|
PR ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$3,863.00
|
|
|
Service Code
|
HCPCS 22633
|
| Min. Negotiated Rate |
$1,545.20 |
| Max. Negotiated Rate |
$2,549.75 |
| Rate for Payer: Aetna Commercial |
$2,372.68
|
| Rate for Payer: Aetna Medicare |
$1,841.49
|
| Rate for Payer: BCBS Complete |
$1,545.20
|
| Rate for Payer: BCBS MAPPO |
$1,770.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,770.66
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Cofinity Commercial |
$2,549.75
|
| Rate for Payer: Cofinity Commercial |
$2,372.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,770.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,859.19
|
| Rate for Payer: Nomi Health Commercial |
$2,124.79
|
| Rate for Payer: PACE SWMI |
$1,770.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,770.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,510.95
|
| Rate for Payer: Priority Health Medicare |
$1,788.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,770.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,770.66
|
| Rate for Payer: UHC Exchange |
$1,770.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,770.66
|
|
|
PR ARTHRODESIS ELBOW JOINT LOCAL
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 24800
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$1,159.91 |
| Rate for Payer: Aetna Commercial |
$1,079.36
|
| Rate for Payer: Aetna Medicare |
$837.71
|
| Rate for Payer: BCBS Complete |
$672.00
|
| Rate for Payer: BCBS MAPPO |
$805.49
|
| Rate for Payer: BCN Medicare Advantage |
$805.49
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$1,159.91
|
| Rate for Payer: Cofinity Commercial |
$1,079.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$845.76
|
| Rate for Payer: Nomi Health Commercial |
$966.59
|
| Rate for Payer: PACE SWMI |
$805.49
|
| Rate for Payer: PHP Medicare Advantage |
$805.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health Medicare |
$813.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.49
|
| Rate for Payer: UHC Exchange |
$805.49
|
| Rate for Payer: UHC Medicare Advantage |
$805.49
|
|
|
PR ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$4,775.00
|
|
|
Service Code
|
HCPCS 24802
|
| Min. Negotiated Rate |
$967.77 |
| Max. Negotiated Rate |
$3,103.75 |
| Rate for Payer: Aetna Commercial |
$1,296.81
|
| Rate for Payer: Aetna Medicare |
$1,006.48
|
| Rate for Payer: BCBS Complete |
$1,910.00
|
| Rate for Payer: BCBS MAPPO |
$967.77
|
| Rate for Payer: BCN Medicare Advantage |
$967.77
|
| Rate for Payer: Cash Price |
$3,820.00
|
| Rate for Payer: Cash Price |
$3,820.00
|
| Rate for Payer: Cofinity Commercial |
$1,393.59
|
| Rate for Payer: Cofinity Commercial |
$1,296.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$967.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.16
|
| Rate for Payer: Nomi Health Commercial |
$1,161.32
|
| Rate for Payer: PACE SWMI |
$967.77
|
| Rate for Payer: PHP Medicare Advantage |
$967.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,103.75
|
| Rate for Payer: Priority Health Medicare |
$977.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$967.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$967.77
|
| Rate for Payer: UHC Exchange |
$967.77
|
| Rate for Payer: UHC Medicare Advantage |
$967.77
|
|
|
PR ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 28755
|
| Min. Negotiated Rate |
$322.19 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Aetna Commercial |
$431.73
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: BCBS Complete |
$560.00
|
| Rate for Payer: BCBS MAPPO |
$322.19
|
| Rate for Payer: BCN Medicare Advantage |
$322.19
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cofinity Commercial |
$463.95
|
| Rate for Payer: Cofinity Commercial |
$431.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.30
|
| Rate for Payer: Nomi Health Commercial |
$386.63
|
| Rate for Payer: PACE SWMI |
$322.19
|
| Rate for Payer: PHP Medicare Advantage |
