|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$198.55
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Medicare |
$99.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: BCBS Complete |
$79.42
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Advantage |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.91
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.06
|
| Rate for Payer: UHC Core |
$103.44
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UMR Bronson Commercial |
$73.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$285.12
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna American Axle |
$185.33
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Medicare |
$142.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: BCBS Complete |
$114.05
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Advantage |
$199.58
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.84
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.33
|
| Rate for Payer: UHC Core |
$148.55
|
| Rate for Payer: UHC Exchange |
$112.05
|
| Rate for Payer: UMR Bronson Commercial |
$105.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$28.01 |
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Medicare |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.57
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.77
|
| Rate for Payer: Nomi Health Commercial |
$20.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.80
|
| Rate for Payer: Priority Health Medicare |
$17.06
|
| Rate for Payer: Priority Health SBD |
$24.80
|
| Rate for Payer: Priority Health Tiered Network |
$24.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.01
|
| Rate for Payer: UHC Core |
$28.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.06
|
| Rate for Payer: UHC Exchange |
$28.01
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,575.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$390.43 |
| Max. Negotiated Rate |
$2,681.25 |
| Rate for Payer: Aetna Commercial |
$798.85
|
| Rate for Payer: Aetna Medicare |
$620.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$858.47
|
| Rate for Payer: BCBS Complete |
$409.95
|
| Rate for Payer: BCBS MAPPO |
$596.16
|
| Rate for Payer: BCN Commercial |
$988.00
|
| Rate for Payer: BCN Medicare Advantage |
$596.16
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cofinity Commercial |
$858.47
|
| Rate for Payer: Cofinity Commercial |
$798.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$596.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.97
|
| Rate for Payer: Meridian Medicaid |
$409.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$655.78
|
| Rate for Payer: Nomi Health Commercial |
$715.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,681.25
|
| Rate for Payer: PACE SWMI |
$596.16
|
| Rate for Payer: PHP Commercial |
$834.62
|
| Rate for Payer: PHP Medicare Advantage |
$596.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,056.13
|
| Rate for Payer: Priority Health Medicare |
$596.16
|
| Rate for Payer: Priority Health SBD |
$1,056.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,056.13
|
| Rate for Payer: Railroad Medicare Medicare |
$596.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.40
|
| Rate for Payer: UHC Core |
$1,138.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$596.16
|
| Rate for Payer: UHC Exchange |
$1,138.40
|
| Rate for Payer: UHC Medicaid |
$390.43
|
| Rate for Payer: UHCCP Medicaid |
$390.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,644.50
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$4,007.00
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$1,075.01 |
| Max. Negotiated Rate |
$3,310.26 |
| Rate for Payer: Aetna Commercial |
$2,232.80
|
| Rate for Payer: Aetna Medicare |
$1,732.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,232.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,399.43
|
| Rate for Payer: BCBS Complete |
$1,128.76
|
| Rate for Payer: BCBS MAPPO |
$1,666.27
|
| Rate for Payer: BCN Commercial |
$2,825.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.27
|
| Rate for Payer: Cash Price |
$3,205.60
|
| Rate for Payer: Cash Price |
$3,205.60
|
| Rate for Payer: Cofinity Commercial |
$2,232.80
|
| Rate for Payer: Cofinity Commercial |
$2,399.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,749.58
|
| Rate for Payer: Meridian Medicaid |
$1,128.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,832.90
|
| Rate for Payer: Nomi Health Commercial |
$1,999.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,005.25
|
| Rate for Payer: PACE SWMI |
$1,666.27
|
| Rate for Payer: PHP Commercial |
$2,332.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,019.90
|
| Rate for Payer: Priority Health Medicare |
$1,666.27
|
| Rate for Payer: Priority Health SBD |
$3,019.90
|
| Rate for Payer: Priority Health Tiered Network |
$3,019.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,666.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,310.26
