|
PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 21390
|
| Min. Negotiated Rate |
$645.20 |
| Max. Negotiated Rate |
$1,088.16 |
| Rate for Payer: Aetna Commercial |
$1,012.60
|
| Rate for Payer: Aetna Medicare |
$755.67
|
| Rate for Payer: BCBS Complete |
$645.20
|
| Rate for Payer: BCBS MAPPO |
$755.67
|
| Rate for Payer: BCN Medicare Advantage |
$755.67
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cofinity Commercial |
$1,088.16
|
| Rate for Payer: Cofinity Commercial |
$1,012.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$755.67
|
| Rate for Payer: Healthscope Commercial |
$906.80
|
| Rate for Payer: Healthscope Whirlpool |
$906.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$793.45
|
| Rate for Payer: Nomi Health Commercial |
$906.80
|
| Rate for Payer: PACE SWMI |
$755.67
|
| Rate for Payer: PHP Medicare Advantage |
$755.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,048.45
|
| Rate for Payer: Priority Health Medicare |
$755.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$755.67
|
| Rate for Payer: UHC Medicare Advantage |
$755.67
|
| Rate for Payer: UHCCP DNSP |
$755.67
|
|
|
PR OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
HCPCS 27566
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: Aetna Commercial |
$1,155.75
|
| Rate for Payer: Aetna Medicare |
$862.50
|
| Rate for Payer: BCBS Complete |
$638.00
|
| Rate for Payer: BCBS MAPPO |
$862.50
|
| Rate for Payer: BCN Medicare Advantage |
$862.50
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cofinity Commercial |
$1,242.00
|
| Rate for Payer: Cofinity Commercial |
$1,155.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.50
|
| Rate for Payer: Healthscope Commercial |
$1,035.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.62
|
| Rate for Payer: Nomi Health Commercial |
$1,035.00
|
| Rate for Payer: PACE SWMI |
$862.50
|
| Rate for Payer: PHP Medicare Advantage |
$862.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,036.75
|
| Rate for Payer: Priority Health Medicare |
$862.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.50
|
| Rate for Payer: UHC Medicare Advantage |
$862.50
|
| Rate for Payer: UHCCP DNSP |
$862.50
|
|
|
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
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
27524
|
| Min. Negotiated Rate |
$728.06 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Medicare |
$728.06
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$728.06
|
| Rate for Payer: BCN Medicare Advantage |
$728.06
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$975.60
|
| Rate for Payer: Cofinity Commercial |
$1,048.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.06
|
| Rate for Payer: Healthscope Commercial |
$873.67
|
| Rate for Payer: Healthscope Whirlpool |
$873.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.46
|
| Rate for Payer: Nomi Health Commercial |
$873.67
|
| Rate for Payer: PACE SWMI |
$728.06
|
| Rate for Payer: PHP Medicare Advantage |
$728.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$728.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
| Rate for Payer: UHCCP DNSP |
$728.06
|
|
|
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 |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| 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 |
$2,433.73
|
| Rate for Payer: ASR Commercial |
$2,433.73
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.62
|
| Rate for Payer: BCN Commercial |
$1,945.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| 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 |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,509.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,433.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$2,258.10
|
| 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 |
$2,132.65
|
| Rate for Payer: Nomi Health Commercial |
$2,057.38
|
| 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 |
$1,630.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,198.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,758.81
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.92
|
| 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 PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 27524
|
| Min. Negotiated Rate |
$728.06 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Medicare |
$728.06
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$728.06
|
| Rate for Payer: BCN Medicare Advantage |
$728.06
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$975.60
|
| Rate for Payer: Cofinity Commercial |
$1,048.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.06
|
| Rate for Payer: Healthscope Commercial |
$873.67
|
| Rate for Payer: Healthscope Whirlpool |
$873.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.46
|
| Rate for Payer: Nomi Health Commercial |
$873.67
|
| Rate for Payer: PACE SWMI |
$728.06
|
| Rate for Payer: PHP Medicare Advantage |
$728.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$728.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.06
|
| Rate for Payer: UHC Medicare Advantage |
