|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,073.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$537.61 |
| Max. Negotiated Rate |
$2,151.10 |
| Rate for Payer: Aetna Commercial |
$1,119.55
|
| Rate for Payer: BCBS Complete |
$564.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.65
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Meridian Medicaid |
$564.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$537.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,279.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,279.68
|
| Rate for Payer: Priority Health SBD |
$1,279.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,413.58
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,175.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$2,222.50 |
| Rate for Payer: Aetna Commercial |
$833.37
|
| Rate for Payer: BCBS Complete |
$425.39
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Meridian Medicaid |
$425.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,222.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$962.57
|
| Rate for Payer: Priority Health Narrow Network |
$962.57
|
| Rate for Payer: Priority Health SBD |
$962.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,460.50
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,413.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$745.07 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,539.08
|
| Rate for Payer: BCBS Complete |
$782.32
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: Cash Price |
$1,930.40
|
| Rate for Payer: Cash Price |
$1,930.40
|
| Rate for Payer: Meridian Medicaid |
$782.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,689.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,768.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,768.38
|
| Rate for Payer: Priority Health SBD |
$1,768.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,109.98
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,373.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$1,661.10 |
| Rate for Payer: Aetna Commercial |
$1,100.22
|
| Rate for Payer: BCBS Complete |
$564.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.36
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Meridian Medicaid |
$564.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$537.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,275.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,275.09
|
| Rate for Payer: Priority Health SBD |
$1,275.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,091.58
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG
|
Professional
|
Both
|
$2,901.00
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$2,030.70 |
| Rate for Payer: Aetna Commercial |
$1,398.32
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS Trust/PPO |
$166.94
|
| Rate for Payer: Cash Price |
$2,320.80
|
| Rate for Payer: Cash Price |
$2,320.80
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,030.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,616.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,616.72
|
| Rate for Payer: Priority Health SBD |
$1,616.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,334.46
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,906.00
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$1,334.20 |
| Rate for Payer: Aetna Commercial |
$981.85
|
| Rate for Payer: BCBS Complete |
$505.45
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Meridian Medicaid |
$505.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: Priority Health SBD |
$1,142.33
|
| Rate for Payer: UMR Bronson Commercial |
$876.76
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$705.22 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna American Axle |
$1,238.90
|
| Rate for Payer: Aetna Commercial |
$1,620.10
|
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,942.51
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,334.20
|
| Rate for Payer: Cofinity Commercial |
$1,639.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$1,715.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,334.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,429.50
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$1,620.10
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Priority Health SBD |
$1,200.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$740.02
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: UMR Bronson Commercial |
$705.22
|
| Rate for Payer: VA VA |
$6,359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,429.50
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,906.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$1,334.20 |
| Rate for Payer: Aetna Commercial |
$981.85
|
| Rate for Payer: BCBS Complete |
$505.45
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Meridian Medicaid |
$505.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: Priority Health SBD |
$1,142.33
|
| Rate for Payer: UMR Bronson Commercial |
$876.76
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$838.64 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Aetna American Axle |
$1,238.90
|
| Rate for Payer: Aetna Commercial |
$1,620.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.90
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,334.20
|
| Rate for Payer: Cofinity Commercial |
$1,639.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Healthscope Commercial |
$1,715.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,334.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,429.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PHP Commercial |