$322.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health Medicare |
$325.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.19
|
| Rate for Payer: UHC Exchange |
$322.19
|
| Rate for Payer: UHC Medicare Advantage |
$322.19
|
|
|
PR ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 28750
|
| Min. Negotiated Rate |
$549.93 |
| Max. Negotiated Rate |
$1,283.75 |
| Rate for Payer: Aetna Commercial |
$736.91
|
| Rate for Payer: Aetna Medicare |
$571.93
|
| Rate for Payer: BCBS Complete |
$790.00
|
| Rate for Payer: BCBS MAPPO |
$549.93
|
| Rate for Payer: BCN Medicare Advantage |
$549.93
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cofinity Commercial |
$791.90
|
| Rate for Payer: Cofinity Commercial |
$736.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.43
|
| Rate for Payer: Nomi Health Commercial |
$659.92
|
| Rate for Payer: PACE SWMI |
$549.93
|
| Rate for Payer: PHP Medicare Advantage |
$549.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,283.75
|
| Rate for Payer: Priority Health Medicare |
$555.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$549.93
|
| Rate for Payer: UHC Exchange |
$549.93
|
| Rate for Payer: UHC Medicare Advantage |
$549.93
|
|
|
PR ARTHRODESIS HIP JOINT W/OBTAINING GRAFT
|
Professional
|
Both
|
$4,757.00
|
|
|
Service Code
|
HCPCS 27284
|
| Min. Negotiated Rate |
$1,543.83 |
| Max. Negotiated Rate |
$3,092.05 |
| Rate for Payer: Aetna Commercial |
$2,068.73
|
| Rate for Payer: Aetna Medicare |
$1,605.58
|
| Rate for Payer: BCBS Complete |
$1,902.80
|
| Rate for Payer: BCBS MAPPO |
$1,543.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,543.83
|
| Rate for Payer: Cash Price |
$3,805.60
|
| Rate for Payer: Cash Price |
$3,805.60
|
| Rate for Payer: Cofinity Commercial |
$2,223.12
|
| Rate for Payer: Cofinity Commercial |
$2,068.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,543.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,621.02
|
| Rate for Payer: Nomi Health Commercial |
$1,852.60
|
| Rate for Payer: PACE SWMI |
$1,543.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,543.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,092.05
|
| Rate for Payer: Priority Health Medicare |
$1,559.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,543.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,543.83
|
| Rate for Payer: UHC Exchange |
$1,543.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,543.83
|
|
|
PR ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 26860
|
| Min. Negotiated Rate |
$568.60 |
| Max. Negotiated Rate |
$1,340.30 |
| Rate for Payer: Aetna Commercial |
$761.92
|
| Rate for Payer: Aetna Medicare |
$591.34
|
| Rate for Payer: BCBS Complete |
$824.80
|
| Rate for Payer: BCBS MAPPO |
$568.60
|
| Rate for Payer: BCN Medicare Advantage |
$568.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cofinity Commercial |
$818.78
|
| Rate for Payer: Cofinity Commercial |
$761.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$568.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$597.03
|
| Rate for Payer: Nomi Health Commercial |
$682.32
|
| Rate for Payer: PACE SWMI |
$568.60
|
| Rate for Payer: PHP Medicare Advantage |
$568.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.30
|
| Rate for Payer: Priority Health Medicare |
$574.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$568.60
|
| Rate for Payer: UHC Exchange |
$568.60
|
| Rate for Payer: UHC Medicare Advantage |
$568.60
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 26861
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$130.89
|
| Rate for Payer: Aetna Medicare |
$101.59
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$97.68
|
| Rate for Payer: BCN Medicare Advantage |
$97.68
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Cofinity Commercial |
$130.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.56
|
| Rate for Payer: Nomi Health Commercial |
$117.22
|
| Rate for Payer: PACE SWMI |