$728.06
|
| Rate for Payer: UHCCP DNSP |
$728.06
|
|
|
PR OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO
|
Professional
|
Both
|
$1,947.00
|
|
|
Service Code
|
HCPCS 24586
|
| Min. Negotiated Rate |
$778.80 |
| Max. Negotiated Rate |
$1,502.88 |
| Rate for Payer: Aetna Commercial |
$1,398.52
|
| Rate for Payer: Aetna Medicare |
$1,043.67
|
| Rate for Payer: BCBS Complete |
$778.80
|
| Rate for Payer: BCBS MAPPO |
$1,043.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,043.67
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cofinity Commercial |
$1,502.88
|
| Rate for Payer: Cofinity Commercial |
$1,398.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,043.67
|
| Rate for Payer: Healthscope Commercial |
$1,252.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,252.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,095.85
|
| Rate for Payer: Nomi Health Commercial |
$1,252.40
|
| Rate for Payer: PACE SWMI |
$1,043.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,043.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.55
|
| Rate for Payer: Priority Health Medicare |
$1,043.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,043.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,043.67
|
| Rate for Payer: UHCCP DNSP |
$1,043.67
|
|
|
PR OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD
|
Professional
|
Both
|
$3,919.00
|
|
|
Service Code
|
HCPCS 27218
|
| Min. Negotiated Rate |
$1,567.60 |
| Max. Negotiated Rate |
$2,547.35 |
| Rate for Payer: Aetna Medicare |
$1,959.50
|
| Rate for Payer: BCBS Complete |
$1,567.60
|
| Rate for Payer: Cash Price |
$3,135.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,547.35
|
|
|
PR OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 24587
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,510.44 |
| Rate for Payer: Aetna Commercial |
$1,405.55
|
| Rate for Payer: Aetna Medicare |
$1,048.92
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$1,048.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.92
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,510.44
|
| Rate for Payer: Cofinity Commercial |
$1,405.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.92
|
| Rate for Payer: Healthscope Commercial |
$1,258.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,101.37
|
| Rate for Payer: Nomi Health Commercial |
$1,258.70
|
| Rate for Payer: PACE SWMI |
$1,048.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$1,048.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.92
|
| Rate for Payer: UHCCP DNSP |
$1,048.92
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$2,074.80 |
| Max. Negotiated Rate |
$19,450.56 |
| Rate for Payer: Aetna Commercial |
$2,872.80
|
| Rate for Payer: Aetna Medicare |
$12,548.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: ASR ASR |
$3,096.24
|
| Rate for Payer: ASR Commercial |
$3,096.24
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,613.93
|
| Rate for Payer: BCN Commercial |
$2,474.76
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$3,000.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Healthscope Commercial |
$3,192.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,096.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,548.75
|
| Rate for Payer: Mclaren Commercial |
$2,872.80
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: Nomi Health Commercial |
$2,617.44
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Commercial |
$13,803.62
|
| Rate for Payer: PHP Medicaid |
$6,726.13
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,796.83
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,237.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,808.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$19,450.56
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP DNSP |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Facility
|
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$2,074.80 |
| Max. Negotiated Rate |
$3,192.00 |
| Rate for Payer: Aetna Commercial |
$2,872.80
|
| Rate for Payer: ASR ASR |
$3,096.24
|
| Rate for Payer: ASR Commercial |
$3,096.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.16
|
| Rate for Payer: BCN Commercial |
$2,474.76
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$3,000.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,553.60
|
| Rate for Payer: Healthscope Commercial |
$3,192.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,096.24
|
| Rate for Payer: Mclaren Commercial |
$2,872.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,713.20
|
| Rate for Payer: Nomi Health Commercial |
$2,617.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,808.96
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$852.30
|
| Rate for Payer: BCBS Complete |
$1,276.80
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Healthscope Commercial |
$1,022.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.91
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$852.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
| Rate for Payer: UHCCP DNSP |
$852.30
|
|
|
PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
23615
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,142.08
|
| Rate for Payer: Aetna Medicare |
$852.30
|
| Rate for Payer: BCBS Complete |
$1,276.80
|
| Rate for Payer: BCBS MAPPO |
$852.30
|
| Rate for Payer: BCN Medicare Advantage |
$852.30
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cofinity Commercial |
$1,227.31
|
| Rate for Payer: Cofinity Commercial |
$1,142.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.30
|
| Rate for Payer: Healthscope Commercial |
$1,022.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$894.91
|
| Rate for Payer: Nomi Health Commercial |
$1,022.76
|
| Rate for Payer: PACE SWMI |
$852.30
|
| Rate for Payer: PHP Medicare Advantage |
$852.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health Medicare |
$852.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.30
|
| Rate for Payer: UHC Medicare Advantage |
$852.30
|
| Rate for Payer: UHCCP DNSP |
$852.30
|
|
|
PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT
|
Professional
|
Both
|
$2,377.00
|
|
|
Service Code
|
HCPCS 23616
|
| Min. Negotiated Rate |
$950.80 |
| Max. Negotiated Rate |
$1,711.53 |
| Rate for Payer: Aetna Commercial |
$1,592.67
|
| Rate for Payer: Aetna Medicare |
$1,188.56
|
| Rate for Payer: BCBS Complete |
$950.80
|
| Rate for Payer: BCBS MAPPO |
$1,188.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,188.56
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cofinity Commercial |
$1,711.53
|
| Rate for Payer: Cofinity Commercial |
$1,592.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,188.56
|
| Rate for Payer: Healthscope Commercial |
$1,426.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,426.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.99
|
| Rate for Payer: Nomi Health Commercial |
$1,426.27
|
| Rate for Payer: PACE SWMI |
$1,188.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,188.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,545.05
|
| Rate for Payer: Priority Health Medicare |
$1,188.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,188.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,188.56
|
| Rate for Payer: UHCCP DNSP |
$1,188.56
|
|
|
PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ
|
Professional
|
Both
|
$3,098.00
|
|
|
Service Code
|
HCPCS 27226
|
| Min. Negotiated Rate |
$1,015.24 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,360.42
|
| Rate for Payer: Aetna Medicare |
$1,015.24
|
| Rate for Payer: BCBS Complete |
$1,239.20
|
| Rate for Payer: BCBS MAPPO |
$1,015.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,015.24
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cash Price |
$2,478.40
|
| Rate for Payer: Cofinity Commercial |
$1,461.95
|
| Rate for Payer: Cofinity Commercial |
$1,360.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,015.24
|
| Rate for Payer: Healthscope Commercial |
$1,218.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,218.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.00
|
| Rate for Payer: Nomi Health Commercial |
$1,218.29
|
| Rate for Payer: PACE SWMI |
$1,015.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,015.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.70
|
| Rate for Payer: Priority Health Medicare |
$1,015.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,015.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,015.24
|
| Rate for Payer: UHCCP DNSP |
$1,015.24
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$2,540.00
|
|
|
Service Code
|
HCPCS 25575
|
| Min. Negotiated Rate |
$873.49 |
| Max. Negotiated Rate |
$1,651.00 |
| Rate for Payer: Aetna Commercial |
$1,170.48
|
| Rate for Payer: Aetna Medicare |
$873.49
|
| Rate for Payer: BCBS Complete |
$1,016.00
|
| Rate for Payer: BCBS MAPPO |
$873.49
|
| Rate for Payer: BCN Medicare Advantage |
$873.49
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cash Price |
$2,032.00
|
| Rate for Payer: Cofinity Commercial |
$1,257.83
|
| Rate for Payer: Cofinity Commercial |
$1,170.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.49
|
| Rate for Payer: Healthscope Commercial |
$1,048.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,048.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.16
|
| Rate for Payer: Nomi Health Commercial |
$1,048.19
|
| Rate for Payer: PACE SWMI |
$873.49
|
| Rate for Payer: PHP Medicare Advantage |
$873.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.00
|
| Rate for Payer: Priority Health Medicare |
$873.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.49
|
| Rate for Payer: UHC Medicare Advantage |
$873.49
|
| Rate for Payer: UHCCP DNSP |
$873.49
|
|
|
PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 25574
|
| Min. Negotiated Rate |
$654.57 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Aetna Commercial |
$877.12
|
| Rate for Payer: Aetna Medicare |
$654.57
|
| Rate for Payer: BCBS Complete |
$748.00
|
| Rate for Payer: BCBS MAPPO |
$654.57
|
| Rate for Payer: BCN Medicare Advantage |
$654.57
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cofinity Commercial |