|
| Rate for Payer: UHC Core |
$3,310.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,666.27
|
| Rate for Payer: UHC Exchange |
$3,310.26
|
| Rate for Payer: UHC Medicaid |
$1,075.01
|
| Rate for Payer: UHCCP Medicaid |
$1,075.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,843.22
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,805.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$949.77 |
| Max. Negotiated Rate |
$3,603.75 |
| Rate for Payer: Aetna Commercial |
$1,969.40
|
| Rate for Payer: Aetna Medicare |
$1,528.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,969.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,116.37
|
| Rate for Payer: BCBS Complete |
$997.26
|
| Rate for Payer: BCBS MAPPO |
$1,469.70
|
| Rate for Payer: BCN Commercial |
$2,489.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,469.70
|
| Rate for Payer: Cash Price |
$3,844.00
|
| Rate for Payer: Cash Price |
$3,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,969.40
|
| Rate for Payer: Cofinity Commercial |
$2,116.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,469.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.18
|
| Rate for Payer: Meridian Medicaid |
$997.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,616.67
|
| Rate for Payer: Nomi Health Commercial |
$1,763.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,603.75
|
| Rate for Payer: PACE SWMI |
$1,469.70
|
| Rate for Payer: PHP Commercial |
$2,057.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,469.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$949.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,661.10
|
| Rate for Payer: Priority Health Medicare |
$1,469.70
|
| Rate for Payer: Priority Health SBD |
$2,661.10
|
| Rate for Payer: Priority Health Tiered Network |
$2,661.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,469.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,911.39
|
| Rate for Payer: UHC Core |
$2,911.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,469.70
|
| Rate for Payer: UHC Exchange |
$2,911.39
|
| Rate for Payer: UHC Medicaid |
$949.77
|
| Rate for Payer: UHCCP Medicaid |
$949.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,210.30
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,095.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$430.47 |
| Max. Negotiated Rate |
$2,321.25 |
| Rate for Payer: Aetna Commercial |
$883.33
|
| Rate for Payer: Aetna Medicare |
$685.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$883.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$949.25
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCBS MAPPO |
$659.20
|
| Rate for Payer: BCN Commercial |
$1,102.03
|
| Rate for Payer: BCN Medicare Advantage |
$659.20
|
| Rate for Payer: Cash Price |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,476.00
|
| Rate for Payer: Cofinity Commercial |
$883.33
|
| Rate for Payer: Cofinity Commercial |
$949.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.16
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$725.12
|
| Rate for Payer: Nomi Health Commercial |
$791.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,321.25
|
| Rate for Payer: PACE SWMI |
$659.20
|
| Rate for Payer: PHP Commercial |
$922.88
|
| Rate for Payer: PHP Medicare Advantage |
$659.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,178.04
|
| Rate for Payer: Priority Health Medicare |
$659.20
|
| Rate for Payer: Priority Health SBD |
$1,178.04
|
| Rate for Payer: Priority Health Tiered Network |
$1,178.04
|
| Rate for Payer: Railroad Medicare Medicare |
$659.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,248.57
|
| Rate for Payer: UHC Core |
$1,248.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$659.20
|
| Rate for Payer: UHC Exchange |
$1,248.57
|
| Rate for Payer: UHC Medicaid |
$430.47
|
| Rate for Payer: UHCCP Medicaid |
$430.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,423.70
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,344.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$470.52 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$967.80
|
| Rate for Payer: Aetna Medicare |
$751.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.80
|
| Rate for Payer: BCBS Complete |
$494.05
|
| Rate for Payer: BCBS MAPPO |
$722.24
|
| Rate for Payer: BCN Commercial |
$1,208.60
|
| Rate for Payer: BCN Medicare Advantage |
$722.24
|
| Rate for Payer: Cash Price |
$2,675.20
|
| Rate for Payer: Cash Price |
$2,675.20
|
| Rate for Payer: Cofinity Commercial |
$1,040.03
|
| Rate for Payer: Cofinity Commercial |
$967.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.35
|
| Rate for Payer: Meridian Medicaid |
$494.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$794.46
|
| Rate for Payer: Nomi Health Commercial |
$866.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,508.00
|
| Rate for Payer: PACE SWMI |
$722.24
|
| Rate for Payer: PHP Commercial |