$97.68
|
| Rate for Payer: PHP Medicare Advantage |
$97.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$98.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.68
|
| Rate for Payer: UHC Exchange |
$97.68
|
| Rate for Payer: UHC Medicare Advantage |
$97.68
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 26863
|
| Min. Negotiated Rate |
$168.40 |
| Max. Negotiated Rate |
$313.04 |
| Rate for Payer: Aetna Commercial |
$291.30
|
| Rate for Payer: Aetna Medicare |
$226.09
|
| Rate for Payer: BCBS Complete |
$168.40
|
| Rate for Payer: BCBS MAPPO |
$217.39
|
| Rate for Payer: BCN Medicare Advantage |
$217.39
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Cofinity Commercial |
$291.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$228.26
|
| Rate for Payer: Nomi Health Commercial |
$260.87
|
| Rate for Payer: PACE SWMI |
$217.39
|
| Rate for Payer: PHP Medicare Advantage |
$217.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.65
|
| Rate for Payer: Priority Health Medicare |
$219.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.39
|
| Rate for Payer: UHC Exchange |
$217.39
|
| Rate for Payer: UHC Medicare Advantage |
$217.39
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
HCPCS 26862
|
| Min. Negotiated Rate |
$719.13 |
| Max. Negotiated Rate |
$1,697.80 |
| Rate for Payer: Aetna Commercial |
$963.63
|
| Rate for Payer: Aetna Medicare |
$747.90
|
| Rate for Payer: BCBS Complete |
$1,044.80
|
| Rate for Payer: BCBS MAPPO |
$719.13
|
| Rate for Payer: BCN Medicare Advantage |
$719.13
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Cofinity Commercial |
$963.63
|
| Rate for Payer: Cofinity Commercial |
$1,035.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.09
|
| Rate for Payer: Nomi Health Commercial |
$862.96
|
| Rate for Payer: PACE SWMI |
$719.13
|
| Rate for Payer: PHP Medicare Advantage |
$719.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,697.80
|
| Rate for Payer: Priority Health Medicare |
$726.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.13
|
| Rate for Payer: UHC Exchange |
$719.13
|
| Rate for Payer: UHC Medicare Advantage |
$719.13
|
|
|
PR ARTHRODESIS KNEE ANY TECHNIQUE
|
Professional
|
Both
|
$3,222.00
|
|
|
Service Code
|
HCPCS 27580
|
| Min. Negotiated Rate |
$1,288.80 |
| Max. Negotiated Rate |
$2,094.30 |
| Rate for Payer: Aetna Commercial |
$1,894.21
|
| Rate for Payer: Aetna Medicare |
$1,470.13
|
| Rate for Payer: BCBS Complete |
$1,288.80
|
| Rate for Payer: BCBS MAPPO |
$1,413.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,413.59
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cofinity Commercial |
$2,035.57
|
| Rate for Payer: Cofinity Commercial |
$1,894.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,413.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,484.27
|
| Rate for Payer: Nomi Health Commercial |
$1,696.31
|
| Rate for Payer: PACE SWMI |
$1,413.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,413.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,094.30
|
| Rate for Payer: Priority Health Medicare |
$1,427.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,413.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,413.59
|
| Rate for Payer: UHC Exchange |
$1,413.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,413.59
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR
|
Professional
|
Both
|
$6,054.00
|
|
|
Service Code
|
HCPCS 22533
|
| Min. Negotiated Rate |
$1,614.48 |
| Max. Negotiated Rate |
$3,935.10 |
| Rate for Payer: Aetna Commercial |
$2,163.40
|
| Rate for Payer: Aetna Medicare |
$1,679.06
|
| Rate for Payer: BCBS Complete |
$2,421.60
|
| Rate for Payer: BCBS MAPPO |
$1,614.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,614.48
|
| Rate for Payer: Cash Price |
$4,843.20
|
| Rate for Payer: Cash Price |
$4,843.20
|
| Rate for Payer: Cofinity Commercial |
$2,324.85
|
| Rate for Payer: Cofinity Commercial |
