|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,239.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$2,105.35 |
| Rate for Payer: Aetna Commercial |
$833.37
|
| Rate for Payer: Aetna Medicare |
$1,619.50
|
| Rate for Payer: BCBS Complete |
$428.96
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: BCN Commercial |
$921.16
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Meridian Medicaid |
$428.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,105.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$967.86
|
| Rate for Payer: Priority Health Narrow Network |
$967.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$702.38
|
| Rate for Payer: UHC Exchange |
$702.38
|
| Rate for Payer: UHCCP Medicaid |
$408.53
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$749.97 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,539.08
|
| Rate for Payer: Aetna Medicare |
$1,230.50
|
| Rate for Payer: BCBS Complete |
$787.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,692.29
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Meridian Medicaid |
$787.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,599.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,780.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,780.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,383.43
|
| Rate for Payer: UHC Exchange |
$1,383.43
|
| Rate for Payer: UHCCP Medicaid |
$749.97
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$1,573.00 |
| Rate for Payer: Aetna Commercial |
$1,100.22
|
| Rate for Payer: Aetna Medicare |
$1,210.00
|
| Rate for Payer: BCBS Complete |
$569.64
|
| Rate for Payer: BCBS Trust/PPO |
$25.36
|
| Rate for Payer: BCN Commercial |
$1,220.23
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Meridian Medicaid |
$569.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,573.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,283.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,283.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$924.90
|
| Rate for Payer: UHC Exchange |
$924.90
|
| Rate for Payer: UHCCP Medicaid |
$542.51
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$1,923.35 |
| Rate for Payer: Aetna Commercial |
$1,398.32
|
| Rate for Payer: Aetna Medicare |
$1,479.50
|
| Rate for Payer: BCBS Complete |
$721.94
|
| Rate for Payer: BCBS Trust/PPO |
$166.94
|
| Rate for Payer: BCN Commercial |
$1,547.16
|
| Rate for Payer: Cash Price |
$2,367.20
|
| Rate for Payer: Cash Price |
$2,367.20
|
| Rate for Payer: Meridian Medicaid |
$721.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$687.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,923.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,625.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,625.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.09
|
| Rate for Payer: UHC Exchange |
$1,181.09
|
| Rate for Payer: UHCCP Medicaid |
$687.56
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$981.85
|
| Rate for Payer: Aetna Medicare |
$972.00
|
| Rate for Payer: BCBS Complete |
$511.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Meridian Medicaid |
$511.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.08
|
| Rate for Payer: UHC Exchange |
$820.08
|
| Rate for Payer: UHCCP Medicaid |
$487.13
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Facility
|
OP
|
$1,944.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$1,263.60 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$1,749.60
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| 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: ASR ASR |
$1,885.68
|
| Rate for Payer: ASR Commercial |
$1,885.68
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.94
|
| Rate for Payer: BCN Commercial |
$1,507.18
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$1,827.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$1,944.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,885.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$1,749.60
|
| 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 |
$1,652.40
|
| Rate for Payer: Nomi Health Commercial |
$1,594.08
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| 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 |
$1,263.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,703.33
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,362.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,710.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Facility
|
IP
|
$1,944.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$1,263.60 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna Commercial |
$1,749.60
|
| Rate for Payer: ASR ASR |
$1,885.68
|
| Rate for Payer: ASR Commercial |
$1,885.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,584.17
|
| Rate for Payer: BCN Commercial |
$1,507.18
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$1,827.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.20
|
| Rate for Payer: Healthscope Commercial |
$1,944.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,885.68
|
| Rate for Payer: Mclaren Commercial |
$1,749.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.40
|
| Rate for Payer: Nomi Health Commercial |
$1,594.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,710.72
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$981.85
|
| Rate for Payer: Aetna Medicare |
$972.00
|
| Rate for Payer: BCBS Complete |
$511.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Meridian Medicaid |
$511.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.08
|
| Rate for Payer: UHC Exchange |
$820.08
|
| Rate for Payer: UHCCP Medicaid |
$487.13
|
|
|
PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 27236