$942.58
|
| Rate for Payer: Cofinity Commercial |
$877.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.57
|
| Rate for Payer: Healthscope Commercial |
$785.48
|
| Rate for Payer: Healthscope Whirlpool |
$785.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.30
|
| Rate for Payer: Nomi Health Commercial |
$785.48
|
| Rate for Payer: PACE SWMI |
$654.57
|
| Rate for Payer: PHP Medicare Advantage |
$654.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,215.50
|
| Rate for Payer: Priority Health Medicare |
$654.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$654.57
|
| Rate for Payer: UHC Medicare Advantage |
$654.57
|
| Rate for Payer: UHCCP DNSP |
$654.57
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$5,711.00
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$1,630.51 |
| Max. Negotiated Rate |
$3,712.15 |
| Rate for Payer: Aetna Commercial |
$2,184.88
|
| Rate for Payer: Aetna Medicare |
$1,630.51
|
| Rate for Payer: BCBS Complete |
$2,284.40
|
| Rate for Payer: BCBS MAPPO |
$1,630.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,630.51
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cash Price |
$4,568.80
|
| Rate for Payer: Cofinity Commercial |
$2,347.93
|
| Rate for Payer: Cofinity Commercial |
$2,184.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,630.51
|
| Rate for Payer: Healthscope Commercial |
$1,956.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,956.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,712.04
|
| Rate for Payer: Nomi Health Commercial |
$1,956.61
|
| Rate for Payer: PACE SWMI |
$1,630.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,630.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.15
|
| Rate for Payer: Priority Health Medicare |
$1,630.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,630.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,630.51
|
| Rate for Payer: UHCCP DNSP |
$1,630.51
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$10,742.00
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,816.13 |
| Max. Negotiated Rate |
$6,982.30 |
| Rate for Payer: Aetna Commercial |
$2,433.61
|
| Rate for Payer: Aetna Medicare |
$1,816.13
|
| Rate for Payer: BCBS Complete |
$4,296.80
|
| Rate for Payer: BCBS MAPPO |
$1,816.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,816.13
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cash Price |
$8,593.60
|
| Rate for Payer: Cofinity Commercial |
$2,615.23
|
| Rate for Payer: Cofinity Commercial |
$2,433.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,816.13
|
| Rate for Payer: Healthscope Commercial |
$2,179.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,179.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,906.94
|
| Rate for Payer: Nomi Health Commercial |
$2,179.36
|
| Rate for Payer: PACE SWMI |
$1,816.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,816.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,982.30
|
| Rate for Payer: Priority Health Medicare |
$1,816.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,816.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,816.13
|
| Rate for Payer: UHCCP DNSP |
$1,816.13
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$4,067.00
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$1,484.57 |
| Max. Negotiated Rate |
$2,643.55 |
| Rate for Payer: Aetna Commercial |
$1,989.32
|
| Rate for Payer: Aetna Medicare |
$1,484.57
|
| Rate for Payer: BCBS Complete |
$1,626.80
|
| Rate for Payer: BCBS MAPPO |
$1,484.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,484.57
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cash Price |
$3,253.60
|
| Rate for Payer: Cofinity Commercial |
$2,137.78
|
| Rate for Payer: Cofinity Commercial |
$1,989.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,484.57
|
| Rate for Payer: Healthscope Commercial |
$1,781.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,781.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,558.80
|
| Rate for Payer: Nomi Health Commercial |
$1,781.48
|
| Rate for Payer: PACE SWMI |
$1,484.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,484.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,643.55
|
| Rate for Payer: Priority Health Medicare |
$1,484.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,484.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.57
|
| Rate for Payer: UHCCP DNSP |
$1,484.57
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$276.81 |
| Max. Negotiated Rate |
$761.15 |
| Rate for Payer: Aetna Commercial |
$370.93
|
| Rate for Payer: Aetna Medicare |
$276.81
|
| Rate for Payer: BCBS Complete |
$468.40
|
| Rate for Payer: BCBS MAPPO |
$276.81
|
| Rate for Payer: BCN Medicare Advantage |
$276.81
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Cofinity Commercial |
$398.61
|
| Rate for Payer: Cofinity Commercial |
$370.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.81
|
| Rate for Payer: Healthscope Commercial |
$332.17
|
| Rate for Payer: Healthscope Whirlpool |
$332.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.65
|