$1,011.14
|
| Rate for Payer: PHP Medicare Advantage |
$722.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,291.96
|
| Rate for Payer: Priority Health Medicare |
$722.24
|
| Rate for Payer: Priority Health SBD |
$1,291.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,291.96
|
| Rate for Payer: Railroad Medicare Medicare |
$722.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.77
|
| Rate for Payer: UHC Core |
$1,398.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$722.24
|
| Rate for Payer: UHC Exchange |
$1,398.77
|
| Rate for Payer: UHC Medicaid |
$470.52
|
| Rate for Payer: UHCCP Medicaid |
$470.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,538.24
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,228.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$2,421.00 |
| Rate for Payer: Aetna Commercial |
$1,119.55
|
| Rate for Payer: Aetna Medicare |
$1,614.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.55
|
| Rate for Payer: BCBS Complete |
$502.32
|
| Rate for Payer: BCN Commercial |
$1,259.40
|
| Rate for Payer: Cash Price |
$2,582.40
|
| Rate for Payer: Cash Price |
$2,582.40
|
| Rate for Payer: Meridian Medicaid |
$502.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,421.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,346.25
|
| Rate for Payer: Priority Health SBD |
$1,346.25
|
| Rate for Payer: Priority Health Tiered Network |
$1,346.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,478.83
|
| Rate for Payer: UHC Core |
$1,478.83
|
| Rate for Payer: UHC Exchange |
$1,478.83
|
| Rate for Payer: UHC Medicaid |
$478.40
|
| Rate for Payer: UHCCP Medicaid |
$478.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,484.88
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,336.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$377.86 |
| Max. Negotiated Rate |
$2,502.00 |
| Rate for Payer: Aetna Commercial |
$772.28
|
| Rate for Payer: Aetna Medicare |
$599.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.92
|
| Rate for Payer: BCBS Complete |
$396.75
|
| Rate for Payer: BCBS MAPPO |
$576.33
|
| Rate for Payer: BCN Commercial |
$955.13
|
| Rate for Payer: BCN Medicare Advantage |
$576.33
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cofinity Commercial |
$829.92
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.15
|
| Rate for Payer: Meridian Medicaid |
$396.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$633.96
|
| Rate for Payer: Nomi Health Commercial |
$691.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,502.00
|
| Rate for Payer: PACE SWMI |
$576.33
|
| Rate for Payer: PHP Commercial |
$806.86
|
| Rate for Payer: PHP Medicare Advantage |
$576.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,021.01
|
| Rate for Payer: Priority Health Medicare |
$576.33
|
| Rate for Payer: Priority Health SBD |
$1,021.01
|
| Rate for Payer: Priority Health Tiered Network |
$1,021.01
|
| Rate for Payer: Railroad Medicare Medicare |
$576.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.46
|
| Rate for Payer: UHC Core |
$1,086.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$576.33
|
| Rate for Payer: UHC Exchange |
$1,086.46
|
| Rate for Payer: UHC Medicaid |
$377.86
|
| Rate for Payer: UHCCP Medicaid |
$377.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,534.56
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,535.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$662.86 |
| Max. Negotiated Rate |
$2,050.03 |
| Rate for Payer: Aetna Commercial |
$1,362.99
|
| Rate for Payer: Aetna Medicare |
$1,057.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.71
|
| Rate for Payer: BCBS Complete |
$696.00
|
| Rate for Payer: BCBS MAPPO |
$1,017.16
|
| Rate for Payer: BCN Commercial |
$1,753.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.16
|
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Cofinity Commercial |
$1,362.99
|
| Rate for Payer: Cofinity Commercial |
$1,464.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.02
|
| Rate for Payer: Meridian Medicaid |
$696.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,118.88
|
| Rate for Payer: Nomi Health Commercial |
$1,220.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,901.25
|
| Rate for Payer: PACE SWMI |
$1,017.16
|
| Rate for Payer: PHP Commercial |
$1,424.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$662.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,874.33
|
| Rate for Payer: Priority Health Medicare |
$1,017.16
|
| Rate for Payer: Priority Health SBD |
$1,874.33
|
| Rate for Payer: Priority Health Tiered Network |
$1,874.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,017.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,050.03
|
| Rate for Payer: UHC Core |
$2,050.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,017.16
|
| Rate for Payer: UHC Exchange |
$2,050.03
|
| Rate for Payer: UHC Medicaid |
$662.86
|
| Rate for Payer: UHCCP Medicaid |
$662.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,166.10
