|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$800.55 |
| Max. Negotiated Rate |
$1,573.00 |
| Rate for Payer: Aetna Commercial |
$1,072.74
|
| Rate for Payer: Aetna Medicare |
$832.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.74
|
| Rate for Payer: BCBS Complete |
$968.00
|
| Rate for Payer: BCBS MAPPO |
$800.55
|
| Rate for Payer: BCN Medicare Advantage |
$800.55
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cofinity Commercial |
$1,152.79
|
| Rate for Payer: Cofinity Commercial |
$1,072.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.58
|
| Rate for Payer: Nomi Health Commercial |
$960.66
|
| Rate for Payer: PACE SWMI |
$800.55
|
| Rate for Payer: PHP Commercial |
$1,120.77
|
| Rate for Payer: PHP Medicare Advantage |
$800.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,573.00
|
| Rate for Payer: Priority Health Medicare |
$800.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.55
|
| Rate for Payer: UHC Medicare Advantage |
$800.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,113.20
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$1,016.00 |
| Max. Negotiated Rate |
$1,923.35 |
| Rate for Payer: Aetna Commercial |
$1,361.44
|
| Rate for Payer: Aetna Medicare |
$1,056.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,463.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,361.44
|
| Rate for Payer: BCBS Complete |
$1,183.60
|
| Rate for Payer: BCBS MAPPO |
$1,016.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,016.00
|
| Rate for Payer: Cash Price |
$2,367.20
|
| Rate for Payer: Cash Price |
$2,367.20
|
| Rate for Payer: Cofinity Commercial |
$1,463.04
|
| Rate for Payer: Cofinity Commercial |
$1,361.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,016.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.80
|
| Rate for Payer: Nomi Health Commercial |
$1,219.20
|
| Rate for Payer: PACE SWMI |
$1,016.00
|
| Rate for Payer: PHP Commercial |
$1,422.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,016.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,923.35
|
| Rate for Payer: Priority Health Medicare |
$1,016.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,016.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,016.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,361.14
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$717.46 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$961.40
|
| Rate for Payer: Aetna Medicare |
$746.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.14
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$717.46
|
| Rate for Payer: BCN Medicare Advantage |
$717.46
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$961.40
|
| Rate for Payer: Cofinity Commercial |
$1,033.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.33
|
| Rate for Payer: Nomi Health Commercial |
$860.95
|
| Rate for Payer: PACE SWMI |
$717.46
|
| Rate for Payer: PHP Commercial |
$1,004.44
|
| Rate for Payer: PHP Medicare Advantage |
$717.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$717.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.46
|
| Rate for Payer: UHC Medicare Advantage |
$717.46
|
| Rate for Payer: UMR Bronson Commercial |
$894.24
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Facility
|
IP
|
$1,944.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$855.36 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna American Axle |
$1,263.60
|
| Rate for Payer: Aetna Commercial |
$1,652.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,263.60
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,671.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,360.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.20
|
| Rate for Payer: Healthscope Commercial |
$1,749.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,360.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.40
|
| Rate for Payer: PHP Commercial |
$1,652.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health SBD |
$1,224.72
|
| Rate for Payer: UMR Bronson Commercial |
$855.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.00
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$717.46 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$961.40
|
| Rate for Payer: Aetna Medicare |
$746.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.14
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$717.46
|
| Rate for Payer: BCN Medicare Advantage |
$717.46
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$1,033.14
|
| Rate for Payer: Cofinity Commercial |
$961.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.33
|
| Rate for Payer: Nomi Health Commercial |
$860.95
|
| Rate for Payer: PACE SWMI |
$717.46
|
| Rate for Payer: PHP Commercial |
$1,004.44
|
| Rate for Payer: PHP Medicare Advantage |
$717.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$717.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.46
|
| Rate for Payer: UHC Medicare Advantage |
$717.46
|
| Rate for Payer: UMR Bronson Commercial |
$894.24
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Facility
|
OP
|
$1,944.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$719.28 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna American Axle |
$1,263.60
|
| Rate for Payer: Aetna Commercial |
$1,652.40
|
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,263.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,671.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,360.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$1,749.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,360.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.00
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.40
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$1,652.40
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health SBD |
$1,224.72
