Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT

Professional

Both

$2,221.00

Service Code	HCPCS 29867
Min. Negotiated Rate	$509.81
Max. Negotiated Rate	$1,956.30
Rate for Payer: Aetna Commercial	$1,707.15
Rate for Payer: BCBS Complete	$863.74
Rate for Payer: BCBS Trust/PPO	$509.81
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Mclaren Medicaid	$822.61
Rate for Payer: Meridian Medicaid	$863.74
Rate for Payer: Priority Health Choice Medicaid	$822.61
Rate for Payer: Priority Health Cigna Priority Health	$1,554.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,956.30
Rate for Payer: Priority Health Narrow Network	$1,956.30
Rate for Payer: Priority Health SBD	$1,956.30

PR ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY

Professional

Both

$1,999.00

Service Code	HCPCS 29874
Hospital Charge Code	29874
Min. Negotiated Rate	$349.32
Max. Negotiated Rate	$1,725.43
Rate for Payer: Aetna Commercial	$716.98
Rate for Payer: BCBS Complete	$366.79
Rate for Payer: BCBS Trust/PPO	$1,725.43
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Mclaren Medicaid	$349.32
Rate for Payer: Meridian Medicaid	$366.79
Rate for Payer: Priority Health Choice Medicaid	$349.32
Rate for Payer: Priority Health Cigna Priority Health	$1,399.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$825.21
Rate for Payer: Priority Health Narrow Network	$825.21
Rate for Payer: Priority Health SBD	$825.21

PR ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY

Facility

$1,999.00

Service Code	CPT 29874
Hospital Charge Code	29874
Min. Negotiated Rate	$537.00
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$1,699.15
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,299.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,234.36
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Cofinity Commercial	$1,719.14
Rate for Payer: Cofinity Commercial	$1,399.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$1,799.10
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,699.15
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$1,699.15
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,399.30
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$1,259.37
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$590.70
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$537.00
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY

Facility

$1,999.00

Service Code	CPT 29874
Hospital Charge Code	29874
Min. Negotiated Rate	$1,259.37
Max. Negotiated Rate	$1,799.10
Rate for Payer: Aetna Commercial	$1,699.15
Rate for Payer: Aetna New Business (MI Preferred)	$1,299.35
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Cofinity Commercial	$1,399.30
Rate for Payer: Cofinity Commercial	$1,719.14
Rate for Payer: Healthscope Commercial	$1,799.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,699.15
Rate for Payer: PHP Commercial	$1,699.15
Rate for Payer: Priority Health Cigna Priority Health	$1,399.30
Rate for Payer: Priority Health SBD	$1,259.37

PR ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY

Professional

Both

$1,999.00

Service Code	HCPCS 29874
Min. Negotiated Rate	$349.32
Max. Negotiated Rate	$1,725.43
Rate for Payer: Aetna Commercial	$716.98
Rate for Payer: BCBS Complete	$366.79
Rate for Payer: BCBS Trust/PPO	$1,725.43
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Mclaren Medicaid	$349.32
Rate for Payer: Meridian Medicaid	$366.79
Rate for Payer: Priority Health Choice Medicaid	$349.32
Rate for Payer: Priority Health Cigna Priority Health	$1,399.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$825.21
Rate for Payer: Priority Health Narrow Network	$825.21
Rate for Payer: Priority Health SBD	$825.21

PR ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS

Professional

Both

$2,348.00

Service Code	HCPCS 29876
Min. Negotiated Rate	$422.81
Max. Negotiated Rate	$1,643.60
Rate for Payer: Aetna Commercial	$871.38
Rate for Payer: BCBS Complete	$443.95
Rate for Payer: BCBS Trust/PPO	$769.20
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Mclaren Medicaid	$422.81
Rate for Payer: Meridian Medicaid	$443.95
Rate for Payer: Priority Health Choice Medicaid	$422.81
Rate for Payer: Priority Health Cigna Priority Health	$1,643.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,003.42
Rate for Payer: Priority Health Narrow Network	$1,003.42
Rate for Payer: Priority Health SBD	$1,003.42