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,493.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$492.24 |
| Max. Negotiated Rate |
$1,869.75 |
| Rate for Payer: Aetna Commercial |
$1,007.35
|
| Rate for Payer: Aetna Medicare |
$781.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.52
|
| Rate for Payer: BCBS Complete |
$516.85
|
| Rate for Payer: BCBS MAPPO |
$751.75
|
| Rate for Payer: BCN Commercial |
$1,268.36
|
| Rate for Payer: BCN Medicare Advantage |
$751.75
|
| Rate for Payer: Cash Price |
$1,994.40
|
| Rate for Payer: Cash Price |
$1,994.40
|
| Rate for Payer: Cofinity Commercial |
$1,007.35
|
| Rate for Payer: Cofinity Commercial |
$1,082.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.34
|
| Rate for Payer: Meridian Medicaid |
$516.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$826.92
|
| Rate for Payer: Nomi Health Commercial |
$902.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.75
|
| Rate for Payer: PACE SWMI |
$751.75
|
| Rate for Payer: PHP Commercial |
$1,052.45
|
| Rate for Payer: PHP Medicare Advantage |
$751.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,355.85
|
| Rate for Payer: Priority Health Medicare |
$751.75
|
| Rate for Payer: Priority Health SBD |
$1,355.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,355.85
|
| Rate for Payer: Railroad Medicare Medicare |
$751.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,436.42
|
| Rate for Payer: UHC Core |
$1,436.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$751.75
|
| Rate for Payer: UHC Exchange |
$1,436.42
|
| Rate for Payer: UHC Medicaid |
$492.24
|
| Rate for Payer: UHCCP Medicaid |
$492.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,146.78
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$3,048.00
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$617.49 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Aetna Commercial |
$1,265.80
|
| Rate for Payer: Aetna Medicare |
$982.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,360.27
|
| Rate for Payer: BCBS Complete |
$648.36
|
| Rate for Payer: BCBS MAPPO |
$944.63
|
| Rate for Payer: BCN Commercial |
$1,607.48
|
| Rate for Payer: BCN Medicare Advantage |
$944.63
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cofinity Commercial |
$1,265.80
|
| Rate for Payer: Cofinity Commercial |
$1,360.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$944.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$991.86
|
| Rate for Payer: Meridian Medicaid |
$648.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,039.09
|
| Rate for Payer: Nomi Health Commercial |
$1,133.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,286.00
|
| Rate for Payer: PACE SWMI |
$944.63
|
| Rate for Payer: PHP Commercial |
$1,322.48
|
| Rate for Payer: PHP Medicare Advantage |
$944.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$617.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,718.36
|
| Rate for Payer: Priority Health Medicare |
$944.63
|
| Rate for Payer: Priority Health SBD |
$1,718.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,718.36
|
| Rate for Payer: Railroad Medicare Medicare |
$944.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,829.63
|
| Rate for Payer: UHC Core |
$1,829.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$944.63
|
| Rate for Payer: UHC Exchange |
$1,829.63
|
| Rate for Payer: UHC Medicaid |
$617.49
|
| Rate for Payer: UHCCP Medicaid |
$617.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,402.08
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$2,002.00
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$444.74 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$907.69
|
| Rate for Payer: Aetna Medicare |
$704.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$907.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.43
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCBS MAPPO |
$677.38
|
| Rate for Payer: BCN Commercial |
$1,138.89
|
| Rate for Payer: BCN Medicare Advantage |
$677.38
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Cofinity Commercial |
$907.69
|
| Rate for Payer: Cofinity Commercial |
$975.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$711.25
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$745.12
|
| Rate for Payer: Nomi Health Commercial |
$812.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.50
|
| Rate for Payer: PACE SWMI |
$677.38
|
| Rate for Payer: PHP Commercial |
$948.33
|
| Rate for Payer: PHP Medicare Advantage |
$677.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,217.43
|
| Rate for Payer: Priority Health Medicare |
$677.38
|
| Rate for Payer: Priority Health SBD |
$1,217.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,217.43
|
| Rate for Payer: Railroad Medicare Medicare |
$677.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,278.64
|
| Rate for Payer: UHC Core |
$1,278.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$677.38
