer: Priority Health Medicare |
$882.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$873.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.49
|
| Rate for Payer: UHC Exchange |
$873.49
|
| Rate for Payer: UHC Medicare Advantage |
$873.49
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 25574
|
| Min. Negotiated Rate |
$654.57 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Aetna Commercial |
$877.12
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: BCBS Complete |
$748.00
|
| Rate for Payer: BCBS MAPPO |
$654.57
|
| Rate for Payer: BCN Medicare Advantage |
$654.57
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cofinity Commercial |
$942.58
|
| Rate for Payer: Cofinity Commercial |
$877.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.30
|
| Rate for Payer: Nomi Health Commercial |
$785.48
|
| Rate for Payer: PACE SWMI |
$654.57
|
| Rate for Payer: PHP Medicare Advantage |
$654.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,215.50
|
| Rate for Payer: Priority Health Medicare |
$661.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.57
|
| Rate for Payer: UHC Exchange |
$654.57
|
| Rate for Payer: UHC Medicare Advantage |
$654.57
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$5,711.00
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$1,630.51 |
| Max. Negotiated Rate |
$3,712.15 |
| Rate for Payer: Aetna Commercial |
$2,184.88
|
| Rate for Payer: Aetna Medicare |
$1,695.73
|
| Rate for Payer: BCBS Complete |
$2,284.40
|
| Rate for Payer: BCBS MAPPO |
$1,630.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,630.51
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cofinity Commercial |
$2,347.93
|
| Rate for Payer: Cofinity Commercial |
$2,184.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,630.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,712.04
|
| Rate for Payer: Nomi Health Commercial |
$1,956.61
|
| Rate for Payer: PACE SWMI |
$1,630.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,630.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.15
|
| Rate for Payer: Priority Health Medicare |
$1,646.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,630.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,630.51
|
| Rate for Payer: UHC Exchange |
$1,630.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,630.51
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$10,742.00
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,816.13 |
| Max. Negotiated Rate |
$6,982.30 |
| Rate for Payer: Aetna Commercial |
$2,433.61
|
| Rate for Payer: Aetna Medicare |
$1,888.78
|
| Rate for Payer: BCBS Complete |
$4,296.80
|
| Rate for Payer: BCBS MAPPO |
$1,816.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,816.13
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cofinity Commercial |
$2,615.23
|
| Rate for Payer: Cofinity Commercial |
$2,433.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,816.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,906.94
|
| Rate for Payer: Nomi Health Commercial |
$2,179.36
|
| Rate for Payer: PACE SWMI |
$1,816.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,816.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,982.30
|
| Rate for Payer: Priority Health Medicare |
$1,834.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,816.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,816.13
|
| Rate for Payer: UHC Exchange |
$1,816.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,816.13
|
|