PR ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS

Professional

Both

$2,348.00

Service Code	HCPCS 29876
Hospital Charge Code	29876
Min. Negotiated Rate	$422.81
Max. Negotiated Rate	$1,643.60
Rate for Payer: Aetna Commercial	$871.38
Rate for Payer: BCBS Complete	$443.95
Rate for Payer: BCBS Trust/PPO	$769.20
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Mclaren Medicaid	$422.81
Rate for Payer: Meridian Medicaid	$443.95
Rate for Payer: Priority Health Choice Medicaid	$422.81
Rate for Payer: Priority Health Cigna Priority Health	$1,643.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,003.42
Rate for Payer: Priority Health Narrow Network	$1,003.42
Rate for Payer: Priority Health SBD	$1,003.42

PR ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS

Facility

$2,348.00

Service Code	CPT 29876
Hospital Charge Code	29876
Min. Negotiated Rate	$649.97
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$1,995.80
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,526.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$2,005.81
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cofinity Commercial	$2,019.28
Rate for Payer: Cofinity Commercial	$1,643.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$2,113.20
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,995.80
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$1,995.80
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,643.60
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$1,479.24
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$714.97
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$649.97
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS

Facility

$2,348.00

Service Code	CPT 29876
Hospital Charge Code	29876
Min. Negotiated Rate	$1,479.24
Max. Negotiated Rate	$2,113.20
Rate for Payer: Aetna Commercial	$1,995.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,526.20
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cofinity Commercial	$1,643.60
Rate for Payer: Cofinity Commercial	$2,019.28
Rate for Payer: Healthscope Commercial	$2,113.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,995.80
Rate for Payer: PHP Commercial	$1,995.80
Rate for Payer: Priority Health Cigna Priority Health	$1,643.60
Rate for Payer: Priority Health SBD	$1,479.24

PR ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX

Professional

Both

$1,840.00

Service Code	HCPCS 29875
Hospital Charge Code	29875
Min. Negotiated Rate	$322.70
Max. Negotiated Rate	$1,288.00
Rate for Payer: Aetna Commercial	$661.47
Rate for Payer: BCBS Complete	$338.84
Rate for Payer: BCBS Trust/PPO	$555.24
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Mclaren Medicaid	$322.70
Rate for Payer: Meridian Medicaid	$338.84
Rate for Payer: Priority Health Choice Medicaid	$322.70
Rate for Payer: Priority Health Cigna Priority Health	$1,288.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$765.47
Rate for Payer: Priority Health Narrow Network	$765.47
Rate for Payer: Priority Health SBD	$765.47

PR ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX

Facility

$1,840.00

Service Code	CPT 29875
Hospital Charge Code	29875
Min. Negotiated Rate	$1,159.20
Max. Negotiated Rate	$1,656.00
Rate for Payer: Aetna Commercial	$1,564.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,196.00
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Cofinity Commercial	$1,288.00
Rate for Payer: Cofinity Commercial	$1,582.40
Rate for Payer: Healthscope Commercial	$1,656.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,564.00
Rate for Payer: PHP Commercial	$1,564.00
Rate for Payer: Priority Health Cigna Priority Health	$1,288.00
Rate for Payer: Priority Health SBD	$1,159.20

PR ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX

Professional

Both

$1,840.00

Service Code	HCPCS 29875
Min. Negotiated Rate	$322.70
Max. Negotiated Rate	$1,288.00
Rate for Payer: Aetna Commercial	$661.47
Rate for Payer: BCBS Complete	$338.84
Rate for Payer: BCBS Trust/PPO	$555.24
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Mclaren Medicaid	$322.70
Rate for Payer: Meridian Medicaid	$338.84
Rate for Payer: Priority Health Choice Medicaid	$322.70
Rate for Payer: Priority Health Cigna Priority Health	$1,288.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$765.47
Rate for Payer: Priority Health Narrow Network	$765.47
Rate for Payer: Priority Health SBD	$765.47