|
| Min. Negotiated Rate |
$772.13 |
| Max. Negotiated Rate |
$2,425.80 |
| Rate for Payer: Aetna Commercial |
$1,594.63
|
| Rate for Payer: Aetna Medicare |
$1,866.00
|
| Rate for Payer: BCBS Complete |
$810.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.77
|
| Rate for Payer: BCN Commercial |
$1,920.92
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Meridian Medicaid |
$810.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,831.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,831.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.97
|
| Rate for Payer: UHC Exchange |
$1,381.97
|
| Rate for Payer: UHCCP Medicaid |
$772.13
|
|
|
PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$4,215.00
|
|
|
Service Code
|
HCPCS 27506
|
| Min. Negotiated Rate |
$763.92 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Aetna Commercial |
$1,786.48
|
| Rate for Payer: Aetna Medicare |
$2,107.50
|
| Rate for Payer: BCBS Complete |
$909.36
|
| Rate for Payer: BCBS Trust/PPO |
$763.92
|
| Rate for Payer: BCN Commercial |
$2,154.98
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Meridian Medicaid |
$909.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$866.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,739.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,052.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,052.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,547.42
|
| Rate for Payer: UHC Exchange |
$1,547.42
|
| Rate for Payer: UHCCP Medicaid |
$866.06
|
|
|
PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,848.00
|
|
|
Service Code
|
HCPCS 27507
|
| Min. Negotiated Rate |
$626.65 |
| Max. Negotiated Rate |
$2,501.20 |
| Rate for Payer: Aetna Commercial |
$1,296.79
|
| Rate for Payer: Aetna Medicare |
$1,924.00
|
| Rate for Payer: BCBS Complete |
$657.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.62
|
| Rate for Payer: BCN Commercial |
$1,416.67
|
| Rate for Payer: Cash Price |
$3,078.40
|
| Rate for Payer: Cash Price |
$3,078.40
|
| Rate for Payer: Meridian Medicaid |
$657.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,501.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,483.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,483.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,135.07
|
| Rate for Payer: UHC Exchange |
$1,135.07
|
| Rate for Payer: UHCCP Medicaid |
$626.65
|
|
|
PR OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23630
|
| Min. Negotiated Rate |
$265.21 |
| Max. Negotiated Rate |
$1,209.05 |
| Rate for Payer: Aetna Commercial |
$1,039.57
|
| Rate for Payer: Aetna Medicare |
$694.00
|
| Rate for Payer: BCBS Complete |
$536.31
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCN Commercial |
$1,149.86
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Meridian Medicaid |
$536.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,209.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,209.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$875.53
|
| Rate for Payer: UHC Exchange |
$875.53
|
| Rate for Payer: UHCCP Medicaid |
$510.77
|
|
|
PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD
|
Professional
|
Both
|
$3,546.00
|
|
|
Service Code
|
HCPCS 27254
|
| Min. Negotiated Rate |
$821.97 |
| Max. Negotiated Rate |
$2,549.58 |
| Rate for Payer: Aetna Commercial |
$1,702.05
|
| Rate for Payer: Aetna Medicare |
$1,773.00
|
| Rate for Payer: BCBS Complete |
$863.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,549.58
|
| Rate for Payer: BCN Commercial |
$1,859.42
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Meridian Medicaid |
$863.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,949.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,949.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,470.78
|
| Rate for Payer: UHC Exchange |
$1,470.78
|
| Rate for Payer: UHCCP Medicaid |
$821.97
|
|
|
PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27253
|
| Min. Negotiated Rate |
$609.82 |
| Max. Negotiated Rate |
$2,442.33 |
| Rate for Payer: Aetna Commercial |
$1,258.60
|
| Rate for Payer: Aetna Medicare |
$1,175.50
|
| Rate for Payer: BCBS Complete |
$640.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,442.33
|
| Rate for Payer: BCN Commercial |
$1,379.05
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Meridian Medicaid |
$640.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$609.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,445.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,445.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,088.11
|
| Rate for Payer: UHC Exchange |
$1,088.11
|
| Rate for Payer: UHCCP Medicaid |
$609.82
|
|
|
PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$3,092.00
|
|
|
Service Code
|
HCPCS 24515
|
| Min. Negotiated Rate |
$338.11 |
| Max. Negotiated Rate |
$2,009.80 |
| Rate for Payer: Aetna Commercial |
$1,174.12
|
| Rate for Payer: Aetna Medicare |
$1,546.00
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: Cash Price |
$2,473.60
|
| Rate for Payer: Cash Price |
$2,473.60
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,359.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,359.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.38
|
| Rate for Payer: UHC Exchange |
$1,001.38
|
| Rate for Payer: UHCCP Medicaid |
$573.82
|
|
|
PR OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS 27215
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$1,741.81 |
| Rate for Payer: Aetna Commercial |
$803.86
|
| Rate for Payer: Aetna Medicare |
$1,317.00
|
| Rate for Payer: BCBS Complete |
$407.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.81
|
| Rate for Payer: BCN Commercial |
$881.57