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: UMR Bronson Commercial |
$719.28
|
| Rate for Payer: VA VA |
$6,967.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.00
|
|
|
PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 27236
|
| Min. Negotiated Rate |
$1,148.90 |
| Max. Negotiated Rate |
$2,425.80 |
| Rate for Payer: Aetna Commercial |
$1,539.53
|
| Rate for Payer: Aetna Medicare |
$1,194.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,654.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,539.53
|
| Rate for Payer: BCBS Complete |
$1,492.80
|
| Rate for Payer: BCBS MAPPO |
$1,148.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,148.90
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cofinity Commercial |
$1,654.42
|
| Rate for Payer: Cofinity Commercial |
$1,539.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,148.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,206.35
|
| Rate for Payer: Nomi Health Commercial |
$1,378.68
|
| Rate for Payer: PACE SWMI |
$1,148.90
|
| Rate for Payer: PHP Commercial |
$1,608.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,148.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.80
|
| Rate for Payer: Priority Health Medicare |
$1,148.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,148.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,148.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,716.72
|
|
|
PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$4,215.00
|
|
|
Service Code
|
HCPCS 27506
|
| Min. Negotiated Rate |
$1,288.45 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Aetna Commercial |
$1,726.52
|
| Rate for Payer: Aetna Medicare |
$1,339.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,726.52
|
| Rate for Payer: BCBS Complete |
$1,686.00
|
| Rate for Payer: BCBS MAPPO |
$1,288.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,288.45
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cofinity Commercial |
$1,855.37
|
| Rate for Payer: Cofinity Commercial |
$1,726.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,288.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,352.87
|
| Rate for Payer: Nomi Health Commercial |
$1,546.14
|
| Rate for Payer: PACE SWMI |
$1,288.45
|
| Rate for Payer: PHP Commercial |
$1,803.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,288.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,739.75
|
| Rate for Payer: Priority Health Medicare |
$1,288.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,288.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,288.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,938.90
|
|
|
PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,848.00
|
|
|
Service Code
|
HCPCS 27507
|
| Min. Negotiated Rate |
$933.54 |
| Max. Negotiated Rate |
$2,501.20 |
| Rate for Payer: Aetna Commercial |
$1,250.94
|
| Rate for Payer: Aetna Medicare |
$970.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.94
|
| Rate for Payer: BCBS Complete |
$1,539.20
|
| Rate for Payer: BCBS MAPPO |
$933.54
|
| Rate for Payer: BCN Medicare Advantage |
$933.54
|
| Rate for Payer: Cash Price |
$3,078.40
|
| Rate for Payer: Cash Price |
$3,078.40
|
| Rate for Payer: Cofinity Commercial |
$1,344.30
|
| Rate for Payer: Cofinity Commercial |
$1,250.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.22
|
| Rate for Payer: Nomi Health Commercial |
$1,120.25
|
| Rate for Payer: PACE SWMI |
$933.54
|
| Rate for Payer: PHP Commercial |
$1,306.96
|
| Rate for Payer: PHP Medicare Advantage |
$933.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,501.20
|
| Rate for Payer: Priority Health Medicare |
$933.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.54
|
| Rate for Payer: UHC Medicare Advantage |
$933.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,770.08
|
|
|
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: Aetna New Business (MI Preferred) |
$1,087.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.63
|
| 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 Commercial |
$1,056.93
|
| Rate for Payer: PHP Medicare Advantage |
$754.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$754.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$754.95
|
| Rate for Payer: UHC Medicare Advantage |
$754.95
|
| Rate for Payer: UMR Bronson Commercial |
$638.48
|
|
|
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: Aetna New Business (MI Preferred) |
$1,763.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,640.68
|
| 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 Commercial |
$1,714.15
|
| 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 |
$1,224.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,224.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,224.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,631.16
|
|
|
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: Aetna New Business (MI Preferred) |
$1,305.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.46
|
| 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 Commercial |
$1,268.83
|
| 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 |
$906.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$906.31
|
| Rate for Payer: UHC Medicare Advantage |
$906.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.46
|
|
|
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: Aetna New Business (MI Preferred) |
$1,222.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,137.89
|
| 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 Commercial |
$1,188.84
|
| 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 |
$849.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.17
|
| Rate for Payer: UHC Medicare Advantage |
$849.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,422.32
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$1,211.64
|
|
|
