|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$4,067.00
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$1,484.57 |
| Max. Negotiated Rate |
$2,643.55 |
| Rate for Payer: Aetna Commercial |
$1,989.32
|
| Rate for Payer: Aetna Medicare |
$1,543.95
|
| Rate for Payer: BCBS Complete |
$1,626.80
|
| Rate for Payer: BCBS MAPPO |
$1,484.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,484.57
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cofinity Commercial |
$2,137.78
|
| Rate for Payer: Cofinity Commercial |
$1,989.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,484.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,558.80
|
| Rate for Payer: Nomi Health Commercial |
$1,781.48
|
| Rate for Payer: PACE SWMI |
$1,484.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,484.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,643.55
|
| Rate for Payer: Priority Health Medicare |
$1,499.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,484.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,484.57
|
| Rate for Payer: UHC Exchange |
$1,484.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.57
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$276.81 |
| Max. Negotiated Rate |
$761.15 |
| Rate for Payer: Aetna Commercial |
$370.93
|
| Rate for Payer: Aetna Medicare |
$287.88
|
| Rate for Payer: BCBS Complete |
$468.40
|
| Rate for Payer: BCBS MAPPO |
$276.81
|
| Rate for Payer: BCN Medicare Advantage |
$276.81
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cofinity Commercial |
$398.61
|
| Rate for Payer: Cofinity Commercial |
$370.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.65
|
| Rate for Payer: Nomi Health Commercial |
$332.17
|
| Rate for Payer: PACE SWMI |
$276.81
|
| Rate for Payer: PHP Medicare Advantage |
$276.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.15
|
| Rate for Payer: Priority Health Medicare |
$279.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.81
|
| Rate for Payer: UHC Exchange |
$276.81
|
| Rate for Payer: UHC Medicare Advantage |
$276.81
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$3,741.00
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$1,452.12 |
| Max. Negotiated Rate |
$2,431.65 |
| Rate for Payer: Aetna Commercial |
$1,945.84
|
| Rate for Payer: Aetna Medicare |
$1,510.20
|
| Rate for Payer: BCBS Complete |
$1,496.40
|
| Rate for Payer: BCBS MAPPO |
$1,452.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,452.12
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cofinity Commercial |
$2,091.05
|
| Rate for Payer: Cofinity Commercial |
$1,945.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,452.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.73
|
| Rate for Payer: Nomi Health Commercial |
$1,742.54
|
| Rate for Payer: PACE SWMI |
$1,452.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,452.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.65
|
| Rate for Payer: Priority Health Medicare |
$1,466.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,452.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,452.12
|
| Rate for Payer: UHC Exchange |
$1,452.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,452.12
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$3,905.00
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$1,509.24 |
| Max. Negotiated Rate |
$2,538.25 |
| Rate for Payer: Aetna Commercial |
$2,022.38
|
| Rate for Payer: Aetna Medicare |
$1,569.61
|
| Rate for Payer: BCBS Complete |
$1,562.00
|
| Rate for Payer: BCBS MAPPO |
$1,509.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,509.24
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cofinity Commercial |
$2,173.31
|
| Rate for Payer: Cofinity Commercial |
$2,022.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,509.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,584.70
|
| Rate for Payer: Nomi Health Commercial |
$1,811.09
|
| Rate for Payer: PACE SWMI |
$1,509.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,509.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,538.25
|
| Rate for Payer: Priority Health Medicare |
$1,524.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,509.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,509.24
|
| Rate for Payer: UHC Exchange |
$1,509.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,509.24
|
|
|
PR OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 25525
|
| Min. Negotiated Rate |
$764.32 |
| Max. Negotiated Rate |
$1,676.35 |
| Rate for Payer: Aetna Commercial |
$1,024.19
|
| Rate for Payer: Aetna Medicare |
$794.89
|
| Rate for Payer: BCBS Complete |
$1,031.60
|
| Rate for Payer: BCBS MAPPO |
$764.32
|
| Rate for Payer: BCN Medicare Advantage |
$764.32
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cofinity Commercial |
$1,100.62
|
| Rate for Payer: Cofinity Commercial |
$1,024.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.54
|
| Rate for Payer: Nomi Health Commercial |
$917.18
|
| Rate for Payer: PACE SWMI |
$764.32
|
| Rate for Payer: PHP Medicare Advantage |
$764.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.35
|
| Rate for Payer: Priority Health Medicare |
$771.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$764.32
|
| Rate for Payer: UHC Exchange |
$764.32
|
| Rate for Payer: UHC Medicare Advantage |
$764.32
|
|
|
PR OPTX RDL SHAFT FX&OPTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25526
|
| Min. Negotiated Rate |
$923.59 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna Commercial |