|
| Rate for Payer: UHC Exchange |
$1,278.64
|
| Rate for Payer: UHC Medicaid |
$444.74
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
| Rate for Payer: UMR Bronson Commercial |
$920.92
|
|
|
PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$3,844.00
|
|
|
Service Code
|
HCPCS 27236
|
| Min. Negotiated Rate |
$695.02 |
| Max. Negotiated Rate |
$2,883.00 |
| Rate for Payer: Aetna Commercial |
$1,435.13
|
| Rate for Payer: Aetna Medicare |
$1,113.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,542.23
|
| Rate for Payer: BCBS Complete |
$729.77
|
| Rate for Payer: BCBS MAPPO |
$1,070.99
|
| Rate for Payer: BCN Commercial |
$1,983.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,070.99
|
| Rate for Payer: Cash Price |
$3,075.20
|
| Rate for Payer: Cash Price |
$3,075.20
|
| Rate for Payer: Cofinity Commercial |
$1,435.13
|
| Rate for Payer: Cofinity Commercial |
$1,542.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,070.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.54
|
| Rate for Payer: Meridian Medicaid |
$729.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,178.09
|
| Rate for Payer: Nomi Health Commercial |
$1,285.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,883.00
|
| Rate for Payer: PACE SWMI |
$1,070.99
|
| Rate for Payer: PHP Commercial |
$1,499.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,070.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$695.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,929.69
|
| Rate for Payer: Priority Health Medicare |
$1,070.99
|
| Rate for Payer: Priority Health SBD |
$1,929.69
|
| Rate for Payer: Priority Health Tiered Network |
$1,929.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,070.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,096.23
|
| Rate for Payer: UHC Core |
$2,096.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,070.99
|
| Rate for Payer: UHC Exchange |
$2,096.23
|
| Rate for Payer: UHC Medicaid |
$695.02
|
| Rate for Payer: UHCCP Medicaid |
$695.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,768.24
|
|
|
PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$4,341.00
|
|
|
Service Code
|
HCPCS 27506
|
| Min. Negotiated Rate |
$780.01 |
| Max. Negotiated Rate |
$3,255.75 |
| Rate for Payer: Aetna Commercial |
$1,609.98
|
| Rate for Payer: Aetna Medicare |
$1,249.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,609.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.13
|
| Rate for Payer: BCBS Complete |
$819.01
|
| Rate for Payer: BCBS MAPPO |
$1,201.48
|
| Rate for Payer: BCN Commercial |
$2,224.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,201.48
|
| Rate for Payer: Cash Price |
$3,472.80
|
| Rate for Payer: Cash Price |
$3,472.80
|
| Rate for Payer: Cofinity Commercial |
$1,609.98
|
| Rate for Payer: Cofinity Commercial |
$1,730.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,201.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,261.55
|
| Rate for Payer: Meridian Medicaid |
$819.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,321.63
|
| Rate for Payer: Nomi Health Commercial |
$1,441.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,255.75
|
| Rate for Payer: PACE SWMI |
$1,201.48
|
| Rate for Payer: PHP Commercial |
$1,682.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,201.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,164.45
|
| Rate for Payer: Priority Health Medicare |
$1,201.48
|
| Rate for Payer: Priority Health SBD |
$2,164.45
|
| Rate for Payer: Priority Health Tiered Network |
$2,164.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,201.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,345.38
|
| Rate for Payer: UHC Core |
$2,345.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,201.48
|
| Rate for Payer: UHC Exchange |
$2,345.38
|
| Rate for Payer: UHC Medicaid |
$780.01
|
| Rate for Payer: UHCCP Medicaid |
$780.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,996.86
|
|
|
PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,963.00
|
|
|
Service Code
|
HCPCS 27507
|
| Min. Negotiated Rate |
$563.39 |
| Max. Negotiated Rate |
$2,972.25 |
| Rate for Payer: Aetna Commercial |
$1,164.73
|
| Rate for Payer: Aetna Medicare |
$903.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.65
|
| Rate for Payer: BCBS Complete |
$591.56
|
| Rate for Payer: BCBS MAPPO |
$869.20
|
| Rate for Payer: BCN Commercial |
$1,465.06
|
| Rate for Payer: BCN Medicare Advantage |
$869.20
|
| Rate for Payer: Cash Price |
$3,170.40
|
| Rate for Payer: Cash Price |
$3,170.40
|
| Rate for Payer: Cofinity Commercial |
$1,164.73
|
| Rate for Payer: Cofinity Commercial |
$1,251.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$869.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.66
|
| Rate for Payer: Meridian Medicaid |
$591.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$956.12
|
| Rate for Payer: Nomi Health Commercial |
$1,043.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,972.25