$1,620.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health SBD |
$1,200.78
|
| Rate for Payer: UMR Bronson Commercial |
$838.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,429.50
|
|
|
PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 27236
|
| Min. Negotiated Rate |
$766.59 |
| Max. Negotiated Rate |
$2,561.30 |
| Rate for Payer: Aetna Commercial |
$1,594.63
|
| Rate for Payer: BCBS Complete |
$804.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.77
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Meridian Medicaid |
$804.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,561.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,823.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,823.02
|
| Rate for Payer: Priority Health SBD |
$1,823.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,683.14
|
|
|
PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$4,132.00
|
|
|
Service Code
|
HCPCS 27506
|
| Min. Negotiated Rate |
$763.92 |
| Max. Negotiated Rate |
$2,892.40 |
| Rate for Payer: Aetna Commercial |
$1,786.48
|
| Rate for Payer: BCBS Complete |
$902.20
|
| Rate for Payer: BCBS Trust/PPO |
$763.92
|
| Rate for Payer: Cash Price |
$3,305.60
|
| Rate for Payer: Cash Price |
$3,305.60
|
| Rate for Payer: Meridian Medicaid |
$902.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,892.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,045.15
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.15
|
| Rate for Payer: Priority Health SBD |
$2,045.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,900.72
|
|
|
PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
HCPCS 27507
|
| Min. Negotiated Rate |
$621.11 |
| Max. Negotiated Rate |
$2,641.10 |
| Rate for Payer: Aetna Commercial |
$1,296.79
|
| Rate for Payer: BCBS Complete |
$652.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.62
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Meridian Medicaid |
$652.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,480.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,480.37
|
| Rate for Payer: Priority Health SBD |
$1,480.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,735.58
|
|
|
PR OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 23630
|
| Min. Negotiated Rate |
$265.21 |
| Max. Negotiated Rate |
$1,201.57 |
| Rate for Payer: Aetna Commercial |
$1,039.57
|
| Rate for Payer: BCBS Complete |
$531.39
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Meridian Medicaid |
$531.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$506.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,201.57
|
| Rate for Payer: Priority Health SBD |
$1,201.57
|
| Rate for Payer: UMR Bronson Commercial |
$626.06
|
|
|
PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD
|
Professional
|
Both
|
$3,476.00
|
|
|
Service Code
|
HCPCS 27254
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$2,549.58 |
| Rate for Payer: Aetna Commercial |
$1,702.05
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,549.58
|
| Rate for Payer: Cash Price |
$2,780.80
|
| Rate for Payer: Cash Price |
$2,780.80
|
| Rate for Payer: Meridian Medicaid |
$856.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,433.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,943.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,943.03
|
| Rate for Payer: Priority Health SBD |
$1,943.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,598.96
|
|
|
PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
HCPCS 27253
|
| Min. Negotiated Rate |
$604.92 |
| Max. Negotiated Rate |
$2,442.33 |
| Rate for Payer: Aetna Commercial |
$1,258.60
|
| Rate for Payer: BCBS Complete |
$635.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,442.33
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Meridian Medicaid |
$635.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$604.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,613.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,441.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,441.06
|
| Rate for Payer: Priority Health SBD |
$1,441.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.30
|
|
|
PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$3,031.00
|
|
|
Service Code
|
HCPCS 24515
|
| Min. Negotiated Rate |
$338.11 |
| Max. Negotiated Rate |
$2,121.70 |
| Rate for Payer: Aetna Commercial |
$1,174.12
|
| Rate for Payer: BCBS Complete |
$597.60
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: Cash Price |
$2,424.80
|
| Rate for Payer: Cash Price |
$2,424.80
|
| Rate for Payer: Meridian Medicaid |
$597.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$569.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,354.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,354.25
|
| Rate for Payer: Priority Health SBD |
$1,354.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,394.26
|
|
|
PR OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 27215
|
| Min. Negotiated Rate |
$387.02 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$803.86
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.81
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$921.22
|
| Rate for Payer: Priority Health Narrow Network |
$921.22
|
| Rate for Payer: Priority Health SBD |
$921.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,187.72
|
|
|
PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN
|
Professional
|
Both
|
$2,014.00
|
|
|
Service Code
|
HCPCS 21347
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$1,596.80 |
| Rate for Payer: Aetna Commercial |