$1,237.61
|
| Rate for Payer: Aetna Medicare |
$960.53
|
| Rate for Payer: BCBS Complete |
$1,190.00
|
| Rate for Payer: BCBS MAPPO |
$923.59
|
| Rate for Payer: BCN Medicare Advantage |
$923.59
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,329.97
|
| Rate for Payer: Cofinity Commercial |
$1,237.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$923.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$969.77
|
| Rate for Payer: Nomi Health Commercial |
$1,108.31
|
| Rate for Payer: PACE SWMI |
$923.59
|
| Rate for Payer: PHP Medicare Advantage |
$923.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health Medicare |
$932.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$923.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.59
|
| Rate for Payer: UHC Exchange |
$923.59
|
| Rate for Payer: UHC Medicare Advantage |
$923.59
|
|
|
PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ
|
Professional
|
Both
|
$2,939.00
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$843.41 |
| Max. Negotiated Rate |
$1,910.35 |
| Rate for Payer: Aetna Commercial |
$1,130.17
|
| Rate for Payer: Aetna Medicare |
$877.15
|
| Rate for Payer: BCBS Complete |
$1,175.60
|
| Rate for Payer: BCBS MAPPO |
$843.41
|
| Rate for Payer: BCN Medicare Advantage |
$843.41
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cofinity Commercial |
$1,214.51
|
| Rate for Payer: Cofinity Commercial |
$1,130.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$843.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$885.58
|
| Rate for Payer: Nomi Health Commercial |
$1,012.09
|
| Rate for Payer: PACE SWMI |
$843.41
|
| Rate for Payer: PHP Medicare Advantage |
$843.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.35
|
| Rate for Payer: Priority Health Medicare |
$851.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$843.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$843.41
|
| Rate for Payer: UHC Exchange |
$843.41
|
| Rate for Payer: UHC Medicare Advantage |
$843.41
|
|
|
PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$662.00 |
| Max. Negotiated Rate |
$1,294.33 |
| Rate for Payer: Aetna Commercial |
$1,204.45
|
| Rate for Payer: Aetna Medicare |
$934.79
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$898.84
|
| Rate for Payer: BCN Medicare Advantage |
$898.84
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,294.33
|
| Rate for Payer: Cofinity Commercial |
$1,204.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.78
|
| Rate for Payer: Nomi Health Commercial |
$1,078.61
|
| Rate for Payer: PACE SWMI |
$898.84
|
| Rate for Payer: PHP Medicare Advantage |
$898.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$907.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$898.84
|
| Rate for Payer: UHC Exchange |
$898.84
|
| Rate for Payer: UHC Medicare Advantage |
$898.84
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$658.80 |
| Max. Negotiated Rate |
$1,281.67 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: BCBS Complete |
$658.80
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.55
|
| Rate for Payer: Priority Health Medicare |
$898.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$890.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Exchange |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$940.40 |
| Max. Negotiated Rate |
$1,555.17 |
| Rate for Payer: Aetna Commercial |
$1,447.17
|
| Rate for Payer: Aetna Medicare |
$1,123.18
|
| Rate for Payer: BCBS Complete |
$940.40
|
| Rate for Payer: BCBS MAPPO |
$1,079.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,079.98
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cofinity Commercial |
$1,555.17
|
| Rate for Payer: Cofinity Commercial |
$1,447.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,079.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,133.98
|
| Rate for Payer: Nomi Health Commercial |
$1,295.98
|
| Rate for Payer: PACE SWMI |
$1,079.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,079.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health Medicare |
$1,090.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,079.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,079.98
|
| Rate for Payer: UHC Exchange |
$1,079.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.98
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$796.40 |
| Max. Negotiated Rate |
$1,548.73 |
| Rate for Payer: Aetna Commercial |
$1,441.18
|
| Rate for Payer: Aetna Medicare |
$1,118.53
|
| Rate for Payer: BCBS Complete |
$796.40
|
| Rate for Payer: BCBS MAPPO |
$1,075.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,075.51
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,548.73
|
| Rate for Payer: Cofinity Commercial |
$1,441.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,075.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,129.29
|
| Rate for Payer: Nomi Health Commercial |
$1,290.61
|
| Rate for Payer: PACE SWMI |
$1,075.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.15
|
| Rate for Payer: Priority Health Medicare |
$1,086.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,075.51
|
| Rate for Payer: UHC Exchange |
$1,075.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,075.51
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$794.40 |
| Max. Negotiated Rate |
$1,542.44 |
| Rate for Payer: Aetna Commercial |
$1,435.33
|
| Rate for Payer: Aetna Medicare |
$1,113.99
|
| Rate for Payer: BCBS Complete |
$794.40
|
