|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$219.46
|
| Rate for Payer: Aetna Medicare |
$121.92
|
| Rate for Payer: ASR ASR |
$236.52
|
| Rate for Payer: ASR Commercial |
$236.52
|
| Rate for Payer: BCBS Complete |
$97.54
|
| Rate for Payer: BCBS Trust/PPO |
$199.68
|
| Rate for Payer: BCN Commercial |
$189.05
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$229.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$243.84
|
| Rate for Payer: Healthscope Whirlpool |
$236.52
|
| Rate for Payer: Mclaren Commercial |
$219.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: Nomi Health Commercial |
$199.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.65
|
| Rate for Payer: Priority Health Narrow Network |
$170.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.58
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna Commercial |
$22.59
|
| Rate for Payer: Aetna Medicare |
$16.86
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$16.86
|
| Rate for Payer: BCN Medicare Advantage |
$16.86
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$20.23
|
| Rate for Payer: Healthscope Whirlpool |
$20.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.70
|
| Rate for Payer: Nomi Health Commercial |
$20.23
|
| Rate for Payer: PACE SWMI |
$16.86
|
| Rate for Payer: PHP Medicare Advantage |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$16.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.86
|
| Rate for Payer: UHC Medicare Advantage |
$16.86
|
| Rate for Payer: UHCCP DNSP |
$16.86
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$623.93 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$836.07
|
| Rate for Payer: Aetna Medicare |
$623.93
|
| Rate for Payer: BCBS Complete |
$1,388.40
|
| Rate for Payer: BCBS MAPPO |
$623.93
|
| Rate for Payer: BCN Medicare Advantage |
$623.93
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$898.46
|
| Rate for Payer: Cofinity Commercial |
$836.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.93
|
| Rate for Payer: Healthscope Commercial |
$748.72
|
| Rate for Payer: Healthscope Whirlpool |
$748.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.13
|
| Rate for Payer: Nomi Health Commercial |
$748.72
|
| Rate for Payer: PACE SWMI |
$623.93
|
| Rate for Payer: PHP Medicare Advantage |
$623.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health Medicare |
$623.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.93
|
| Rate for Payer: UHC Medicare Advantage |
$623.93
|
| Rate for Payer: UHCCP DNSP |
$623.93
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,890.00
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$1,556.00 |
| Max. Negotiated Rate |
$2,601.94 |
| Rate for Payer: Aetna Commercial |
$2,421.25
|
| Rate for Payer: Aetna Medicare |
$1,806.90
|
| Rate for Payer: BCBS Complete |
$1,556.00
|
| Rate for Payer: BCBS MAPPO |
$1,806.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,806.90
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cofinity Commercial |
$2,601.94
|
| Rate for Payer: Cofinity Commercial |
$2,421.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,806.90
|
| Rate for Payer: Healthscope Commercial |
$2,168.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,168.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,897.24
|
| Rate for Payer: Nomi Health Commercial |
$2,168.28
|
| Rate for Payer: PACE SWMI |
$1,806.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,806.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,528.50
|
| Rate for Payer: Priority Health Medicare |
$1,806.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,806.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,806.90
|
| Rate for Payer: UHCCP DNSP |
$1,806.90
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,665.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,590.05 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Aetna Commercial |
$2,130.67
|
| Rate for Payer: Aetna Medicare |
$1,590.05
|
| Rate for Payer: BCBS Complete |
$1,866.00
|
| Rate for Payer: BCBS MAPPO |
$1,590.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,590.05
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cofinity Commercial |
$2,289.67
|
| Rate for Payer: Cofinity Commercial |
$2,130.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,590.05
|
| Rate for Payer: Healthscope Commercial |
$1,908.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,908.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,669.55
|
| Rate for Payer: Nomi Health Commercial |
$1,908.06
|
| Rate for Payer: PACE SWMI |
$1,590.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,590.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,032.25
|
| Rate for Payer: Priority Health Medicare |
$1,590.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,590.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,590.05