$2,163.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,614.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,695.20
|
| Rate for Payer: Nomi Health Commercial |
$1,937.38
|
| Rate for Payer: PACE SWMI |
$1,614.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,614.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,935.10
|
| Rate for Payer: Priority Health Medicare |
$1,630.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,614.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,614.48
|
| Rate for Payer: UHC Exchange |
$1,614.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,614.48
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY THORACIC
|
Professional
|
Both
|
$6,049.00
|
|
|
Service Code
|
HCPCS 22532
|
| Min. Negotiated Rate |
$1,751.31 |
| Max. Negotiated Rate |
$3,931.85 |
| Rate for Payer: Aetna Commercial |
$2,346.76
|
| Rate for Payer: Aetna Medicare |
$1,821.36
|
| Rate for Payer: BCBS Complete |
$2,419.60
|
| Rate for Payer: BCBS MAPPO |
$1,751.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,751.31
|
| Rate for Payer: Cash Price |
$4,839.20
|
| Rate for Payer: Cash Price |
$4,839.20
|
| Rate for Payer: Cofinity Commercial |
$2,521.89
|
| Rate for Payer: Cofinity Commercial |
$2,346.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,751.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,838.88
|
| Rate for Payer: Nomi Health Commercial |
$2,101.57
|
| Rate for Payer: PACE SWMI |
$1,751.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,751.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.85
|
| Rate for Payer: Priority Health Medicare |
$1,768.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,751.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,751.31
|
| Rate for Payer: UHC Exchange |
$1,751.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,751.31
|
|
|
PR ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$3,010.00
|
|
|
Service Code
|
HCPCS 22534
|
| Min. Negotiated Rate |
$351.93 |
| Max. Negotiated Rate |
$1,956.50 |
| Rate for Payer: Aetna Commercial |
$471.59
|
| Rate for Payer: Aetna Medicare |
$366.01
|
| Rate for Payer: BCBS Complete |
$1,204.00
|
| Rate for Payer: BCBS MAPPO |
$351.93
|
| Rate for Payer: BCN Medicare Advantage |
$351.93
|
| Rate for Payer: Cash Price |
$2,408.00
|
| Rate for Payer: Cash Price |
$2,408.00
|
| Rate for Payer: Cofinity Commercial |
$506.78
|
| Rate for Payer: Cofinity Commercial |
$471.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.53
|
| Rate for Payer: Nomi Health Commercial |
$422.32
|
| Rate for Payer: PACE SWMI |
$351.93
|
| Rate for Payer: PHP Medicare Advantage |
$351.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,956.50
|
| Rate for Payer: Priority Health Medicare |
$355.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.93
|
| Rate for Payer: UHC Exchange |
$351.93
|
| Rate for Payer: UHC Medicare Advantage |
$351.93
|
|
|
PR ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,310.00
|
|
|
Service Code
|
HCPCS 26850
|
| Min. Negotiated Rate |
$688.83 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$923.03
|
| Rate for Payer: Aetna Medicare |
$716.38
|
| Rate for Payer: BCBS Complete |
$924.00
|
| Rate for Payer: BCBS MAPPO |
$688.83
|
| Rate for Payer: BCN Medicare Advantage |
$688.83
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cofinity Commercial |
$991.92
|
| Rate for Payer: Cofinity Commercial |
$923.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$688.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.27
|
| Rate for Payer: Nomi Health Commercial |
$826.60
|
| Rate for Payer: PACE SWMI |
$688.83
|
| Rate for Payer: PHP Medicare Advantage |
$688.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,501.50
|
| Rate for Payer: Priority Health Medicare |
$695.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$688.83
|
| Rate for Payer: UHC Exchange |
$688.83
|
| Rate for Payer: UHC Medicare Advantage |
$688.83
|
|
|
PR ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$2,154.00