|
| Rate for Payer: PACE SWMI |
$869.20
|
| Rate for Payer: PHP Commercial |
$1,216.88
|
| Rate for Payer: PHP Medicare Advantage |
$869.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$563.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,566.10
|
| Rate for Payer: Priority Health Medicare |
$869.20
|
| Rate for Payer: Priority Health SBD |
$1,566.10
|
| Rate for Payer: Priority Health Tiered Network |
$1,566.10
|
| Rate for Payer: Railroad Medicare Medicare |
$869.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,705.18
|
| Rate for Payer: UHC Core |
$1,705.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$869.20
|
| Rate for Payer: UHC Exchange |
$1,705.18
|
| Rate for Payer: UHC Medicaid |
$563.39
|
| Rate for Payer: UHCCP Medicaid |
$563.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,822.98
|
|
|
PR OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 23630
|
| Min. Negotiated Rate |
$468.17 |
| Max. Negotiated Rate |
$1,359.31 |
| Rate for Payer: Aetna Commercial |
$958.72
|
| Rate for Payer: Aetna Medicare |
$744.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,030.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.72
|
| Rate for Payer: BCBS Complete |
$491.58
|
| Rate for Payer: BCBS MAPPO |
$715.46
|
| Rate for Payer: BCN Commercial |
$1,194.15
|
| Rate for Payer: BCN Medicare Advantage |
$715.46
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$1,030.26
|
| Rate for Payer: Cofinity Commercial |
$958.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.23
|
| Rate for Payer: Meridian Medicaid |
$491.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$787.01
|
| Rate for Payer: Nomi Health Commercial |
$858.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$715.46
|
| Rate for Payer: PHP Commercial |
$1,001.64
|
| Rate for Payer: PHP Medicare Advantage |
$715.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$468.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,276.52
|
| Rate for Payer: Priority Health Medicare |
$715.46
|
| Rate for Payer: Priority Health SBD |
$1,276.52
|
| Rate for Payer: Priority Health Tiered Network |
$1,276.52
|
| Rate for Payer: Railroad Medicare Medicare |
$715.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,359.31
|
| Rate for Payer: UHC Core |
$1,359.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$715.46
|
| Rate for Payer: UHC Exchange |
$1,359.31
|
| Rate for Payer: UHC Medicaid |
$468.17
|
| Rate for Payer: UHCCP Medicaid |
$468.17
|
| Rate for Payer: UMR Bronson Commercial |
$657.80
|
|
|
PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD
|
Professional
|
Both
|
$3,652.00
|
|
|
Service Code
|
HCPCS 27254
|
| Min. Negotiated Rate |
$737.83 |
| Max. Negotiated Rate |
$2,739.00 |
| Rate for Payer: Aetna Commercial |
$1,525.42
|
| Rate for Payer: Aetna Medicare |
$1,183.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,525.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.25
|
| Rate for Payer: BCBS Complete |
$774.72
|
| Rate for Payer: BCBS MAPPO |
$1,138.37
|
| Rate for Payer: BCN Commercial |
$1,921.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,138.37
|
| Rate for Payer: Cash Price |
$2,921.60
|
| Rate for Payer: Cash Price |
$2,921.60
|
| Rate for Payer: Cofinity Commercial |
$1,525.42
|
| Rate for Payer: Cofinity Commercial |
$1,639.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,138.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,195.29
|
| Rate for Payer: Meridian Medicaid |
$774.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,252.21
|
| Rate for Payer: Nomi Health Commercial |
$1,366.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,739.00
|
| Rate for Payer: PACE SWMI |
$1,138.37
|
| Rate for Payer: PHP Commercial |
$1,593.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,138.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$737.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,054.25
|
| Rate for Payer: Priority Health Medicare |
$1,138.37
|
| Rate for Payer: Priority Health SBD |
$2,054.25
|
| Rate for Payer: Priority Health Tiered Network |
$2,054.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,138.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,235.97
|
| Rate for Payer: UHC Core |
$2,235.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,138.37
|
| Rate for Payer: UHC Exchange |
$2,235.97
|
| Rate for Payer: UHC Medicaid |
$737.83
|
| Rate for Payer: UHCCP Medicaid |
$737.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,679.92
|
|
|
PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ
|
Professional
|
Both
|
$2,422.00
|
|
|
Service Code
|
HCPCS 27253
|
| Min. Negotiated Rate |
$554.65 |
| Max. Negotiated Rate |
$1,816.50 |
| Rate for Payer: Aetna Commercial |
$1,142.99
|
| Rate for Payer: Aetna Medicare |
$887.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,228.29
|
| Rate for Payer: BCBS Complete |
$582.38
|
| Rate for Payer: BCBS MAPPO |
$852.98
|
