|
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 |
$1,334.20 |
| Max. Negotiated Rate |
$1,906.00 |
| Rate for Payer: Aetna Commercial |
$1,715.40
|
| Rate for Payer: ASR ASR |
$1,848.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.72
|
| Rate for Payer: BCN Commercial |
$1,477.72
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,791.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Healthscope Commercial |
$1,906.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,848.82
|
| Rate for Payer: Mclaren Commercial |
$1,715.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,677.28
|
|
|
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 |
$1,574.14
|
| Rate for Payer: Aetna Medicare |
$1,174.73
|
| Rate for Payer: BCBS Complete |
$804.92
|
| Rate for Payer: BCBS MAPPO |
$1,174.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.77
|
| Rate for Payer: BCN Commercial |
$1,920.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,174.73
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Cash Price |
$2,927.20
|
| Rate for Payer: Cofinity Commercial |
$1,574.14
|
| Rate for Payer: Cofinity Commercial |
$1,691.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,174.73
|
| Rate for Payer: Healthscope Commercial |
$1,409.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,409.68
|
| Rate for Payer: Meridian Medicaid |
$804.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,233.47
|
| Rate for Payer: PACE SWMI |
$1,174.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,174.73
|
| 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 Medicare |
$1,174.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,823.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,209.97
|
|
|
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 |
$1,765.62
|
| Rate for Payer: Aetna Medicare |
$1,317.63
|
| Rate for Payer: BCBS Complete |
$902.20
|
| Rate for Payer: BCBS MAPPO |
$1,317.63
|
| Rate for Payer: BCBS Trust/PPO |
$763.92
|
| Rate for Payer: BCN Commercial |
$2,154.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,317.63
|
| Rate for Payer: Cash Price |
$3,305.60
|
| Rate for Payer: Cash Price |
$3,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,897.39
|
| Rate for Payer: Cofinity Commercial |
$1,765.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,317.63
|
| Rate for Payer: Healthscope Commercial |
$1,581.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,581.16
|
| Rate for Payer: Meridian Medicaid |
$902.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,383.51
|
| Rate for Payer: PACE SWMI |
$1,317.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,317.63
|
| 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 Medicare |
$1,317.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,357.16
|
|
|
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 |
$1,279.42
|
| Rate for Payer: Aetna Medicare |
$954.79
|
| Rate for Payer: BCBS Complete |
$652.17
|
| Rate for Payer: BCBS MAPPO |
$954.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.62
|
| Rate for Payer: BCN Commercial |
$1,416.67
|
| Rate for Payer: BCN Medicare Advantage |
$954.79
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cash Price |
$3,018.40
|
| Rate for Payer: Cofinity Commercial |
$1,374.90
|
| Rate for Payer: Cofinity Commercial |
$1,279.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$954.79
|
| Rate for Payer: Healthscope Commercial |
$1,145.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.75
|
| Rate for Payer: Meridian Medicaid |
$652.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,002.53
|
| Rate for Payer: PACE SWMI |
$954.79
|
| Rate for Payer: PHP Medicare Advantage |
$954.79
|
| 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 Medicare |
$954.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,480.37
|
| Rate for Payer: UHC Medicare Advantage |
$983.43
|
|
|
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 |
$1,031.60
|
| Rate for Payer: Aetna Medicare |
$769.85
|
| Rate for Payer: BCBS Complete |
$531.39
|
| Rate for Payer: BCBS MAPPO |
$769.85
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCN Commercial |
$1,149.86
|
| Rate for Payer: BCN Medicare Advantage |
$769.85
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cofinity Commercial |
$1,108.58
|
| Rate for Payer: Cofinity Commercial |
$1,031.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.85
|
| Rate for Payer: Healthscope Commercial |
$923.82
|
| Rate for Payer: Healthscope Whirlpool |
$923.82
|
| Rate for Payer: Meridian Medicaid |
$531.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$808.34
|
| Rate for Payer: PACE SWMI |
$769.85
|
| Rate for Payer: PHP Medicare Advantage |
$769.85
|
| 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 Medicare |
$769.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,201.57
|
| Rate for Payer: UHC Medicare Advantage |
$792.95
|
|
|
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 |
$1,678.97
|
| Rate for Payer: Aetna Medicare |
$1,252.96
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS MAPPO |
$1,252.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,549.58
|
| Rate for Payer: BCN Commercial |
$1,859.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,252.96
|
| Rate for Payer: Cash Price |
$2,780.80
|
| Rate for Payer: Cash Price |
$2,780.80
|
| Rate for Payer: Cofinity Commercial |
$1,678.97
|
| Rate for Payer: Cofinity Commercial |
$1,804.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,252.96
|
| Rate for Payer: Healthscope Commercial |
$1,503.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,503.55
|
| Rate for Payer: Meridian Medicaid |
$856.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,315.61
|
| Rate for Payer: PACE SWMI |