$1,362.92
|
| Rate for Payer: BCBS Complete |
$697.79
|
| Rate for Payer: BCBS Trust/PPO |
$86.11
|
| Rate for Payer: Cash Price |
$1,611.20
|
| Rate for Payer: Cash Price |
$1,611.20
|
| Rate for Payer: Meridian Medicaid |
$697.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$664.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,596.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,596.80
|
| Rate for Payer: Priority Health SBD |
$1,596.80
|
| Rate for Payer: UMR Bronson Commercial |
$926.44
|
|
|
PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS 21390
|
| Min. Negotiated Rate |
$514.18 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$1,059.79
|
| Rate for Payer: BCBS Complete |
$539.89
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Meridian Medicaid |
$539.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$514.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,227.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,227.09
|
| Rate for Payer: Priority Health SBD |
$1,227.09
|
| Rate for Payer: UMR Bronson Commercial |
$727.26
|
|
|
PR OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 27566
|
| Min. Negotiated Rate |
$576.38 |
| Max. Negotiated Rate |
$1,369.56 |
| Rate for Payer: Aetna Commercial |
$1,193.01
|
| Rate for Payer: BCBS Complete |
$605.20
|
| Rate for Payer: BCBS Trust/PPO |
$897.05
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Meridian Medicaid |
$605.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,369.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,369.56
|
| Rate for Payer: Priority Health SBD |
$1,369.56
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,460.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$487.56 |
| Max. Negotiated Rate |
$1,722.00 |
| Rate for Payer: Aetna Commercial |
$1,005.26
|
| Rate for Payer: BCBS Complete |
$511.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Meridian Medicaid |
$511.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,159.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.18
|
| Rate for Payer: Priority Health SBD |
$1,159.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,131.60
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,460.00
|
|
|
Service Code
|
HCPCS 27524
|
| Min. Negotiated Rate |
$487.56 |
| Max. Negotiated Rate |
$1,722.00 |
| Rate for Payer: Aetna Commercial |
$1,005.26
|
| Rate for Payer: BCBS Complete |
$511.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Meridian Medicaid |
$511.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,159.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.18
|
| Rate for Payer: Priority Health SBD |
$1,159.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,131.60
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Facility
|
IP
|
$2,460.00
|
|
|
Service Code
|
CPT 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$1,082.40 |
| Max. Negotiated Rate |
$2,214.00 |
| Rate for Payer: Aetna American Axle |
$1,599.00
|
| Rate for Payer: Aetna Commercial |
$2,091.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$1,722.00
|
| Rate for Payer: Cofinity Commercial |
$2,115.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,968.00
|
| Rate for Payer: Healthscope Commercial |
$2,214.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,722.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,845.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,091.00
|
| Rate for Payer: PHP Commercial |
$2,091.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.00
|
| Rate for Payer: Priority Health SBD |
$1,549.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,082.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,845.00
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Facility
|
OP
|
$2,460.00
|
|
|
Service Code
|
CPT 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$749.51 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna American Axle |
$1,599.00
|
| Rate for Payer: Aetna Commercial |
$2,091.00
|
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,599.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$6,186.65
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$1,722.00
|
| Rate for Payer: Cofinity Commercial |
$2,115.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,968.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$2,214.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,722.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,845.00
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,091.00
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$2,091.00
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Priority Health SBD |
$1,549.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$749.51
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: UMR Bronson Commercial |
$910.20
|
| Rate for Payer: VA VA |
$6,359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,845.00
|
|
|
PR OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO
|
Professional
|
Both
|
$1,909.00
|
|
|
Service Code
|
HCPCS 24586
|
| Min. Negotiated Rate |
$194.94 |
| Max. Negotiated Rate |
$1,664.71 |
| Rate for Payer: Aetna Commercial |
$1,452.52
|
| Rate for Payer: BCBS Complete |
$734.24
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Meridian Medicaid |
$734.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$699.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,664.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,664.71
|
| Rate for Payer: Priority Health SBD |
$1,664.71
|
| Rate for Payer: UMR Bronson Commercial |
$878.14
|
|
