|
PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 21390
|
| Min. Negotiated Rate |
$513.97 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$1,012.60
|
| Rate for Payer: Aetna Medicare |
$785.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,012.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,088.16
|
| Rate for Payer: BCBS Complete |
$539.67
|
| Rate for Payer: BCBS MAPPO |
$755.67
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$1,174.29
|
| 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 |
$1,012.60
|
| Rate for Payer: Cofinity Commercial |
$1,088.16
|
| 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: Meridian Medicaid |
$539.67
|
| 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 Choice Medicaid |
$513.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,048.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.39
|
| Rate for Payer: Priority Health Medicare |
$755.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,228.39
|
| Rate for Payer: Priority Health SBD |
$1,228.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$755.67
|
| Rate for Payer: UHC Medicare Advantage |
$755.67
|
| Rate for Payer: UHCCP Medicaid |
$513.97
|
| 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 |
$581.06 |
| Max. Negotiated Rate |
$1,376.98 |
| Rate for Payer: Aetna Commercial |
$1,155.75
|
| Rate for Payer: Aetna Medicare |
$897.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,242.00
|
| Rate for Payer: BCBS Complete |
$610.11
|
| Rate for Payer: BCBS MAPPO |
$862.50
|
| Rate for Payer: BCBS Trust/PPO |
$897.05
|
| Rate for Payer: BCN Commercial |
$1,310.63
|
| 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 |
$1,155.75
|
| Rate for Payer: Cofinity Commercial |
$1,242.00
|
| 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: Meridian Medicaid |
$610.11
|
| 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 Choice Medicaid |
$581.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,036.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,376.98
|
| Rate for Payer: Priority Health Medicare |
$862.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.98
|
| Rate for Payer: Priority Health SBD |
$1,376.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.50
|
| Rate for Payer: UHC Medicare Advantage |
$862.50
|
| Rate for Payer: UHCCP Medicaid |
$581.06
|
| 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 |
$731.13 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna American Axle |
$1,630.85
|
| Rate for Payer: Aetna Commercial |
$2,132.65
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,630.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,488.64
|
| Rate for Payer: BCN Commercial |
$6,488.64
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,007.20
|
| 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 |
$6,999.28
|
| 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 |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.65
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$2,132.65
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$1,580.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$804.24
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$731.13
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: UMR Bronson Commercial |
$928.33
|
| Rate for Payer: VA VA |
$6,999.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,881.75
|
|
|
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
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$491.82 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Cofinity Commercial |
$1,048.41
|
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Medicare |
$757.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.60
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS MAPPO |
$728.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$1,221.43
|
| 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: Health Alliance Plan Medicare Advantage |
$728.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.46
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| 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 Choice Medicaid |
$491.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,164.78
|
| Rate for Payer: Priority Health Medicare |
$728.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.78
|
| Rate for Payer: Priority Health SBD |
$1,164.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,154.14
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 27524
|
| Min. Negotiated Rate |
$491.82 |
| 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) |
$1,048.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.60
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS MAPPO |
$728.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$1,221.43
|
| 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: Meridian Medicaid |
$516.41
|
| 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 Choice Medicaid |
$491.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,164.78
|
| Rate for Payer: Priority Health Medicare |
$728.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.78
|
| Rate for Payer: Priority Health SBD |
$1,164.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
| 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 |
$194.94 |
| Max. Negotiated Rate |
$1,670.59 |
| Rate for Payer: Aetna Commercial |
$1,398.52
|
| Rate for Payer: Aetna Medicare |
$1,085.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,502.88
|
| Rate for Payer: BCBS Complete |
$737.82
|
| Rate for Payer: BCBS MAPPO |
$1,043.67
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Commercial |
$1,593.09