$1,252.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,252.96
|
| 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 Medicare |
$1,252.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,943.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,290.55
|
|
|
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 |
$1,242.58
|
| Rate for Payer: Aetna Medicare |
$927.30
|
| Rate for Payer: BCBS Complete |
$635.17
|
| Rate for Payer: BCBS MAPPO |
$927.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,442.33
|
| Rate for Payer: BCN Commercial |
$1,379.05
|
| Rate for Payer: BCN Medicare Advantage |
$927.30
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,335.31
|
| Rate for Payer: Cofinity Commercial |
$1,242.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$927.30
|
| Rate for Payer: Healthscope Commercial |
$1,112.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,112.76
|
| Rate for Payer: Meridian Medicaid |
$635.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$973.66
|
| Rate for Payer: PACE SWMI |
$927.30
|
| Rate for Payer: PHP Medicare Advantage |
$927.30
|
| 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 Medicare |
$927.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,441.06
|
| Rate for Payer: UHC Medicare Advantage |
$955.12
|
|
|
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 |
$1,164.03
|
| Rate for Payer: Aetna Medicare |
$868.68
|
| Rate for Payer: BCBS Complete |
$597.60
|
| Rate for Payer: BCBS MAPPO |
$868.68
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: BCN Medicare Advantage |
$868.68
|
| Rate for Payer: Cash Price |
$2,424.80
|
| Rate for Payer: Cash Price |
$2,424.80
|
| Rate for Payer: Cofinity Commercial |
$1,250.90
|
| Rate for Payer: Cofinity Commercial |
$1,164.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.68
|
| Rate for Payer: Healthscope Commercial |
$1,042.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.42
|
| Rate for Payer: Meridian Medicaid |
$597.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$912.11
|
| Rate for Payer: PACE SWMI |
$868.68
|
| Rate for Payer: PHP Medicare Advantage |
$868.68
|
| 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 Medicare |
$868.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,354.25
|
| Rate for Payer: UHC Medicare Advantage |
$894.74
|
|
|
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: BCN Commercial |
$881.57
|
| 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
|
|
|
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 |
$1,362.70
|
| Rate for Payer: Aetna Medicare |
$1,016.94
|
| Rate for Payer: BCBS Complete |
$697.79
|
| Rate for Payer: BCBS MAPPO |
$1,016.94
|
| Rate for Payer: BCBS Trust/PPO |
$86.11
|
| Rate for Payer: BCN Commercial |
$1,528.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,016.94
|
| Rate for Payer: Cash Price |
$1,611.20
|
| Rate for Payer: Cash Price |
$1,611.20
|
| Rate for Payer: Cofinity Commercial |
$1,464.39
|
| Rate for Payer: Cofinity Commercial |
$1,362.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,016.94
|
| Rate for Payer: Healthscope Commercial |
$1,220.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,220.33
|
| Rate for Payer: Meridian Medicaid |
$697.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,067.79
|
| Rate for Payer: PACE SWMI |
$1,016.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,016.94
|
| 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 Medicare |
$1,016.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,596.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.45
|
|
|
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 |
$1,050.76
|
| Rate for Payer: Aetna Medicare |
$784.15
|
| Rate for Payer: BCBS Complete |
$539.89
|
| Rate for Payer: BCBS MAPPO |
$784.15
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$1,174.29
|
| Rate for Payer: BCN Medicare Advantage |
$784.15
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$1,129.18
|
| Rate for Payer: Cofinity Commercial |
$1,050.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$784.15
|
| Rate for Payer: Healthscope Commercial |
$940.98
|
| Rate for Payer: Healthscope Whirlpool |
$940.98
|
| Rate for Payer: Meridian Medicaid |
$539.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$823.36
|
| Rate for Payer: PACE SWMI |
$784.15
|
| Rate for Payer: PHP Medicare Advantage |
$784.15
|
| 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 Medicare |
$784.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,227.09
|
| Rate for Payer: UHC Medicare Advantage |
$807.67
|
|
|
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 |
$1,179.95
|
| Rate for Payer: Aetna Medicare |
$880.56
|
| Rate for Payer: BCBS Complete |
$605.20
|
| Rate for Payer: BCBS MAPPO |
$880.56
|
| Rate for Payer: BCBS Trust/PPO |
$897.05
|
| Rate for Payer: BCN Commercial |
$1,310.63
|
| Rate for Payer: BCN Medicare Advantage |
$880.56
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,268.01
|
| Rate for Payer: Cofinity Commercial |
$1,179.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.56
|
| Rate for Payer: Healthscope Commercial |
$1,056.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.67
|
| Rate for Payer: Meridian Medicaid |
$605.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$924.59
|
| Rate for Payer: PACE SWMI |
$880.56
|
| Rate for Payer: PHP Medicare Advantage |
$880.56
|
| 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 Medicare |
$880.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,369.56
|
| Rate for Payer: UHC Medicare Advantage |
$906.98
|
|
|
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 |
$996.30
|
| Rate for Payer: Aetna Medicare |
$743.51
|
| Rate for Payer: BCBS Complete |
$511.94
|
| Rate for Payer: BCBS MAPPO |