| Rate for Payer: Nomi Health Commercial |
$332.17
|
| Rate for Payer: PACE SWMI |
$276.81
|
| Rate for Payer: PHP Medicare Advantage |
$276.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.15
|
| Rate for Payer: Priority Health Medicare |
$276.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.81
|
| Rate for Payer: UHC Medicare Advantage |
$276.81
|
| Rate for Payer: UHCCP DNSP |
$276.81
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$3,741.00
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$1,452.12 |
| Max. Negotiated Rate |
$2,431.65 |
| Rate for Payer: Aetna Commercial |
$1,945.84
|
| Rate for Payer: Aetna Medicare |
$1,452.12
|
| Rate for Payer: BCBS Complete |
$1,496.40
|
| Rate for Payer: BCBS MAPPO |
$1,452.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,452.12
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cash Price |
$2,992.80
|
| Rate for Payer: Cofinity Commercial |
$2,091.05
|
| Rate for Payer: Cofinity Commercial |
$1,945.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,452.12
|
| Rate for Payer: Healthscope Commercial |
$1,742.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,742.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.73
|
| Rate for Payer: Nomi Health Commercial |
$1,742.54
|
| Rate for Payer: PACE SWMI |
$1,452.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,452.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.65
|
| Rate for Payer: Priority Health Medicare |
$1,452.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,452.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,452.12
|
| Rate for Payer: UHCCP DNSP |
$1,452.12
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$3,905.00
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$1,509.24 |
| Max. Negotiated Rate |
$2,538.25 |
| Rate for Payer: Aetna Commercial |
$2,022.38
|
| Rate for Payer: Aetna Medicare |
$1,509.24
|
| Rate for Payer: BCBS Complete |
$1,562.00
|
| Rate for Payer: BCBS MAPPO |
$1,509.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,509.24
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cash Price |
$3,124.00
|
| Rate for Payer: Cofinity Commercial |
$2,173.31
|
| Rate for Payer: Cofinity Commercial |
$2,022.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,509.24
|
| Rate for Payer: Healthscope Commercial |
$1,811.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,811.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,584.70
|
| Rate for Payer: Nomi Health Commercial |
$1,811.09
|
| Rate for Payer: PACE SWMI |
$1,509.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,509.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,538.25
|
| Rate for Payer: Priority Health Medicare |
$1,509.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,509.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,509.24
|
| Rate for Payer: UHCCP DNSP |
$1,509.24
|
|
|
PR OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 25525
|
| Min. Negotiated Rate |
$764.32 |
| Max. Negotiated Rate |
$1,676.35 |
| Rate for Payer: Aetna Commercial |
$1,024.19
|
| Rate for Payer: Aetna Medicare |
$764.32
|
| Rate for Payer: BCBS Complete |
$1,031.60
|
| Rate for Payer: BCBS MAPPO |
$764.32
|
| Rate for Payer: BCN Medicare Advantage |
$764.32
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cofinity Commercial |
$1,100.62
|
| Rate for Payer: Cofinity Commercial |
$1,024.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.32
|
| Rate for Payer: Healthscope Commercial |
$917.18
|
| Rate for Payer: Healthscope Whirlpool |
$917.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.54
|
| Rate for Payer: Nomi Health Commercial |
$917.18
|
| Rate for Payer: PACE SWMI |
$764.32
|
| Rate for Payer: PHP Medicare Advantage |
$764.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.35
|
| Rate for Payer: Priority Health Medicare |
$764.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$764.32
|
| Rate for Payer: UHC Medicare Advantage |
$764.32
|
| Rate for Payer: UHCCP DNSP |
$764.32
|
|
|
PR OPTX RDL SHAFT FX&OPTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25526
|
| Min. Negotiated Rate |
$923.59 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna Commercial |
$1,237.61
|
| Rate for Payer: Aetna Medicare |
$923.59
|
| Rate for Payer: BCBS Complete |
$1,190.00
|
| Rate for Payer: BCBS MAPPO |
$923.59
|
| Rate for Payer: BCN Medicare Advantage |
$923.59
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,329.97
|
| Rate for Payer: Cofinity Commercial |
$1,237.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$923.59
|
| Rate for Payer: Healthscope Commercial |
$1,108.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,108.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$969.77
|
| Rate for Payer: Nomi Health Commercial |
$1,108.31
|
| Rate for Payer: PACE SWMI |
$923.59
|
| Rate for Payer: PHP Medicare Advantage |
$923.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health Medicare |
$923.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.59
|
| Rate for Payer: UHC Medicare Advantage |
$923.59
|
| Rate for Payer: UHCCP DNSP |
$923.59
|
|