|
| 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: Meridian Medicaid |
$737.82
|
| 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 Choice Medicaid |
$702.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,670.59
|
| Rate for Payer: Priority Health Medicare |
$1,043.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,670.59
|
| Rate for Payer: Priority Health SBD |
$1,670.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,043.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,043.67
|
| Rate for Payer: UHCCP Medicaid |
$702.69
|
| 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 |
$738.90 |
| Max. Negotiated Rate |
$2,547.35 |
| Rate for Payer: Aetna Commercial |
$1,541.82
|
| Rate for Payer: Aetna Medicare |
$1,959.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,541.82
|
| Rate for Payer: BCBS Complete |
$775.84
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: BCN Commercial |
$1,679.59
|
| Rate for Payer: Cash Price |
$3,135.20
|
| Rate for Payer: Cash Price |
$3,135.20
|
| Rate for Payer: Meridian Medicaid |
$775.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$738.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,547.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,760.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,760.14
|
| Rate for Payer: Priority Health SBD |
$1,760.14
|
| Rate for Payer: UHCCP Medicaid |
$738.90
|
| 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 |
$435.85 |
| Max. Negotiated Rate |
$1,674.15 |
| 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 |
$740.95
|
| Rate for Payer: BCBS MAPPO |
$1,048.92
|
| Rate for Payer: BCBS Trust/PPO |
$435.85
|
| Rate for Payer: BCN Commercial |
$1,596.02
|
| 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: Meridian Medicaid |
$740.95
|
| 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 Choice Medicaid |
$705.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,674.15
|
| Rate for Payer: Priority Health Medicare |
$1,048.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,674.15
|
| Rate for Payer: Priority Health SBD |
$1,674.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.92
|
| Rate for Payer: UHCCP Medicaid |
$705.67
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$333.89 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$886.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.31
|
| Rate for Payer: BCBS Complete |
$604.31
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCBS Trust/PPO |
$333.89
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.92
|
| Rate for Payer: Meridian Medicaid |
$604.31
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Commercial |
$1,193.22
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.23
|
| Rate for Payer: Priority Health Medicare |
$852.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,363.23
|
| Rate for Payer: Priority Health SBD |
$1,363.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
| Rate for Payer: UHCCP Medicaid |
$575.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,468.32
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Min. Negotiated Rate |
$333.89 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$886.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.31
|
| Rate for Payer: BCBS Complete |
$604.31
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCBS Trust/PPO |
$333.89
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.92
|
| Rate for Payer: Meridian Medicaid |
$604.31
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Commercial |
$1,193.22
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.23
|
| Rate for Payer: Priority Health Medicare |
$852.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,363.23
|
| Rate for Payer: Priority Health SBD |
$1,363.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
| Rate for Payer: UHCCP Medicaid |
$575.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,468.32
|
|
|
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
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$856.18 |
| Max. Negotiated Rate |
$39,622.51 |
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Aetna American Axle |
$2,074.80
|
| Rate for Payer: Aetna Commercial |
$2,713.20
|
| Rate for Payer: Aetna Medicare |
$13,110.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,074.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,561.93
|
| Rate for Payer: BCN Commercial |
$7,561.93
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| 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: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| 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: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: Nomi Health Commercial |
$26,473.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Commercial |
$2,713.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,622.51
|
| Rate for Payer: Priority Health Narrow Network |
$31,698.01
|
| Rate for Payer: Priority Health SBD |
$2,010.96
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.80
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$856.18
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$6,757.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,181.04
|
| Rate for Payer: VA VA |
$12,606.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,394.00
|
|
|
PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT
|
Professional
|
Both
|
$2,377.00
|
|
|
Service Code
|
HCPCS 23616
|
| Min. Negotiated Rate |
$496.07 |
| Max. Negotiated Rate |
$1,897.54 |
| Rate for Payer: Aetna Commercial |
$1,592.67
|
| Rate for Payer: Aetna Medicare |