$743.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$1,221.43
|
| Rate for Payer: BCN Medicare Advantage |
$743.51
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$996.30
|
| Rate for Payer: Cofinity Commercial |
$1,070.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.51
|
| Rate for Payer: Healthscope Commercial |
$892.21
|
| Rate for Payer: Healthscope Whirlpool |
$892.21
|
| Rate for Payer: Meridian Medicaid |
$511.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$780.69
|
| Rate for Payer: PACE SWMI |
$743.51
|
| Rate for Payer: PHP Medicare Advantage |
$743.51
|
| 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 Medicare |
$743.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.18
|
| Rate for Payer: UHC Medicare Advantage |
$765.82
|
|
|
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 |
$1,722.00 |
| Max. Negotiated Rate |
$7,948.86 |
| Rate for Payer: Aetna Commercial |
$2,214.00
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| 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: ASR ASR |
$2,386.20
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,907.24
|
| Rate for Payer: BCN Commercial |
$1,907.24
|
| 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 |
$2,312.40
|
| 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 |
$2,460.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,386.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$2,214.00
|
| 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 |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| 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 |
$2,238.60
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,746.60
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,164.80
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
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 |
$1,722.00 |
| Max. Negotiated Rate |
$2,460.00 |
| Rate for Payer: Aetna Commercial |
$2,214.00
|
| Rate for Payer: ASR ASR |
$2,386.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,907.24
|
| Rate for Payer: BCN Commercial |
$1,907.24
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$2,312.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,968.00
|
| Rate for Payer: Healthscope Commercial |
$2,460.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,386.20
|
| Rate for Payer: Mclaren Commercial |
$2,214.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,091.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,164.80
|
|
|
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 |
$996.30
|
| Rate for Payer: Aetna Medicare |
$743.51
|
| Rate for Payer: BCBS Complete |
$511.94
|
| Rate for Payer: BCBS MAPPO |
$743.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$1,221.43
|
| Rate for Payer: BCN Medicare Advantage |
$743.51
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$1,070.65
|
| Rate for Payer: Cofinity Commercial |
$996.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.51
|
| Rate for Payer: Healthscope Commercial |
$892.21
|
| Rate for Payer: Healthscope Whirlpool |
$892.21
|
| Rate for Payer: Meridian Medicaid |
$511.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$780.69
|
| Rate for Payer: PACE SWMI |
$743.51
|
| Rate for Payer: PHP Medicare Advantage |
$743.51
|
| 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 Medicare |
$743.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.18
|
| Rate for Payer: UHC Medicare Advantage |
$765.82
|
|
|
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 |
$1,435.50
|
| Rate for Payer: Aetna Medicare |
$1,071.27
|
| Rate for Payer: BCBS Complete |
$734.24
|
| Rate for Payer: BCBS MAPPO |
$1,071.27
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Commercial |
$1,593.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.27
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cofinity Commercial |
$1,542.63
|
| Rate for Payer: Cofinity Commercial |
$1,435.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.27
|
| Rate for Payer: Healthscope Commercial |
$1,285.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,285.52
|
| Rate for Payer: Meridian Medicaid |
$734.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,124.83
|
| Rate for Payer: PACE SWMI |
$1,071.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.27
|
| 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 Medicare |
$1,071.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,664.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,103.41
|
|
|
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: BCN Commercial |
$1,679.59
|
| 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
|
|
|
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 |
$1,438.70
|
| Rate for Payer: Aetna Medicare |
$1,073.66
|
| Rate for Payer: BCBS Complete |
$735.81
|
| Rate for Payer: BCBS MAPPO |
$1,073.66
|
| Rate for Payer: BCBS Trust/PPO |
$435.85
|
| Rate for Payer: BCN Commercial |
$1,596.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,073.66
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,546.07
|
| Rate for Payer: Cofinity Commercial |
$1,438.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,073.66
|
| Rate for Payer: Healthscope Commercial |
$1,288.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,288.39
|
| Rate for Payer: Meridian Medicaid |
$735.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,127.34
|
| Rate for Payer: PACE SWMI |
$1,073.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,073.66
|
| 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 Medicare |
$1,073.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,667.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,105.87
|
|
|
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 |
$1,166.98
|