| Rate for Payer: BCN Commercial |
$1,425.72
|
| Rate for Payer: BCN Medicare Advantage |
$852.98
|
| Rate for Payer: Cash Price |
$1,937.60
|
| Rate for Payer: Cash Price |
$1,937.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.99
|
| Rate for Payer: Cofinity Commercial |
$1,228.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.63
|
| Rate for Payer: Meridian Medicaid |
$582.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$938.28
|
| Rate for Payer: Nomi Health Commercial |
$1,023.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,816.50
|
| Rate for Payer: PACE SWMI |
$852.98
|
| Rate for Payer: PHP Commercial |
$1,194.17
|
| Rate for Payer: PHP Medicare Advantage |
$852.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$554.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,524.05
|
| Rate for Payer: Priority Health Medicare |
$852.98
|
| Rate for Payer: Priority Health SBD |
$1,524.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,524.05
|
| Rate for Payer: Railroad Medicare Medicare |
$852.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,650.79
|
| Rate for Payer: UHC Core |
$1,650.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$852.98
|
| Rate for Payer: UHC Exchange |
$1,650.79
|
| Rate for Payer: UHC Medicaid |
$554.65
|
| Rate for Payer: UHCCP Medicaid |
$554.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,114.12
|
|
|
PR OPTX HUMERAL SHFT FX PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,185.00
|
|
|
Service Code
|
HCPCS 24515
|
| Min. Negotiated Rate |
$524.41 |
| Max. Negotiated Rate |
$2,388.75 |
| Rate for Payer: Aetna Commercial |
$1,075.95
|
| Rate for Payer: Aetna Medicare |
$835.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,156.25
|
| Rate for Payer: BCBS Complete |
$550.63
|
| Rate for Payer: BCBS MAPPO |
$802.95
|
| Rate for Payer: BCN Commercial |
$1,341.56
|
| Rate for Payer: BCN Medicare Advantage |
$802.95
|
| Rate for Payer: Cash Price |
$2,548.00
|
| Rate for Payer: Cash Price |
$2,548.00
|
| Rate for Payer: Cofinity Commercial |
$1,075.95
|
| Rate for Payer: Cofinity Commercial |
$1,156.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$843.10
|
| Rate for Payer: Meridian Medicaid |
$550.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$883.25
|
| Rate for Payer: Nomi Health Commercial |
$963.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,388.75
|
| Rate for Payer: PACE SWMI |
$802.95
|
| Rate for Payer: PHP Commercial |
$1,124.13
|
| Rate for Payer: PHP Medicare Advantage |
$802.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$524.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,434.08
|
| Rate for Payer: Priority Health Medicare |
$802.95
|
| Rate for Payer: Priority Health SBD |
$1,434.08
|
| Rate for Payer: Priority Health Tiered Network |
$1,434.08
|
| Rate for Payer: Railroad Medicare Medicare |
$802.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,534.80
|
| Rate for Payer: UHC Core |
$1,534.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$802.95
|
| Rate for Payer: UHC Exchange |
$1,534.80
|
| Rate for Payer: UHC Medicaid |
$524.41
|
| Rate for Payer: UHCCP Medicaid |
$524.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,465.10
|
|
|
PR OPTX HUMERAL SPRCNYLR/TRANSCNDYLR FRACTURE W/XTN
|
Professional
|
Both
|
$4,101.00
|
|
|
Service Code
|
HCPCS 24546
|
| Min. Negotiated Rate |
$608.12 |
| Max. Negotiated Rate |
$3,075.75 |
| Rate for Payer: Aetna Commercial |
$1,252.27
|
| Rate for Payer: Aetna Medicare |
$971.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,345.72
|
| Rate for Payer: BCBS Complete |
$638.53
|
| Rate for Payer: BCBS MAPPO |
$934.53
|
| Rate for Payer: BCN Commercial |
$1,577.61
|
| Rate for Payer: BCN Medicare Advantage |
$934.53
|
| Rate for Payer: Cash Price |
$3,280.80
|
| Rate for Payer: Cash Price |
$3,280.80
|
| Rate for Payer: Cofinity Commercial |
$1,252.27
|
| Rate for Payer: Cofinity Commercial |
$1,345.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$981.26
|
| Rate for Payer: Meridian Medicaid |
$638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,027.98
|
| Rate for Payer: Nomi Health Commercial |
$1,121.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,075.75
|
| Rate for Payer: PACE SWMI |
$934.53
|
| Rate for Payer: PHP Commercial |
$1,308.34
|
| Rate for Payer: PHP Medicare Advantage |
$934.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$608.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,686.42
|
| Rate for Payer: Priority Health Medicare |
$934.53
|
| Rate for Payer: Priority Health SBD |
$1,686.42
|
| Rate for Payer: Priority Health Tiered Network |
$1,686.42
|
| Rate for Payer: Railroad Medicare Medicare |
$934.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,817.38
|
| Rate for Payer: UHC Core |
$1,817.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$934.53
|
| Rate for Payer: UHC Exchange |
$1,817.38
|
| Rate for Payer: UHC Medicaid |
$608.12
|
| Rate for Payer: UHCCP Medicaid |