$1,236.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,592.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.53
|
| Rate for Payer: BCBS Complete |
$838.47
|
| Rate for Payer: BCBS MAPPO |
$1,188.56
|
| Rate for Payer: BCBS Trust/PPO |
$496.07
|
| Rate for Payer: BCN Commercial |
$1,809.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,188.56
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cofinity Commercial |
$1,592.67
|
| Rate for Payer: Cofinity Commercial |
$1,711.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,188.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.99
|
| Rate for Payer: Meridian Medicaid |
$838.47
|
| Rate for Payer: Nomi Health Commercial |
$1,426.27
|
| Rate for Payer: PACE SWMI |
$1,188.56
|
| Rate for Payer: PHP Commercial |
$1,663.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,188.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,545.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,897.54
|
| Rate for Payer: Priority Health Medicare |
$1,188.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,897.54
|
| Rate for Payer: Priority Health SBD |
$1,897.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,188.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,188.56
|
| Rate for Payer: UHCCP Medicaid |
$798.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,093.42
|
|
|
PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ
|
Professional
|
Both
|
$3,098.00
|
|
|
Service Code
|
HCPCS 27226
|
| Min. Negotiated Rate |
$558.94 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,360.42
|
| Rate for Payer: Aetna Medicare |
$1,055.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,360.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.95
|
| Rate for Payer: BCBS Complete |
$716.13
|
| Rate for Payer: BCBS MAPPO |
$1,015.24
|
| Rate for Payer: BCBS Trust/PPO |
$558.94
|
| Rate for Payer: BCN Commercial |
$1,546.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,015.24
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cofinity Commercial |
$1,360.42
|
| Rate for Payer: Cofinity Commercial |
$1,461.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,015.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.00
|
| Rate for Payer: Meridian Medicaid |
$716.13
|
| Rate for Payer: Nomi Health Commercial |
$1,218.29
|
| Rate for Payer: PACE SWMI |
$1,015.24
|
| Rate for Payer: PHP Commercial |
$1,421.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,015.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,625.30
|
| Rate for Payer: Priority Health Medicare |
$1,015.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,625.30
|
| Rate for Payer: Priority Health SBD |
$1,625.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,015.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,015.24
|
| Rate for Payer: UHCCP Medicaid |
$682.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,425.08
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$2,540.00
|
|
|
Service Code
|
HCPCS 25575
|
| Min. Negotiated Rate |
$590.86 |
| Max. Negotiated Rate |
$1,676.82 |
| Rate for Payer: Aetna Commercial |
$1,170.48
|
| Rate for Payer: Aetna Medicare |
$908.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,257.83
|
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: BCBS MAPPO |
$873.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.82
|
| Rate for Payer: BCN Commercial |
$1,331.16
|
| Rate for Payer: BCN Medicare Advantage |
$873.49
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cofinity Commercial |
$1,170.48
|
| Rate for Payer: Cofinity Commercial |
$1,257.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.16
|
| Rate for Payer: Meridian Medicaid |
$620.40
|
| Rate for Payer: Nomi Health Commercial |
$1,048.19
|
| Rate for Payer: PACE SWMI |
$873.49
|
| Rate for Payer: PHP Commercial |
$1,222.89
|
| Rate for Payer: PHP Medicare Advantage |
$873.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,398.35
|
| Rate for Payer: Priority Health Medicare |
$873.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,398.35
|
| Rate for Payer: Priority Health SBD |
$1,398.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.49
|
| Rate for Payer: UHC Medicare Advantage |
$873.49
|
| Rate for Payer: UHCCP Medicaid |
$590.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,168.40
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 25574
|
| Min. Negotiated Rate |
$444.11 |
| Max. Negotiated Rate |
$4,249.65 |
| Rate for Payer: Aetna Commercial |
$877.12
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.58
|
| Rate for Payer: BCBS Complete |
$466.32
|
| Rate for Payer: BCBS MAPPO |
$654.57
|
| Rate for Payer: BCBS Trust/PPO |
$4,249.65
|
| Rate for Payer: BCN Commercial |
$998.86
|
| Rate for Payer: BCN Medicare Advantage |
$654.57
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cofinity Commercial |
$877.12
|
| Rate for Payer: Cofinity Commercial |
$942.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.30
|
| Rate for Payer: Meridian Medicaid |
$466.32
|
| Rate for Payer: Nomi Health Commercial |
$785.48
|
| Rate for Payer: PACE SWMI |
$654.57
|
| Rate for Payer: PHP Commercial |
$916.40
|
| Rate for Payer: PHP Medicare Advantage |
$654.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,215.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.27
|
| Rate for Payer: Priority Health Medicare |
$654.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,049.27
|
| Rate for Payer: Priority Health SBD |
$1,049.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.57
|
| Rate for Payer: UHC Medicare Advantage |
$654.57
|
| Rate for Payer: UHCCP Medicaid |
$444.11