|
|
|
Service Code
|
HCPCS 28740
|
| Min. Negotiated Rate |
$589.65 |
| Max. Negotiated Rate |
$1,400.10 |
| Rate for Payer: Aetna Commercial |
$790.13
|
| Rate for Payer: Aetna Medicare |
$613.24
|
| Rate for Payer: BCBS Complete |
$861.60
|
| Rate for Payer: BCBS MAPPO |
$589.65
|
| Rate for Payer: BCN Medicare Advantage |
$589.65
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cofinity Commercial |
$849.10
|
| Rate for Payer: Cofinity Commercial |
$790.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.13
|
| Rate for Payer: Nomi Health Commercial |
$707.58
|
| Rate for Payer: PACE SWMI |
$589.65
|
| Rate for Payer: PHP Medicare Advantage |
$589.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.10
|
| Rate for Payer: Priority Health Medicare |
$595.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$589.65
|
| Rate for Payer: UHC Exchange |
$589.65
|
| Rate for Payer: UHC Medicare Advantage |
$589.65
|
|
|
PR ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT
|
Professional
|
Both
|
$2,860.00
|
|
|
Service Code
|
HCPCS 26852
|
| Min. Negotiated Rate |
$785.60 |
| Max. Negotiated Rate |
$1,859.00 |
| Rate for Payer: Aetna Commercial |
$1,052.70
|
| Rate for Payer: Aetna Medicare |
$817.02
|
| Rate for Payer: BCBS Complete |
$1,144.00
|
| Rate for Payer: BCBS MAPPO |
$785.60
|
| Rate for Payer: BCN Medicare Advantage |
$785.60
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cofinity Commercial |
$1,131.26
|
| Rate for Payer: Cofinity Commercial |
$1,052.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.88
|
| Rate for Payer: Nomi Health Commercial |
$942.72
|
| Rate for Payer: PACE SWMI |
$785.60
|
| Rate for Payer: PHP Medicare Advantage |
$785.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,859.00
|
| Rate for Payer: Priority Health Medicare |
$793.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$785.60
|
| Rate for Payer: UHC Exchange |
$785.60
|
| Rate for Payer: UHC Medicare Advantage |
$785.60
|
|
|
PR ARTHRODESIS PANTALAR
|
Professional
|
Both
|
$3,938.00
|
|
|
Service Code
|
HCPCS 28705
|
| Min. Negotiated Rate |
$1,173.16 |
| Max. Negotiated Rate |
$2,559.70 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Aetna Medicare |
$1,220.09
|
| Rate for Payer: BCBS Complete |
$1,575.20
|
| Rate for Payer: BCBS MAPPO |
$1,173.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,173.16
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: Cofinity Commercial |
$1,689.35
|
| Rate for Payer: Cofinity Commercial |
$1,572.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,173.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,231.82
|
| Rate for Payer: Nomi Health Commercial |
$1,407.79
|
| Rate for Payer: PACE SWMI |
$1,173.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,173.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,559.70
|
| Rate for Payer: Priority Health Medicare |
$1,184.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,173.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,173.16
|
| Rate for Payer: UHC Exchange |
$1,173.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,173.16
|
|
|
PR ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2
|
Professional
|
Both
|
$5,175.00
|
|
|
Service Code
|
HCPCS 22595
|
| Min. Negotiated Rate |
$1,497.11 |
| Max. Negotiated Rate |
$3,363.75 |
| Rate for Payer: Aetna Commercial |
$2,006.13
|
| Rate for Payer: Aetna Medicare |
$1,556.99
|
| Rate for Payer: BCBS Complete |
$2,070.00
|
| Rate for Payer: BCBS MAPPO |
$1,497.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,497.11
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Cofinity Commercial |
$2,155.84
|
| Rate for Payer: Cofinity Commercial |
$2,006.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,497.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,571.97
|
| Rate for Payer: Nomi Health Commercial |
$1,796.53
|
| Rate for Payer: PACE SWMI |