$608.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,886.46
|
|
|
PR OPTX HUMERAL SPRCNYLR/TRANSCNDYLR FX W/O XTN
|
Professional
|
Both
|
$3,136.00
|
|
|
Service Code
|
HCPCS 24545
|
| Min. Negotiated Rate |
$548.69 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,128.37
|
| Rate for Payer: Aetna Medicare |
$875.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,128.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.58
|
| Rate for Payer: BCBS Complete |
$576.12
|
| Rate for Payer: BCBS MAPPO |
$842.07
|
| Rate for Payer: BCN Commercial |
$1,414.26
|
| Rate for Payer: BCN Medicare Advantage |
$842.07
|
| Rate for Payer: Cash Price |
$2,508.80
|
| Rate for Payer: Cash Price |
$2,508.80
|
| Rate for Payer: Cofinity Commercial |
$1,128.37
|
| Rate for Payer: Cofinity Commercial |
$1,212.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$842.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$884.17
|
| Rate for Payer: Meridian Medicaid |
$576.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$926.28
|
| Rate for Payer: Nomi Health Commercial |
$1,010.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,352.00
|
| Rate for Payer: PACE SWMI |
$842.07
|
| Rate for Payer: PHP Commercial |
$1,178.90
|
| Rate for Payer: PHP Medicare Advantage |
$842.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$548.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,511.81
|
| Rate for Payer: Priority Health Medicare |
$842.07
|
| Rate for Payer: Priority Health SBD |
$1,511.81
|
| Rate for Payer: Priority Health Tiered Network |
$1,511.81
|
| Rate for Payer: Railroad Medicare Medicare |
$842.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,625.87
|
| Rate for Payer: UHC Core |
$1,625.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$842.07
|
| Rate for Payer: UHC Exchange |
$1,625.87
|
| Rate for Payer: UHC Medicaid |
$548.69
|
| Rate for Payer: UHCCP Medicaid |
$548.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,442.56
|
|
|
PR OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD
|
Professional
|
Both
|
$2,713.00
|
|
|
Service Code
|
HCPCS 27215
|
| Min. Negotiated Rate |
$345.06 |
| Max. Negotiated Rate |
$2,034.75 |
| Rate for Payer: Aetna Commercial |
$803.86
|
| Rate for Payer: Aetna Medicare |
$1,356.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.86
|
| Rate for Payer: BCBS Complete |
$362.31
|
| Rate for Payer: BCN Commercial |
$906.32
|
| Rate for Payer: Cash Price |
$2,170.40
|
| Rate for Payer: Cash Price |
$2,170.40
|
| Rate for Payer: Meridian Medicaid |
$362.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,034.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$968.84
|
| Rate for Payer: Priority Health SBD |
$968.84
|
| Rate for Payer: Priority Health Tiered Network |
$968.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.18
|
| Rate for Payer: UHC Core |
$1,062.18
|
| Rate for Payer: UHC Exchange |
$1,062.18
|
| Rate for Payer: UHC Medicaid |
$345.06
|
| Rate for Payer: UHCCP Medicaid |
$345.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,247.98
|
|
|
PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN
|
Professional
|
Both
|
$2,116.00
|
|
|
Service Code
|
HCPCS 21347
|
| Min. Negotiated Rate |
$598.96 |
| Max. Negotiated Rate |
$1,752.28 |
| Rate for Payer: Aetna Commercial |
$1,219.00
|
| Rate for Payer: Aetna Medicare |
$946.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,219.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.97
|
| Rate for Payer: BCBS Complete |
$628.91
|
| Rate for Payer: BCBS MAPPO |
$909.70
|
| Rate for Payer: BCN Commercial |
$1,561.67
|
| Rate for Payer: BCN Medicare Advantage |
$909.70
|
| Rate for Payer: Cash Price |
$1,692.80
|
| Rate for Payer: Cash Price |
$1,692.80
|
| Rate for Payer: Cofinity Commercial |
$1,309.97
|
| Rate for Payer: Cofinity Commercial |
$1,219.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$955.18
|
| Rate for Payer: Meridian Medicaid |
$628.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,000.67
|
| Rate for Payer: Nomi Health Commercial |
$1,091.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,587.00
|
| Rate for Payer: PACE SWMI |
$909.70
|
| Rate for Payer: PHP Commercial |
$1,273.58
|
| Rate for Payer: PHP Medicare Advantage |
$909.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$598.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,669.39
|
| Rate for Payer: Priority Health Medicare |
$909.70
|
| Rate for Payer: Priority Health SBD |
$1,669.39
|
| Rate for Payer: Priority Health Tiered Network |
$1,669.39
|
| Rate for Payer: Railroad Medicare Medicare |
$909.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,752.28
|
| Rate for Payer: UHC Core |
$1,752.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$909.70
|
| Rate for Payer: UHC Exchange |
$1,752.28
|
| Rate for Payer: UHC Medicaid |
$598.96
|
| Rate for Payer: UHCCP Medicaid |
$598.96
|
| Rate for Payer: UMR Bronson Commercial |
$973.36
|
|