|
| Rate for Payer: UHCCP DNSP |
$1,590.05
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$697.73 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$934.96
|
| Rate for Payer: Aetna Medicare |
$697.73
|
| Rate for Payer: BCBS Complete |
$1,202.00
|
| Rate for Payer: BCBS MAPPO |
$697.73
|
| Rate for Payer: BCN Medicare Advantage |
$697.73
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$934.96
|
| Rate for Payer: Cofinity Commercial |
$1,004.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.73
|
| Rate for Payer: Healthscope Commercial |
$837.28
|
| Rate for Payer: Healthscope Whirlpool |
$837.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.62
|
| Rate for Payer: Nomi Health Commercial |
$837.28
|
| Rate for Payer: PACE SWMI |
$697.73
|
| Rate for Payer: PHP Medicare Advantage |
$697.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health Medicare |
$697.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.73
|
| Rate for Payer: UHC Medicare Advantage |
$697.73
|
| Rate for Payer: UHCCP DNSP |
$697.73
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$766.60 |
| Max. Negotiated Rate |
$2,110.55 |
| Rate for Payer: Aetna Commercial |
$1,027.24
|
| Rate for Payer: Aetna Medicare |
$766.60
|
| Rate for Payer: BCBS Complete |
$1,298.80
|
| Rate for Payer: BCBS MAPPO |
$766.60
|
| Rate for Payer: BCN Medicare Advantage |
$766.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,027.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.60
|
| Rate for Payer: Healthscope Commercial |
$919.92
|
| Rate for Payer: Healthscope Whirlpool |
$919.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.93
|
| Rate for Payer: Nomi Health Commercial |
$919.92
|
| Rate for Payer: PACE SWMI |
$766.60
|
| Rate for Payer: PHP Medicare Advantage |
$766.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
| Rate for Payer: Priority Health Medicare |
$766.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.60
|
| Rate for Payer: UHC Medicare Advantage |
$766.60
|
| Rate for Payer: UHCCP DNSP |
$766.60
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$1,253.60 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Medicare |
$1,567.00
|
| Rate for Payer: BCBS Complete |
$1,253.60
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,239.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$602.95 |
| Max. Negotiated Rate |
$2,105.35 |
| Rate for Payer: Aetna Commercial |
$807.95
|
| Rate for Payer: Aetna Medicare |
$602.95
|
| Rate for Payer: BCBS Complete |
$1,295.60
|
| Rate for Payer: BCBS MAPPO |
$602.95
|
| Rate for Payer: BCN Medicare Advantage |
$602.95
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cofinity Commercial |
$868.25
|
| Rate for Payer: Cofinity Commercial |
$807.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.95
|
| Rate for Payer: Healthscope Commercial |
$723.54
|
| Rate for Payer: Healthscope Whirlpool |
$723.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.10
|
| Rate for Payer: Nomi Health Commercial |
$723.54
|
| Rate for Payer: PACE SWMI |
$602.95
|
| Rate for Payer: PHP Medicare Advantage |
$602.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,105.35
|
| Rate for Payer: Priority Health Medicare |
$602.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.95
|
| Rate for Payer: UHC Medicare Advantage |
$602.95
|
| Rate for Payer: UHCCP DNSP |
$602.95
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$984.40 |
| Max. Negotiated Rate |
$1,599.65 |
| Rate for Payer: Aetna Commercial |
$1,484.79
|
| Rate for Payer: Aetna Medicare |
$1,108.05
|
| Rate for Payer: BCBS Complete |
$984.40
|
| Rate for Payer: BCBS MAPPO |
$1,108.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,108.05
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cofinity Commercial |
$1,595.59
|
| Rate for Payer: Cofinity Commercial |
$1,484.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,108.05
|
| Rate for Payer: Healthscope Commercial |
$1,329.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,329.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,163.45
|
| Rate for Payer: Nomi Health Commercial |
$1,329.66
|
| Rate for Payer: PACE SWMI |
$1,108.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,108.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,599.65
|
| Rate for Payer: Priority Health Medicare |
$1,108.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,108.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,108.05
|
| Rate for Payer: UHCCP DNSP |
$1,108.05
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$800.55 |
| Max. Negotiated Rate |
$1,573.00 |
| Rate for Payer: Aetna Commercial |
$1,072.74
|
| Rate for Payer: Aetna Medicare |
$800.55
|
| Rate for Payer: BCBS Complete |
$968.00
|
| Rate for Payer: BCBS MAPPO |
$800.55
|
| Rate for Payer: BCN Medicare Advantage |