PR ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX

Facility

$1,840.00

Service Code	CPT 29875
Hospital Charge Code	29875
Min. Negotiated Rate	$496.07
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$1,564.00
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,196.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,895.74
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Cash Price	$1,472.00
Rate for Payer: Cofinity Commercial	$1,582.40
Rate for Payer: Cofinity Commercial	$1,288.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$1,656.00
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,564.00
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$1,564.00
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,288.00
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$1,159.20
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$545.68
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$496.07
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX

Professional

Both

$2,221.00

Service Code	HCPCS 29884
Hospital Charge Code	29884
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$1,554.70
Rate for Payer: Aetna Commercial	$825.18
Rate for Payer: BCBS Complete	$421.81
Rate for Payer: BCBS Trust/PPO	$1,049.73
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Mclaren Medicaid	$401.72
Rate for Payer: Meridian Medicaid	$421.81
Rate for Payer: Priority Health Choice Medicaid	$401.72
Rate for Payer: Priority Health Cigna Priority Health	$1,554.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$953.38
Rate for Payer: Priority Health Narrow Network	$953.38
Rate for Payer: Priority Health SBD	$953.38

PR ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX

Professional

Both

$2,221.00

Service Code	HCPCS 29884
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$1,554.70
Rate for Payer: Aetna Commercial	$825.18
Rate for Payer: BCBS Complete	$421.81
Rate for Payer: BCBS Trust/PPO	$1,049.73
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Mclaren Medicaid	$401.72
Rate for Payer: Meridian Medicaid	$421.81
Rate for Payer: Priority Health Choice Medicaid	$401.72
Rate for Payer: Priority Health Cigna Priority Health	$1,554.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$953.38
Rate for Payer: Priority Health Narrow Network	$953.38
Rate for Payer: Priority Health SBD	$953.38

PR ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX

Facility

$2,221.00

Service Code	CPT 29884
Hospital Charge Code	29884
Min. Negotiated Rate	$617.56
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$1,887.85
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,443.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,234.36
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Cofinity Commercial	$1,910.06
Rate for Payer: Cofinity Commercial	$1,554.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$1,998.90
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,887.85
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$1,887.85
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,554.70
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$1,399.23
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$679.32
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$617.56
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX

Facility

$2,221.00

Service Code	CPT 29884
Hospital Charge Code	29884
Min. Negotiated Rate	$1,399.23
Max. Negotiated Rate	$1,998.90
Rate for Payer: Aetna Commercial	$1,887.85
Rate for Payer: Aetna New Business (MI Preferred)	$1,443.65
Rate for Payer: Cash Price	$1,776.80
Rate for Payer: Cofinity Commercial	$1,554.70
Rate for Payer: Cofinity Commercial	$1,910.06
Rate for Payer: Healthscope Commercial	$1,998.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,887.85
Rate for Payer: PHP Commercial	$1,887.85
Rate for Payer: Priority Health Cigna Priority Health	$1,554.70
Rate for Payer: Priority Health SBD	$1,399.23

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL

Professional

Both

$2,704.00

Service Code	HCPCS 29883
Min. Negotiated Rate	$544.43
Max. Negotiated Rate	$1,892.80
Rate for Payer: Aetna Commercial	$1,118.78
Rate for Payer: BCBS Complete	$571.65
Rate for Payer: BCBS Trust/PPO	$654.56
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Mclaren Medicaid	$544.43
Rate for Payer: Meridian Medicaid	$571.65
Rate for Payer: Priority Health Choice Medicaid	$544.43
Rate for Payer: Priority Health Cigna Priority Health	$1,892.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,295.01
Rate for Payer: Priority Health Narrow Network	$1,295.01
Rate for Payer: Priority Health SBD	$1,295.01

