|
PR OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD
|
Professional
|
Both
|
$3,842.00
|
|
|
Service Code
|
HCPCS 27218
|
| Min. Negotiated Rate |
$736.77 |
| Max. Negotiated Rate |
$2,689.40 |
| Rate for Payer: Aetna Commercial |
$1,541.82
|
| Rate for Payer: BCBS Complete |
$773.61
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: Cash Price |
$3,073.60
|
| Rate for Payer: Cash Price |
$3,073.60
|
| Rate for Payer: Meridian Medicaid |
$773.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,689.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,755.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,755.10
|
| Rate for Payer: Priority Health SBD |
$1,755.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,767.32
|
|
|
PR OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24587
|
| Min. Negotiated Rate |
$435.85 |
| Max. Negotiated Rate |
$1,667.79 |
| Rate for Payer: Aetna Commercial |
$1,453.71
|
| Rate for Payer: BCBS Complete |
$735.81
|
| Rate for Payer: BCBS Trust/PPO |
$435.85
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Meridian Medicaid |
$735.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$700.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,667.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,667.79
|
| Rate for Payer: Priority Health SBD |
$1,667.79
|
| Rate for Payer: UMR Bronson Commercial |
$874.00
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
IP
|
$3,129.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$1,376.76 |
| Max. Negotiated Rate |
$2,816.10 |
| Rate for Payer: Aetna American Axle |
$2,033.85
|
| Rate for Payer: Aetna Commercial |
$2,659.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,033.85
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cofinity Commercial |
$2,190.30
|
| Rate for Payer: Cofinity Commercial |
$2,690.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,503.20
|
| Rate for Payer: Healthscope Commercial |
$2,816.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,190.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,346.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,659.65
|
| Rate for Payer: PHP Commercial |
$2,659.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,190.30
|
| Rate for Payer: Priority Health SBD |
$1,971.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,376.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,346.75
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
OP
|
$3,129.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$877.22 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna American Axle |
$2,033.85
|
| Rate for Payer: Aetna Commercial |
$2,659.65
|
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,033.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,209.99
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cofinity Commercial |
$2,190.30
|
| Rate for Payer: Cofinity Commercial |
$2,690.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,503.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Healthscope Commercial |
$2,816.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,190.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,346.75
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,659.65
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Commercial |
$2,659.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,190.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Priority Health SBD |
$1,971.27
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$964.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$877.22
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,157.73
|
| Rate for Payer: VA VA |
$11,698.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,346.75
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,129.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$333.89 |
| Max. Negotiated Rate |
$2,190.30 |
| Rate for Payer: Aetna Commercial |
$1,179.32
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS Trust/PPO |
$333.89
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,190.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,356.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,356.79
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,439.34
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,129.00
|
|
|
Service Code
|
HCPCS 23615
|
| Min. Negotiated Rate |
$333.89 |
| Max. Negotiated Rate |
$2,190.30 |
| Rate for Payer: Aetna Commercial |
$1,179.32
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS Trust/PPO |
$333.89
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,190.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,356.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,356.79
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,439.34
|
|
|
PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT
|
Professional
|
Both
|
$2,330.00
|
|
|
Service Code
|
HCPCS 23616
|
| Min. Negotiated Rate |
$496.07 |
| Max. Negotiated Rate |
$1,890.42 |
| Rate for Payer: Aetna Commercial |
$1,651.81
|
| Rate for Payer: BCBS Complete |
$833.99
|
| Rate for Payer: BCBS Trust/PPO |
$496.07
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Meridian Medicaid |
$833.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$794.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,890.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,890.42
|
| Rate for Payer: Priority Health SBD |
$1,890.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,071.80
|
|
|
PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 27226
|
| Min. Negotiated Rate |
$558.94 |
| Max. Negotiated Rate |
$2,125.90 |
| Rate for Payer: Aetna Commercial |
$1,412.38
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS Trust/PPO |
$558.94
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,616.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,616.21
|
| Rate for Payer: Priority Health SBD |
$1,616.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,397.02
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$5,599.00
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$3,919.30 |
| Rate for Payer: Aetna Commercial |
$2,196.46
|
| Rate for Payer: BCBS Complete |
$1,127.65
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: Cash Price |
$4,479.20
|
| Rate for Payer: Cash Price |
$4,479.20
|
| Rate for Payer: Meridian Medicaid |
$1,127.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,073.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,919.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,545.59
|
| Rate for Payer: Priority Health Narrow Network |
$2,545.59
|
| Rate for Payer: Priority Health SBD |
$2,545.59
|
| Rate for Payer: UMR Bronson Commercial |
$2,575.54
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$10,531.00
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,190.67 |
| Max. Negotiated Rate |
$7,371.70 |
| Rate for Payer: Aetna Commercial |
$2,450.58
|
| Rate for Payer: BCBS Complete |
$1,250.20
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: Cash Price |
$8,424.80
|
| Rate for Payer: Cash Price |
$8,424.80
|
| Rate for Payer: Meridian Medicaid |
$1,250.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,190.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,371.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,825.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,825.94
|
| Rate for Payer: Priority Health SBD |
$2,825.94
|
| Rate for Payer: UMR Bronson Commercial |
$4,844.26
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$3,987.00
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$979.59 |
| Max. Negotiated Rate |
$2,790.90 |
| Rate for Payer: Aetna Commercial |
$2,012.34
|
| Rate for Payer: BCBS Complete |
$1,028.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.59
|
| Rate for Payer: Cash Price |
$3,189.60
|
| Rate for Payer: Cash Price |
$3,189.60
|
| Rate for Payer: Meridian Medicaid |
$1,028.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$979.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,790.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,327.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,327.03
|
| Rate for Payer: Priority Health SBD |
$2,327.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,834.02
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$950.50 |
| Rate for Payer: Aetna Commercial |
$380.05
|
| Rate for Payer: BCBS Complete |
$188.32
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Meridian Medicaid |
$188.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.48
|
| Rate for Payer: Priority Health Narrow Network |
$430.48
|
| Rate for Payer: Priority Health SBD |
$430.48
|
| Rate for Payer: UMR Bronson Commercial |
$528.08
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$3,668.00
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$957.44 |
| Max. Negotiated Rate |
$17,177.60 |
| Rate for Payer: Aetna Commercial |
$1,958.38
|
| Rate for Payer: BCBS Complete |
$1,005.31
|
| Rate for Payer: BCBS Trust/PPO |
$17,177.60
|
| Rate for Payer: Cash Price |
$2,934.40
|
| Rate for Payer: Cash Price |
$2,934.40
|
| Rate for Payer: Meridian Medicaid |
$1,005.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$957.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,567.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,270.34
|
| Rate for Payer: Priority Health Narrow Network |
$2,270.34
|
| Rate for Payer: Priority Health SBD |
$2,270.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,687.28
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$3,828.00
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$950.50 |
| Max. Negotiated Rate |
$2,679.60 |
| Rate for Payer: Aetna Commercial |
$2,041.44
|
| Rate for Payer: BCBS Complete |
$1,047.57
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: Cash Price |
$3,062.40
|
| Rate for Payer: Cash Price |
$3,062.40
|
| Rate for Payer: Meridian Medicaid |
$1,047.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$997.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,679.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,365.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,365.84
|
| Rate for Payer: Priority Health SBD |
$2,365.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,760.88
|
|
|
PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ
|
Professional
|
Both
|
$2,881.00
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$196.12 |
| Max. Negotiated Rate |
$2,016.70 |
| Rate for Payer: Aetna Commercial |
$1,162.77
|
| Rate for Payer: BCBS Complete |
$592.00
|
| Rate for Payer: BCBS Trust/PPO |
$196.12
|
| Rate for Payer: Cash Price |
$2,304.80
|
| Rate for Payer: Cash Price |
$2,304.80
|
| Rate for Payer: Meridian Medicaid |
$592.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$563.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,337.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,337.40
|
| Rate for Payer: Priority Health SBD |
$1,337.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,325.26