$800.55
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cofinity Commercial |
$1,152.79
|
| Rate for Payer: Cofinity Commercial |
$1,072.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.55
|
| Rate for Payer: Healthscope Commercial |
$960.66
|
| Rate for Payer: Healthscope Whirlpool |
$960.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.58
|
| Rate for Payer: Nomi Health Commercial |
$960.66
|
| Rate for Payer: PACE SWMI |
$800.55
|
| Rate for Payer: PHP Medicare Advantage |
$800.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,573.00
|
| Rate for Payer: Priority Health Medicare |
$800.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.55
|
| Rate for Payer: UHC Medicare Advantage |
$800.55
|
| Rate for Payer: UHCCP DNSP |
$800.55
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$1,016.00 |
| Max. Negotiated Rate |
$1,923.35 |
| Rate for Payer: Aetna Commercial |
$1,361.44
|
| Rate for Payer: Aetna Medicare |
$1,016.00
|
| Rate for Payer: BCBS Complete |
$1,183.60
|
| Rate for Payer: BCBS MAPPO |
$1,016.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,016.00
|
| Rate for Payer: Cash Price |
$2,367.20
|
| Rate for Payer: Cash Price |
$2,367.20
|
| Rate for Payer: Cofinity Commercial |
$1,463.04
|
| Rate for Payer: Cofinity Commercial |
$1,361.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,016.00
|
| Rate for Payer: Healthscope Commercial |
$1,219.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,219.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.80
|
| Rate for Payer: Nomi Health Commercial |
$1,219.20
|
| Rate for Payer: PACE SWMI |
$1,016.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,016.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,923.35
|
| Rate for Payer: Priority Health Medicare |
$1,016.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,016.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,016.00
|
| Rate for Payer: UHCCP DNSP |
$1,016.00
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$717.46 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$961.40
|
| Rate for Payer: Aetna Medicare |
$717.46
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$717.46
|
| Rate for Payer: BCN Medicare Advantage |
$717.46
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$961.40
|
| Rate for Payer: Cofinity Commercial |
$1,033.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.46
|
| Rate for Payer: Healthscope Commercial |
$860.95
|
| Rate for Payer: Healthscope Whirlpool |
$860.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.33
|
| Rate for Payer: Nomi Health Commercial |
$860.95
|
| Rate for Payer: PACE SWMI |
$717.46
|
| Rate for Payer: PHP Medicare Advantage |
$717.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$717.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.46
|
| Rate for Payer: UHC Medicare Advantage |
$717.46
|
| Rate for Payer: UHCCP DNSP |
$717.46
|
|
|
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 |
$717.46 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$961.40
|
| Rate for Payer: Aetna Medicare |
$717.46
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$717.46
|
| Rate for Payer: BCN Medicare Advantage |
$717.46
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$961.40
|
| Rate for Payer: Cofinity Commercial |
$1,033.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.46
|
| Rate for Payer: Healthscope Commercial |
$860.95
|
| Rate for Payer: Healthscope Whirlpool |
$860.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.33
|
| Rate for Payer: Nomi Health Commercial |
$860.95
|
| Rate for Payer: PACE SWMI |
$717.46
|
| Rate for Payer: PHP Medicare Advantage |
$717.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$717.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.46
|
| Rate for Payer: UHC Medicare Advantage |
$717.46
|
| Rate for Payer: UHCCP DNSP |
$717.46
|
|
|
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
|
Facility
|
OP
|
$1,944.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$1,263.60 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$1,749.60
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$1,885.68
|
| Rate for Payer: ASR Commercial |
$1,885.68
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.94
|
| Rate for Payer: BCN Commercial |
$1,507.18
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| 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 |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$1,944.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,885.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$1,749.60
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| 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 |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| 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 |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,362.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,710.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 27236