| Rate for Payer: Aetna Medicare |
$870.88
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS MAPPO |
$870.88
|
| Rate for Payer: BCBS Trust/PPO |
$333.89
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: BCN Medicare Advantage |
$870.88
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cofinity Commercial |
$1,254.07
|
| Rate for Payer: Cofinity Commercial |
$1,166.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.88
|
| Rate for Payer: Healthscope Commercial |
$1,045.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,045.06
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$914.42
|
| Rate for Payer: PACE SWMI |
$870.88
|
| Rate for Payer: PHP Medicare Advantage |
$870.88
|
| 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 Medicare |
$870.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,356.79
|
| Rate for Payer: UHC Medicare Advantage |
$897.01
|
|
|
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 |
$2,190.30 |
| Max. Negotiated Rate |
$14,623.31 |
| Rate for Payer: Aetna Commercial |
$2,816.10
|
| Rate for Payer: Aetna Medicare |
$11,698.65
|
| 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: ASR ASR |
$3,035.13
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.91
|
| Rate for Payer: BCN Commercial |
$2,425.91
|
| 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 |
$2,941.26
|
| 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 |
$3,129.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,035.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,698.65
|
| Rate for Payer: Mclaren Commercial |
$2,816.10
|
| 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 |
$12,868.52
|
| Rate for Payer: PHP Medicaid |
$6,399.16
|
| 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 |
$2,847.39
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,221.59
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,753.52
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
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 |
$2,190.30 |
| Max. Negotiated Rate |
$3,129.00 |
| Rate for Payer: Aetna Commercial |
$2,816.10
|
| Rate for Payer: ASR ASR |
$3,035.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.91
|
| Rate for Payer: BCN Commercial |
$2,425.91
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cofinity Commercial |
$2,941.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,503.20
|
| Rate for Payer: Healthscope Commercial |
$3,129.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,035.13
|
| Rate for Payer: Mclaren Commercial |
$2,816.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,659.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,190.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,753.52
|
|
|
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 |
$1,166.98
|
| Rate for Payer: Aetna Medicare |
$870.88
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS MAPPO |
$870.88
|
| Rate for Payer: BCBS Trust/PPO |
$333.89
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: BCN Medicare Advantage |
$870.88
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cash Price |
$2,503.20
|
| Rate for Payer: Cofinity Commercial |
$1,166.98
|
| Rate for Payer: Cofinity Commercial |
$1,254.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.88
|
| Rate for Payer: Healthscope Commercial |
$1,045.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,045.06
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$914.42
|
| Rate for Payer: PACE SWMI |
$870.88
|
| Rate for Payer: PHP Medicare Advantage |
$870.88
|
| 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 Medicare |
$870.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,356.79
|
| Rate for Payer: UHC Medicare Advantage |
$897.01
|
|
|
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 |
$1,633.02
|
| Rate for Payer: Aetna Medicare |
$1,218.67
|
| Rate for Payer: BCBS Complete |
$833.99
|
| Rate for Payer: BCBS MAPPO |
$1,218.67
|
| Rate for Payer: BCBS Trust/PPO |
$496.07
|
| Rate for Payer: BCN Commercial |
$1,809.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.67
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.88
|
| Rate for Payer: Cofinity Commercial |
$1,633.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.67
|
| Rate for Payer: Healthscope Commercial |
$1,462.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,462.40
|
| Rate for Payer: Meridian Medicaid |
$833.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,279.60
|
| Rate for Payer: PACE SWMI |
$1,218.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.67
|
| 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 Medicare |
$1,218.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,890.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,255.23
|
|
|
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 |
$1,395.81
|
| Rate for Payer: Aetna Medicare |
$1,041.65
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS MAPPO |
$1,041.65
|
| Rate for Payer: BCBS Trust/PPO |
$558.94
|
| Rate for Payer: BCN Commercial |
$1,546.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.65
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cofinity Commercial |
$1,499.98
|
| Rate for Payer: Cofinity Commercial |
$1,395.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.65
|
| Rate for Payer: Healthscope Commercial |
$1,249.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.98
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,093.73
|
| Rate for Payer: PACE SWMI |
$1,041.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.65
|
| 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 Medicare |
$1,041.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,616.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,072.90
|
|