|
| Rate for Payer: UMR Bronson Commercial |
$860.20
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$5,711.00
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$3,712.15 |
| Rate for Payer: Aetna Commercial |
$2,184.88
|
| Rate for Payer: Aetna Medicare |
$1,695.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,184.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.93
|
| Rate for Payer: BCBS Complete |
$1,130.56
|
| Rate for Payer: BCBS MAPPO |
$1,630.51
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$2,682.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,630.51
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cofinity Commercial |
$2,184.88
|
| Rate for Payer: Cofinity Commercial |
$2,347.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,630.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,712.04
|
| Rate for Payer: Meridian Medicaid |
$1,130.56
|
| Rate for Payer: Nomi Health Commercial |
$1,956.61
|
| Rate for Payer: PACE SWMI |
$1,630.51
|
| Rate for Payer: PHP Commercial |
$2,282.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,630.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,076.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,565.68
|
| Rate for Payer: Priority Health Medicare |
$1,630.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,565.68
|
| Rate for Payer: Priority Health SBD |
$2,565.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,630.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,630.51
|
| Rate for Payer: UHCCP Medicaid |
$1,076.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,627.06
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$10,742.00
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,196.21 |
| Max. Negotiated Rate |
$6,982.30 |
| Rate for Payer: Aetna Commercial |
$2,433.61
|
| Rate for Payer: Aetna Medicare |
$1,888.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,433.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,615.23
|
| Rate for Payer: BCBS Complete |
$1,256.02
|
| Rate for Payer: BCBS MAPPO |
$1,816.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: BCN Commercial |
$2,704.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,816.13
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cofinity Commercial |
$2,433.61
|
| Rate for Payer: Cofinity Commercial |
$2,615.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,816.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,906.94
|
| Rate for Payer: Meridian Medicaid |
$1,256.02
|
| Rate for Payer: Nomi Health Commercial |
$2,179.36
|
| Rate for Payer: PACE SWMI |
$1,816.13
|
| Rate for Payer: PHP Commercial |
$2,542.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,816.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,982.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,844.53
|
| Rate for Payer: Priority Health Medicare |
$1,816.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,844.53
|
| Rate for Payer: Priority Health SBD |
$2,844.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,816.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,816.13
|
| Rate for Payer: UHCCP Medicaid |
$1,196.21
|
| Rate for Payer: UMR Bronson Commercial |
$4,941.32
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$4,067.00
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$984.70 |
| 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: Aetna New Business (MI Preferred) |
$1,989.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.78
|
| Rate for Payer: BCBS Complete |
$1,033.94
|
| Rate for Payer: BCBS MAPPO |
$1,484.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.59
|
| Rate for Payer: BCN Commercial |
$2,452.00
|
| 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 |
$1,989.32
|
| Rate for Payer: Cofinity Commercial |
$2,137.78
|
| 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: Meridian Medicaid |
$1,033.94
|
| Rate for Payer: Nomi Health Commercial |
$1,781.48
|
| Rate for Payer: PACE SWMI |
$1,484.57
|
| Rate for Payer: PHP Commercial |
$2,078.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,484.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$984.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,643.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,340.25
|
| Rate for Payer: Priority Health Medicare |
$1,484.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,340.25
|
| Rate for Payer: Priority Health SBD |
$2,340.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,484.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.57
|
| Rate for Payer: UHCCP Medicaid |
$984.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,870.82
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$180.84 |
| Max. Negotiated Rate |
$950.50 |
| Rate for Payer: Aetna Commercial |
$370.93
|
| Rate for Payer: Aetna Medicare |
$287.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.61
|
| Rate for Payer: BCBS Complete |
$189.88
|
| Rate for Payer: BCBS MAPPO |
$276.81
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$453.59
|
| 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 |
$370.93
|
| Rate for Payer: Cofinity Commercial |
$398.61
|
| 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: Meridian Medicaid |
$189.88
|
| Rate for Payer: Nomi Health Commercial |
$332.17
|
| Rate for Payer: PACE SWMI |
$276.81
|
| Rate for Payer: PHP Commercial |
$387.53
|
| Rate for Payer: PHP Medicare Advantage |
$276.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.46
|
| Rate for Payer: Priority Health Medicare |
$276.81
|
| Rate for Payer: Priority Health Narrow Network |
$428.46
|
| Rate for Payer: Priority Health SBD |