|
| Min. Negotiated Rate |
$1,148.90 |
| Max. Negotiated Rate |
$2,425.80 |
| Rate for Payer: Aetna Commercial |
$1,539.53
|
| Rate for Payer: Aetna Medicare |
$1,148.90
|
| Rate for Payer: BCBS Complete |
$1,492.80
|
| Rate for Payer: BCBS MAPPO |
$1,148.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,148.90
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cofinity Commercial |
$1,654.42
|
| Rate for Payer: Cofinity Commercial |
$1,539.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,148.90
|
| Rate for Payer: Healthscope Commercial |
$1,378.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,378.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,206.35
|
| Rate for Payer: Nomi Health Commercial |
$1,378.68
|
| Rate for Payer: PACE SWMI |
$1,148.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,148.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.80
|
| Rate for Payer: Priority Health Medicare |
$1,148.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,148.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,148.90
|
| Rate for Payer: UHCCP DNSP |
$1,148.90
|
|
|
PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$4,215.00
|
|
|
Service Code
|
HCPCS 27506
|
| Min. Negotiated Rate |
$1,288.45 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Aetna Commercial |
$1,726.52
|
| Rate for Payer: Aetna Medicare |
$1,288.45
|
| Rate for Payer: BCBS Complete |
$1,686.00
|
| Rate for Payer: BCBS MAPPO |
$1,288.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,288.45
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cofinity Commercial |
$1,855.37
|
| Rate for Payer: Cofinity Commercial |
$1,726.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,288.45
|
| Rate for Payer: Healthscope Commercial |
$1,546.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,546.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,352.87
|
| Rate for Payer: Nomi Health Commercial |
$1,546.14
|
| Rate for Payer: PACE SWMI |
$1,288.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,288.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,739.75
|
| Rate for Payer: Priority Health Medicare |
$1,288.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,288.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,288.45
|
| Rate for Payer: UHCCP DNSP |
$1,288.45
|
|
|
PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,848.00
|
|
|
Service Code
|
HCPCS 27507
|
| Min. Negotiated Rate |
$933.54 |
| Max. Negotiated Rate |
$2,501.20 |
| Rate for Payer: Aetna Commercial |
$1,250.94
|
| Rate for Payer: Aetna Medicare |
$933.54
|
| Rate for Payer: BCBS Complete |
$1,539.20
|
| Rate for Payer: BCBS MAPPO |
$933.54
|
| Rate for Payer: BCN Medicare Advantage |
$933.54
|
| Rate for Payer: Cash Price |
$3,078.40
|
| Rate for Payer: Cash Price |
$3,078.40
|
| Rate for Payer: Cofinity Commercial |
$1,344.30
|
| Rate for Payer: Cofinity Commercial |
$1,250.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.54
|
| Rate for Payer: Healthscope Commercial |
$1,120.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,120.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.22
|
| Rate for Payer: Nomi Health Commercial |
$1,120.25
|
| Rate for Payer: PACE SWMI |
$933.54
|
| Rate for Payer: PHP Medicare Advantage |
$933.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,501.20
|
| Rate for Payer: Priority Health Medicare |
$933.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.54
|
| Rate for Payer: UHC Medicare Advantage |
$933.54
|
| Rate for Payer: UHCCP DNSP |
$933.54
|
|
|
PR OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23630
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$1,087.13 |
| Rate for Payer: Aetna Commercial |
$1,011.63
|
| Rate for Payer: Aetna Medicare |
$754.95
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$754.95
|
| Rate for Payer: BCN Medicare Advantage |
$754.95
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$1,087.13
|
| Rate for Payer: Cofinity Commercial |
$1,011.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$754.95
|
| Rate for Payer: Healthscope Commercial |
$905.94
|
| Rate for Payer: Healthscope Whirlpool |
$905.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$792.70
|
| Rate for Payer: Nomi Health Commercial |
$905.94
|
| Rate for Payer: PACE SWMI |
$754.95
|
| Rate for Payer: PHP Medicare Advantage |
$754.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$754.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$754.95
|
| Rate for Payer: UHC Medicare Advantage |
$754.95
|
| Rate for Payer: UHCCP DNSP |
$754.95
|
|
|
PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD
|
Professional
|
Both
|
$3,546.00
|
|
|