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Meridian Medicaid |
$407.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$924.59
|
| Rate for Payer: Priority Health Narrow Network |
$924.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$764.94
|
| Rate for Payer: UHC Exchange |
$764.94
|
| Rate for Payer: UHCCP Medicaid |
$387.66
|
|
|
PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN
|
Professional
|
Both
|
$2,054.00
|
|
|
Service Code
|
HCPCS 21347
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$1,587.65 |
| Rate for Payer: Aetna Commercial |
$1,362.92
|
| Rate for Payer: Aetna Medicare |
$1,027.00
|
| Rate for Payer: BCBS Complete |
$701.37
|
| Rate for Payer: BCBS Trust/PPO |
$86.11
|
| Rate for Payer: BCN Commercial |
$1,528.09
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Meridian Medicaid |
$701.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$667.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,587.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,587.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,224.76
|
| Rate for Payer: UHC Exchange |
$1,224.76
|
| Rate for Payer: UHCCP Medicaid |
$667.97
|
|
|
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 |
$1,059.79
|
| Rate for Payer: Aetna Medicare |
$806.50
|
| Rate for Payer: BCBS Complete |
$539.67
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$1,174.29
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Meridian Medicaid |
$539.67
|
| 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 Narrow Network |
$1,228.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$905.32
|
| Rate for Payer: UHC Exchange |
$905.32
|
| Rate for Payer: UHCCP Medicaid |
$513.97
|
|
|
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 |
$1,193.01
|
| Rate for Payer: Aetna Medicare |
$797.50
|
| Rate for Payer: BCBS Complete |
$610.11
|
| Rate for Payer: BCBS Trust/PPO |
$897.05
|
| Rate for Payer: BCN Commercial |
$1,310.63
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Meridian Medicaid |
$610.11
|
| 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 Narrow Network |
$1,376.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,027.27
|
| Rate for Payer: UHC Exchange |
$1,027.27
|
| Rate for Payer: UHCCP Medicaid |
$581.06
|
|
|
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: Aetna Commercial |
$1,005.26
|
| Rate for Payer: Aetna Medicare |
$1,254.50
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$1,221.43
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| 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 Narrow Network |
$1,164.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$861.41
|
| Rate for Payer: UHC Exchange |
$861.41
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
|
|
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 |
$1,005.26
|
| Rate for Payer: Aetna Medicare |
$1,254.50
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$1,221.43
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| 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 Narrow Network |
$1,164.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$861.41
|
| Rate for Payer: UHC Exchange |
$861.41
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
|
|
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 |
$1,630.85 |
| Max. Negotiated Rate |
$2,509.00 |
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: ASR ASR |
$2,433.73
|
| Rate for Payer: ASR Commercial |
$2,433.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,044.58
|
| Rate for Payer: BCN Commercial |
$1,945.23
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$2,358.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.20
|
| Rate for Payer: Healthscope Commercial |
$2,509.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,433.73
|
| Rate for Payer: Mclaren Commercial |
$2,258.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,132.65
|
| Rate for Payer: Nomi Health Commercial |
$2,057.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.92
|
|
|
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 |
$1,630.85 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| 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: ASR ASR |
$2,433.73
|
| Rate for Payer: ASR Commercial |
$2,433.73
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.62
|
| Rate for Payer: BCN Commercial |
$1,945.23
|
| 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: Cofinity Commercial |
$2,358.46
|
| 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 |
$2,509.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,433.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$2,258.10
|
| 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 |
$2,057.38
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| 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 |
$2,198.39
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,758.81
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
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 |
$1,452.52
|
| Rate for Payer: Aetna Medicare |
$973.50
|
| Rate for Payer: BCBS Complete |
$737.82
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Commercial |
$1,593.09
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Meridian Medicaid |
$737.82
|
| 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 Narrow Network |
$1,670.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,256.34
|
| Rate for Payer: UHC Exchange |
$1,256.34
|
| Rate for Payer: UHCCP Medicaid |
$702.69
|
|
|
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: 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: UHC All Payor (Choice/PPO) + Core |
$1,463.64
|
| Rate for Payer: UHC Exchange |
$1,463.64
|
| Rate for Payer: UHCCP Medicaid |
$738.90
|
|