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL

Professional

Both

$2,704.00

Service Code	HCPCS 29883
Hospital Charge Code	29883
Min. Negotiated Rate	$544.43
Max. Negotiated Rate	$1,892.80
Rate for Payer: Aetna Commercial	$1,118.78
Rate for Payer: BCBS Complete	$571.65
Rate for Payer: BCBS Trust/PPO	$654.56
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Mclaren Medicaid	$544.43
Rate for Payer: Meridian Medicaid	$571.65
Rate for Payer: Priority Health Choice Medicaid	$544.43
Rate for Payer: Priority Health Cigna Priority Health	$1,892.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,295.01
Rate for Payer: Priority Health Narrow Network	$1,295.01
Rate for Payer: Priority Health SBD	$1,295.01

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL

Facility

$2,704.00

Service Code	CPT 29883
Hospital Charge Code	29883
Min. Negotiated Rate	$1,703.52
Max. Negotiated Rate	$2,433.60
Rate for Payer: Aetna Commercial	$2,298.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,757.60
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Cofinity Commercial	$1,892.80
Rate for Payer: Cofinity Commercial	$2,325.44
Rate for Payer: Healthscope Commercial	$2,433.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,298.40
Rate for Payer: PHP Commercial	$2,298.40
Rate for Payer: Priority Health Cigna Priority Health	$1,892.80
Rate for Payer: Priority Health SBD	$1,703.52

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL

Facility

$2,704.00

Service Code	CPT 29883
Hospital Charge Code	29883
Min. Negotiated Rate	$836.94
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$2,298.40
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,757.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,426.07
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Cofinity Commercial	$1,892.80
Rate for Payer: Cofinity Commercial	$2,325.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$2,433.60
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,298.40
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$2,298.40
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,892.80
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$1,703.52
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$920.63
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$836.94
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL

Facility

$2,380.00

Service Code	CPT 29882
Hospital Charge Code	29882
Min. Negotiated Rate	$684.35
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$2,023.00
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,547.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$2,612.44
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Cofinity Commercial	$1,666.00
Rate for Payer: Cofinity Commercial	$2,046.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$2,142.00
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,023.00
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$2,023.00
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,666.00
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$1,499.40
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$752.78
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$684.35
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL

Professional

Both

$2,380.00

Service Code	HCPCS 29882
Hospital Charge Code	29882
Min. Negotiated Rate	$321.77
Max. Negotiated Rate	$1,666.00
Rate for Payer: Aetna Commercial	$922.00
Rate for Payer: BCBS Complete	$467.43
Rate for Payer: BCBS Trust/PPO	$321.77
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Mclaren Medicaid	$445.17
Rate for Payer: Meridian Medicaid	$467.43
Rate for Payer: Priority Health Choice Medicaid	$445.17
Rate for Payer: Priority Health Cigna Priority Health	$1,666.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,059.60
Rate for Payer: Priority Health Narrow Network	$1,059.60
Rate for Payer: Priority Health SBD	$1,059.60

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL

Professional

Both

$2,380.00

Service Code	HCPCS 29882
Min. Negotiated Rate	$321.77
Max. Negotiated Rate	$1,666.00
Rate for Payer: Aetna Commercial	$922.00
Rate for Payer: BCBS Complete	$467.43
Rate for Payer: BCBS Trust/PPO	$321.77
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Mclaren Medicaid	$445.17
Rate for Payer: Meridian Medicaid	$467.43
Rate for Payer: Priority Health Choice Medicaid	$445.17
Rate for Payer: Priority Health Cigna Priority Health	$1,666.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,059.60
Rate for Payer: Priority Health Narrow Network	$1,059.60
Rate for Payer: Priority Health SBD	$1,059.60

PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL

Facility

$2,380.00

Service Code	CPT 29882
Hospital Charge Code	29882
Min. Negotiated Rate	$1,499.40
Max. Negotiated Rate	$2,142.00
Rate for Payer: Aetna Commercial	$2,023.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,547.00
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Cofinity Commercial	$1,666.00
Rate for Payer: Cofinity Commercial	$2,046.80
Rate for Payer: Healthscope Commercial	$2,142.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,023.00
Rate for Payer: PHP Commercial	$2,023.00
Rate for Payer: Priority Health Cigna Priority Health	$1,666.00
Rate for Payer: Priority Health SBD	$1,499.40

Know your out-of-pocket cost for care.

All Charges