Service Code
|
HCPCS 27254
|
| Min. Negotiated Rate |
$1,224.39 |
| Max. Negotiated Rate |
$2,304.90 |
| Rate for Payer: Aetna Commercial |
$1,640.68
|
| Rate for Payer: Aetna Medicare |
$1,224.39
|
| Rate for Payer: BCBS Complete |
$1,418.40
|
| Rate for Payer: BCBS MAPPO |
$1,224.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,224.39
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cofinity Commercial |
$1,763.12
|
| Rate for Payer: Cofinity Commercial |
$1,640.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,224.39
|
| Rate for Payer: Healthscope Commercial |
$1,469.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,469.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,285.61
|
| Rate for Payer: Nomi Health Commercial |
$1,469.27
|
| Rate for Payer: PACE SWMI |
$1,224.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,224.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.90
|
| Rate for Payer: Priority Health Medicare |
$1,224.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,224.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,224.39
|
| Rate for Payer: UHCCP DNSP |
$1,224.39
|
|
|
PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27253
|
| Min. Negotiated Rate |
$906.31 |
| Max. Negotiated Rate |
$1,528.15 |
| Rate for Payer: Aetna Commercial |
$1,214.46
|
| Rate for Payer: Aetna Medicare |
$906.31
|
| Rate for Payer: BCBS Complete |
$940.40
|
| Rate for Payer: BCBS MAPPO |
$906.31
|
| Rate for Payer: BCN Medicare Advantage |
$906.31
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cofinity Commercial |
$1,305.09
|
| Rate for Payer: Cofinity Commercial |
$1,214.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$906.31
|
| Rate for Payer: Healthscope Commercial |
$1,087.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$951.63
|
| Rate for Payer: Nomi Health Commercial |
$1,087.57
|
| Rate for Payer: PACE SWMI |
$906.31
|
| Rate for Payer: PHP Medicare Advantage |
$906.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health Medicare |
$906.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$906.31
|
| Rate for Payer: UHC Medicare Advantage |
$906.31
|
| Rate for Payer: UHCCP DNSP |
$906.31
|
|
|
PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$3,092.00
|
|
|
Service Code
|
HCPCS 24515
|
| Min. Negotiated Rate |
$849.17 |
| Max. Negotiated Rate |
$2,009.80 |
| Rate for Payer: Aetna Commercial |
$1,137.89
|
| Rate for Payer: Aetna Medicare |
$849.17
|
| Rate for Payer: BCBS Complete |
$1,236.80
|
| Rate for Payer: BCBS MAPPO |
$849.17
|
| Rate for Payer: BCN Medicare Advantage |
$849.17
|
| Rate for Payer: Cash Price |
$2,473.60
|
| Rate for Payer: Cash Price |
$2,473.60
|
| Rate for Payer: Cofinity Commercial |
$1,222.80
|
| Rate for Payer: Cofinity Commercial |
$1,137.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.17
|
| Rate for Payer: Healthscope Commercial |
$1,019.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,019.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.63
|
| Rate for Payer: Nomi Health Commercial |
$1,019.00
|
| Rate for Payer: PACE SWMI |
$849.17
|
| Rate for Payer: PHP Medicare Advantage |
$849.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.80
|
| Rate for Payer: Priority Health Medicare |
$849.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.17
|
| Rate for Payer: UHC Medicare Advantage |
$849.17
|
| Rate for Payer: UHCCP DNSP |
$849.17
|
|
|
PR OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS 27215
|
| Min. Negotiated Rate |
$1,053.60 |
| Max. Negotiated Rate |
$1,712.10 |
| Rate for Payer: Aetna Medicare |
$1,317.00
|
| Rate for Payer: BCBS Complete |
$1,053.60
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.10
|
|
|
PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN
|
Professional
|
Both
|
$2,054.00
|
|
|
Service Code
|
HCPCS 21347
|
| Min. Negotiated Rate |
$821.60 |
| Max. Negotiated Rate |
$1,410.72 |
| Rate for Payer: Aetna Commercial |
$1,312.76
|
| Rate for Payer: Aetna Medicare |
$979.67
|
| Rate for Payer: BCBS Complete |
$821.60
|
| Rate for Payer: BCBS MAPPO |
$979.67
|
| Rate for Payer: BCN Medicare Advantage |
$979.67
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Cofinity Commercial |
$1,410.72
|
| Rate for Payer: Cofinity Commercial |
$1,312.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.67
|
| Rate for Payer: Healthscope Commercial |
$1,175.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.65
|
| Rate for Payer: Nomi Health Commercial |
$1,175.60
|
| Rate for Payer: PACE SWMI |
$979.67
|
| Rate for Payer: PHP Medicare Advantage |
$979.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.10
|
| Rate for Payer: Priority Health Medicare |
$979.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.67
|
| Rate for Payer: UHC Medicare Advantage |
$979.67
|
| Rate for Payer: UHCCP DNSP |
$979.67
|
|