| Rate for Payer: BCBS MAPPO |
$1,071.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.14
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,542.44
|
| Rate for Payer: Cofinity Commercial |
$1,435.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.70
|
| Rate for Payer: Nomi Health Commercial |
$1,285.37
|
| Rate for Payer: PACE SWMI |
$1,071.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.90
|
| Rate for Payer: Priority Health Medicare |
$1,081.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,071.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.14
|
| Rate for Payer: UHC Exchange |
$1,071.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.14
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$607.54 |
| Max. Negotiated Rate |
$1,389.70 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna Medicare |
$631.84
|
| Rate for Payer: BCBS Complete |
$855.20
|
| Rate for Payer: BCBS MAPPO |
$607.54
|
| Rate for Payer: BCN Medicare Advantage |
$607.54
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cofinity Commercial |
$874.86
|
| Rate for Payer: Cofinity Commercial |
$814.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.92
|
| Rate for Payer: Nomi Health Commercial |
$729.05
|
| Rate for Payer: PACE SWMI |
$607.54
|
| Rate for Payer: PHP Medicare Advantage |
$607.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.70
|
| Rate for Payer: Priority Health Medicare |
$613.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.54
|
| Rate for Payer: UHC Exchange |
$607.54
|
| Rate for Payer: UHC Medicare Advantage |
$607.54
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$1,144.56 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$1,533.71
|
| Rate for Payer: Aetna Medicare |
$1,190.34
|
| Rate for Payer: BCBS Complete |
$1,238.80
|
| Rate for Payer: BCBS MAPPO |
$1,144.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.56
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,648.17
|
| Rate for Payer: Cofinity Commercial |
$1,533.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,201.79
|
| Rate for Payer: Nomi Health Commercial |
$1,373.47
|
| Rate for Payer: PACE SWMI |
$1,144.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health Medicare |
$1,156.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.56
|
| Rate for Payer: UHC Exchange |
$1,144.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.56
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$864.20 |
| Max. Negotiated Rate |
$2,330.90 |
| Rate for Payer: Aetna Commercial |
$1,158.03
|
| Rate for Payer: Aetna Medicare |
$898.77
|
| Rate for Payer: BCBS Complete |
$1,434.40
|
| Rate for Payer: BCBS MAPPO |
$864.20
|
| Rate for Payer: BCN Medicare Advantage |
$864.20
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cofinity Commercial |
$1,244.45
|
| Rate for Payer: Cofinity Commercial |
$1,158.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.41
|
| Rate for Payer: Nomi Health Commercial |
$1,037.04
|
| Rate for Payer: PACE SWMI |
$864.20
|
| Rate for Payer: PHP Medicare Advantage |
$864.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,330.90
|
| Rate for Payer: Priority Health Medicare |
$872.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$864.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.20
|
| Rate for Payer: UHC Exchange |
$864.20
|
| Rate for Payer: UHC Medicare Advantage |
$864.20
|
|
|
PROPYLENE GLYCOL 0.6 % EYE DROPS
|
Facility
|
OP
|
$36.93
|
|
|
Service Code
|
NDC 00650048111
|
| Hospital Charge Code |
106794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$33.24 |
| Rate for Payer: Aetna Commercial |
$31.39
|
| Rate for Payer: Aetna Medicare |
$9.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.54
|
| Rate for Payer: BCBS Complete |
$14.77
|
| Rate for Payer: BCBS MAPPO |
$9.23
|
| Rate for Payer: BCBS Trust/PPO |
$30.36
|
| Rate for Payer: BCN Commercial |
$28.71
|
| Rate for Payer: BCN Medicare Advantage |
$9.23
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$31.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.23
|
| Rate for Payer: Healthscope Commercial |
$33.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.39
|
| Rate for Payer: Nomi Health Commercial |
$30.28
|
| Rate for Payer: PACE Senior Care Partners |
$8.77
|
| Rate for Payer: PACE SWMI |
$9.23
|
| Rate for Payer: PHP Commercial |
$31.39
|
| Rate for Payer: PHP Medicare Advantage |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: Priority Health HMO/PPO |
$32.13
|
| Rate for Payer: Priority Health Medicare |
$9.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.50
|
| Rate for Payer: UHC Core |
$30.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.23
|
| Rate for Payer: UHC Exchange |
$9.23
|
| Rate for Payer: UHC Medicare Advantage |
$9.23
|
| Rate for Payer: VA VA |
$9.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
PROPYLENE GLYCOL 0.6 % EYE DROPS
|
Facility
|
IP
|
$36.93
|
|
|
Service Code
|
NDC 00650048111
|
| Hospital Charge Code |
106794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$33.24 |
| Rate for Payer: Aetna Commercial |
$31.39
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Commercial |
$28.54
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$31.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$33.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.39
|
| Rate for Payer: Nomi Health Commercial |
$30.28
|
| Rate for Payer: PHP Commercial |
$31.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: Priority Health HMO/PPO |