$428.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.81
|
| Rate for Payer: UHC Medicare Advantage |
$276.81
|
| Rate for Payer: UHCCP Medicaid |
$180.84
|
| Rate for Payer: UMR Bronson Commercial |
$538.66
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$3,741.00
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$966.38 |
| Max. Negotiated Rate |
$17,177.60 |
| Rate for Payer: Aetna Commercial |
$1,945.84
|
| Rate for Payer: Aetna Medicare |
$1,510.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,091.05
|
| Rate for Payer: BCBS Complete |
$1,014.70
|
| Rate for Payer: BCBS MAPPO |
$1,452.12
|
| Rate for Payer: BCBS Trust/PPO |
$17,177.60
|
| Rate for Payer: BCN Commercial |
$2,172.66
|
| 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 |
$1,945.84
|
| Rate for Payer: Cofinity Commercial |
$2,091.05
|
| 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: Meridian Medicaid |
$1,014.70
|
| Rate for Payer: Nomi Health Commercial |
$1,742.54
|
| Rate for Payer: PACE SWMI |
$1,452.12
|
| Rate for Payer: PHP Commercial |
$2,032.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,452.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$966.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,287.32
|
| Rate for Payer: Priority Health Medicare |
$1,452.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,287.32
|
| Rate for Payer: Priority Health SBD |
$2,287.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,452.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,452.12
|
| Rate for Payer: UHCCP Medicaid |
$966.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,720.86
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$3,905.00
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$950.50 |
| 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: Aetna New Business (MI Preferred) |
$2,022.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,173.31
|
| Rate for Payer: BCBS Complete |
$1,053.84
|
| Rate for Payer: BCBS MAPPO |
$1,509.24
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$2,264.04
|
| 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 |
$2,022.38
|
| Rate for Payer: Cofinity Commercial |
$2,173.31
|
| 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: Meridian Medicaid |
$1,053.84
|
| Rate for Payer: Nomi Health Commercial |
$1,811.09
|
| Rate for Payer: PACE SWMI |
$1,509.24
|
| Rate for Payer: PHP Commercial |
$2,112.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,509.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,538.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,383.51
|
| Rate for Payer: Priority Health Medicare |
$1,509.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,383.51
|
| Rate for Payer: Priority Health SBD |
$2,383.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,509.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,509.24
|
| Rate for Payer: UHCCP Medicaid |
$1,003.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,796.30
|
|
|
PR OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 25525
|
| Min. Negotiated Rate |
$517.59 |
| Max. Negotiated Rate |
$1,676.35 |
| Rate for Payer: Aetna Commercial |
$1,024.19
|
| Rate for Payer: Aetna Medicare |
$794.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.62
|
| Rate for Payer: BCBS Complete |
$543.47
|
| Rate for Payer: BCBS MAPPO |
$764.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.84
|
| Rate for Payer: BCN Commercial |
$1,166.47
|
| 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 |
$1,024.19
|
| Rate for Payer: Cofinity Commercial |
$1,100.62
|
| 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: Meridian Medicaid |
$543.47
|
| Rate for Payer: Nomi Health Commercial |
$917.18
|
| Rate for Payer: PACE SWMI |
$764.32
|
| Rate for Payer: PHP Commercial |
$1,070.05
|
| Rate for Payer: PHP Medicare Advantage |
$764.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,225.33
|
| Rate for Payer: Priority Health Medicare |
$764.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,225.33
|
| Rate for Payer: Priority Health SBD |
$1,225.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$764.32
|
| Rate for Payer: UHC Medicare Advantage |
$764.32
|
| Rate for Payer: UHCCP Medicaid |
$517.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,186.34
|
|
|
PR OPTX RDL SHAFT FX&OPTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25526
|
| Min. Negotiated Rate |
$623.88 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna Commercial |
$1,237.61
|
| Rate for Payer: Aetna Medicare |
$960.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,329.97
|
| Rate for Payer: BCBS Complete |
$655.07
|
| Rate for Payer: BCBS MAPPO |
$923.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.05
|
| Rate for Payer: BCN Commercial |
$1,406.91
|
| 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 |
$1,237.61
|
| Rate for Payer: Cofinity Commercial |
$1,329.97
|
| 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: Meridian Medicaid |
$655.07
|
| Rate for Payer: Nomi Health Commercial |
$1,108.31
|
| Rate for Payer: PACE SWMI |
$923.59
|
| Rate for Payer: PHP Commercial |
$1,293.03
|
| Rate for Payer: PHP Medicare Advantage |
$923.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,478.24
|
| Rate for Payer: Priority Health Medicare |
$923.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,478.24
|
| Rate for Payer: Priority Health SBD |
$1,478.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.59
|
| Rate for Payer: UHC Medicare Advantage |
$923.59
|
| Rate for Payer: UHCCP Medicaid |
$623.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,368.50
|
|