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: Aetna New Business (MI Preferred) |
$1,312.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,410.72
|
| 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 |
$1,312.76
|
| Rate for Payer: Cofinity Commercial |
$1,410.72
|
| 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 Commercial |
$1,371.54
|
| 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 |
$979.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.67
|
| Rate for Payer: UHC Medicare Advantage |
$979.67
|
| Rate for Payer: UMR Bronson Commercial |
$944.84
|
|
|
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: Aetna New Business (MI Preferred) |
$1,088.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,012.60
|
| 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 Commercial |
$1,057.94
|
| 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 |
$755.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$755.67
|
| Rate for Payer: UHC Medicare Advantage |
$755.67
|
| Rate for Payer: UMR Bronson Commercial |
$741.98
|
|
|
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: Aetna New Business (MI Preferred) |
$1,242.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.75
|
| 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 Commercial |
$1,207.50
|
| 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 |
$862.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.50
|
| Rate for Payer: UHC Medicare Advantage |
$862.50
|
| Rate for Payer: UMR Bronson Commercial |
$733.70
|
|
|
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 |
$928.33 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna American Axle |
$1,630.85
|
| Rate for Payer: Aetna Commercial |
$2,132.65
|
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| 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: Cofinity Commercial |
$1,756.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,258.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,756.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,881.75
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.65
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$2,132.65
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health SBD |
$1,580.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: UMR Bronson Commercial |
$928.33
|
| Rate for Payer: VA VA |
$6,967.14
|
| 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: Aetna New Business (MI Preferred) |
$975.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.41
|
| 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 |
$1,048.41
|
| Rate for Payer: Cofinity Commercial |
$975.60
|
| 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 Commercial |
$1,019.28
|
| 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 |
$728.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,154.14
|
|
|
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 |
$1,103.96 |
| Max. Negotiated Rate |
$2,258.10 |
| Rate for Payer: Aetna American Axle |
$1,630.85
|
| Rate for Payer: Aetna Commercial |
$2,132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.85
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$1,756.30
|
| Rate for Payer: Cofinity Commercial |
$2,157.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.20
|
| Rate for Payer: Healthscope Commercial |
$2,258.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,756.30
|
| 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: PHP Commercial |
$2,132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health SBD |
$1,580.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,103.96
|
| 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
|
| 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: Aetna New Business (MI Preferred) |
$975.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.41
|
| 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 Commercial |
$1,019.28
|
| 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 |
$728.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,154.14
|
|
|
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: Aetna New Business (MI Preferred) |
$1,502.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.52
|
| 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 Commercial |
$1,461.14
|
| 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 |
$1,043.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,043.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,043.67
|
| Rate for Payer: UMR Bronson Commercial |
$895.62
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$1,802.74
|
|
|
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: Aetna New Business (MI Preferred) |
$1,405.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,510.44
|
| 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 |
$1,405.55
|
| Rate for Payer: Cofinity Commercial |
$1,510.44
|
| 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 Commercial |
$1,468.49
|
| 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 |
$1,048.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.92
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
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 |
$1,404.48 |
| Max. Negotiated Rate |
$2,872.80 |
| Rate for Payer: Aetna American Axle |
$2,074.80
|
| Rate for Payer: Aetna Commercial |
$2,713.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,074.80
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,234.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Healthscope Commercial |
$2,872.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,234.40
|
| 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: PHP Commercial |
$2,713.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health SBD |
$2,010.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,404.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,394.00
|
|