$32.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.50
|
| Rate for Payer: UHC Core |
$30.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
PROPYLENE GLYCOL 0.6 % EYE DROPS
|
Facility
|
IP
|
$39.45
|
|
|
Service Code
|
NDC 00065048111
|
| Hospital Charge Code |
106794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$35.51 |
| Rate for Payer: Aetna Commercial |
$33.53
|
| Rate for Payer: BCBS Trust/PPO |
$32.20
|
| Rate for Payer: BCN Commercial |
$30.49
|
| Rate for Payer: Cash Price |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.56
|
| Rate for Payer: Healthscope Commercial |
$35.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.53
|
| Rate for Payer: Nomi Health Commercial |
$32.35
|
| Rate for Payer: PHP Commercial |
$33.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.64
|
| Rate for Payer: Priority Health HMO/PPO |
$34.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.72
|
| Rate for Payer: UHC Core |
$32.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.59
|
|
|
PROPYLENE GLYCOL 0.6 % EYE DROPS
|
Facility
|
OP
|
$39.45
|
|
|
Service Code
|
NDC 00065048111
|
| Hospital Charge Code |
106794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$35.51 |
| Rate for Payer: Aetna Commercial |
$33.53
|
| Rate for Payer: Aetna Medicare |
$10.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.33
|
| Rate for Payer: BCBS Complete |
$15.78
|
| Rate for Payer: BCBS MAPPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.43
|
| Rate for Payer: BCN Commercial |
$30.67
|
| Rate for Payer: BCN Medicare Advantage |
$9.86
|
| Rate for Payer: Cash Price |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.86
|
| Rate for Payer: Healthscope Commercial |
$35.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.53
|
| Rate for Payer: Nomi Health Commercial |
$32.35
|
| Rate for Payer: PACE Senior Care Partners |
$9.37
|
| Rate for Payer: PACE SWMI |
$9.86
|
| Rate for Payer: PHP Commercial |
$33.53
|
| Rate for Payer: PHP Medicare Advantage |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.64
|
| Rate for Payer: Priority Health HMO/PPO |
$34.32
|
| Rate for Payer: Priority Health Medicare |
$9.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.43
|
| Rate for Payer: Railroad Medicare Medicare |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.72
|
| Rate for Payer: UHC Core |
$32.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.86
|
| Rate for Payer: UHC Exchange |
$9.86
|
| Rate for Payer: UHC Medicare Advantage |
$9.86
|
| Rate for Payer: VA VA |
$9.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.59
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Medicare Advantage |
$0.02
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$97.50
|
| Rate for Payer: Aetna Medicare |
$75.67
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$72.76
|
| Rate for Payer: BCN Medicare Advantage |
$72.76
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Cofinity Commercial |
$97.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.40
|
| Rate for Payer: Nomi Health Commercial |
$87.31
|
| Rate for Payer: PACE SWMI |
$72.76
|
| Rate for Payer: PHP Medicare Advantage |
$72.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$73.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.76
|
| Rate for Payer: UHC Exchange |
$72.76
|
| Rate for Payer: UHC Medicare Advantage |
$72.76
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$7,956.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$2,802.64 |
| Max. Negotiated Rate |
$5,171.40 |
| Rate for Payer: Aetna Commercial |
$3,755.54
|
| Rate for Payer: Aetna Medicare |
$2,914.75
|
| Rate for Payer: BCBS Complete |
$3,182.40
|
| Rate for Payer: BCBS MAPPO |
$2,802.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,802.64
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cofinity Commercial |
$4,035.80
|
| Rate for Payer: Cofinity Commercial |
$3,755.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,802.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,942.77
|
| Rate for Payer: Nomi Health Commercial |
$3,363.17
|
| Rate for Payer: PACE SWMI |
$2,802.64
|
| Rate for Payer: PHP Medicare Advantage |
$2,802.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,171.40
|
| Rate for Payer: Priority Health Medicare |
$2,830.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,802.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,802.64
|
| Rate for Payer: UHC Exchange |
$2,802.64
|
| Rate for Payer: UHC Medicare Advantage |
$2,802.64
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,759.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$2,303.60 |
| Max. Negotiated Rate |
$4,440.38 |
| Rate for Payer: Aetna Commercial |
$4,132.02
|
| Rate for Payer: Aetna Medicare |
$3,206.94
|
| Rate for Payer: BCBS Complete |
$2,303.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.60
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cofinity Commercial |
$4,440.38
|
| Rate for Payer: Cofinity Commercial |
$4,132.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,237.78
|
| Rate for Payer: Nomi Health Commercial |
$3,700.32
|
| Rate for Payer: PACE SWMI |
$3,083.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,743.35
|
| Rate for Payer: Priority Health Medicare |
$3,114.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,083.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.60
|
| Rate for Payer: UHC Exchange |
$3,083.60
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.60
|
|