|
|
|
PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$1,427.27 |
| Rate for Payer: Aetna Commercial |
$1,237.80
|
| Rate for Payer: BCBS Complete |
$623.98
|
| Rate for Payer: BCBS Trust/PPO |
$228.81
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Meridian Medicaid |
$623.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,427.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,427.27
|
| Rate for Payer: Priority Health SBD |
$1,427.27
|
| Rate for Payer: UMR Bronson Commercial |
$746.58
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$595.12 |
| Max. Negotiated Rate |
$1,416.03 |
| Rate for Payer: Aetna Commercial |
$1,230.99
|
| Rate for Payer: BCBS Complete |
$624.88
|
| Rate for Payer: BCBS Trust/PPO |
$969.43
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Meridian Medicaid |
$624.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,130.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.03
|
| Rate for Payer: Priority Health SBD |
$1,416.03
|
| Rate for Payer: UMR Bronson Commercial |
$742.90
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$1,714.25 |
| Rate for Payer: Aetna Commercial |
$1,496.07
|
| Rate for Payer: BCBS Complete |
$757.06
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Meridian Medicaid |
$757.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,613.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,714.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,714.25
|
| Rate for Payer: Priority Health SBD |
$1,714.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.30
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$1,952.00
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$718.02 |
| Max. Negotiated Rate |
$1,708.64 |
| Rate for Payer: Aetna Commercial |
$1,490.05
|
| Rate for Payer: BCBS Complete |
$753.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.86
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Meridian Medicaid |
$753.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,708.64
|
| Rate for Payer: Priority Health SBD |
$1,708.64
|
| Rate for Payer: UMR Bronson Commercial |
$897.92
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$1,947.00
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$715.04 |
| Max. Negotiated Rate |
$2,598.71 |
| Rate for Payer: Aetna Commercial |
$1,486.20
|
| Rate for Payer: BCBS Complete |
$750.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,598.71
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Meridian Medicaid |
$750.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,701.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,701.48
|
| Rate for Payer: Priority Health SBD |
$1,701.48
|
| Rate for Payer: UMR Bronson Commercial |
$895.62
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,096.00
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$1,467.20 |
| Rate for Payer: Aetna Commercial |
$835.21
|
| Rate for Payer: BCBS Complete |
$428.06
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Meridian Medicaid |
$428.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,467.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$968.19
|
| Rate for Payer: Priority Health Narrow Network |
$968.19
|
| Rate for Payer: Priority Health SBD |
$968.19
|
| Rate for Payer: UMR Bronson Commercial |
$964.16
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$3,036.00
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$763.39 |
| Max. Negotiated Rate |
$2,125.20 |
| Rate for Payer: Aetna Commercial |
$1,583.28
|
| Rate for Payer: BCBS Complete |
$801.56
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Meridian Medicaid |
$801.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$763.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,815.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,815.36
|
| Rate for Payer: Priority Health SBD |
$1,815.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,396.56
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,516.00
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$578.72 |
| Max. Negotiated Rate |
$2,461.20 |
| Rate for Payer: Aetna Commercial |
$1,195.54
|
| Rate for Payer: BCBS Complete |
$607.66
|
| Rate for Payer: BCBS Trust/PPO |
$623.39
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Meridian Medicaid |
$607.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,461.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,375.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,375.69
|
| Rate for Payer: Priority Health SBD |
$1,375.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,617.36
|
|
|
PROPYLENE GLYCOL 1 %-GLYCERIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$26.80
|
|
|
Service Code
|
NDC 1011902003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna American Axle |
$17.42
|
| Rate for Payer: Aetna Commercial |
$22.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.42
|
| Rate for Payer: Cash Price |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.44
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.78
|
| Rate for Payer: PHP Commercial |
$22.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health SBD |
$16.88
|
| Rate for Payer: UMR Bronson Commercial |
$11.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.10
|
|
|
PROPYLPARABEN (BULK) CRYSTALS
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 3877915515
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.64
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