$1,497.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,497.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,363.75
|
| Rate for Payer: Priority Health Medicare |
$1,512.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,497.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,497.11
|
| Rate for Payer: UHC Exchange |
$1,497.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,497.11
|
|
|
PR ARTHRODESIS POSTERIOR CRANIOCERVICAL
|
Professional
|
Both
|
$5,337.00
|
|
|
Service Code
|
HCPCS 22590
|
| Min. Negotiated Rate |
$1,568.47 |
| Max. Negotiated Rate |
$3,469.05 |
| Rate for Payer: Aetna Commercial |
$2,101.75
|
| Rate for Payer: Aetna Medicare |
$1,631.21
|
| Rate for Payer: BCBS Complete |
$2,134.80
|
| Rate for Payer: BCBS MAPPO |
$1,568.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.47
|
| Rate for Payer: Cash Price |
$4,269.60
|
| Rate for Payer: Cash Price |
$4,269.60
|
| Rate for Payer: Cofinity Commercial |
$2,258.60
|
| Rate for Payer: Cofinity Commercial |
$2,101.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.89
|
| Rate for Payer: Nomi Health Commercial |
$1,882.16
|
| Rate for Payer: PACE SWMI |
$1,568.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,469.05
|
| Rate for Payer: Priority Health Medicare |
$1,584.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,568.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.47
|
| Rate for Payer: UHC Exchange |
$1,568.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.47
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 22632
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$820.30 |
| Rate for Payer: Aetna Commercial |
$421.23
|
| Rate for Payer: Aetna Medicare |
$326.92
|
| Rate for Payer: BCBS Complete |
$504.80
|
| Rate for Payer: BCBS MAPPO |
$314.35
|
| Rate for Payer: BCN Medicare Advantage |
$314.35
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cofinity Commercial |
$452.66
|
| Rate for Payer: Cofinity Commercial |
$421.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.07
|
| Rate for Payer: Nomi Health Commercial |
$377.22
|
| Rate for Payer: PACE SWMI |
$314.35
|
| Rate for Payer: PHP Medicare Advantage |
$314.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.30
|
| Rate for Payer: Priority Health Medicare |
$317.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.35
|
| Rate for Payer: UHC Exchange |
$314.35
|
| Rate for Payer: UHC Medicare Advantage |
$314.35
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,749.00
|
|
|
Service Code
|
HCPCS 22630
|
| Min. Negotiated Rate |
$1,536.91 |
| Max. Negotiated Rate |
$4,386.85 |
| Rate for Payer: Aetna Commercial |
$2,059.46
|
| Rate for Payer: Aetna Medicare |
$1,598.39
|
| Rate for Payer: BCBS Complete |
$2,699.60
|
| Rate for Payer: BCBS MAPPO |
$1,536.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,536.91
|
| Rate for Payer: Cash Price |
$5,399.20
|
| Rate for Payer: Cash Price |
$5,399.20
|
| Rate for Payer: Cofinity Commercial |
$2,213.15
|
| Rate for Payer: Cofinity Commercial |
$2,059.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,536.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,613.76
|
| Rate for Payer: Nomi Health Commercial |
$1,844.29
|
| Rate for Payer: PACE SWMI |
$1,536.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,536.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,386.85
|
| Rate for Payer: Priority Health Medicare |
$1,552.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,536.91
|
| Rate for Payer: UHC Exchange |
$1,536.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,536.91
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$3,299.00
|
|
|
Service Code
|
HCPCS 22612
|
| Min. Negotiated Rate |
$1,319.60 |
| Max. Negotiated Rate |
$2,216.65 |
| Rate for Payer: Aetna Commercial |
$2,062.72
|
| Rate for Payer: Aetna Medicare |
$1,600.91
|
| Rate for Payer: BCBS Complete |
$1,319.60
|
| Rate for Payer: BCBS MAPPO |
$1,539.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,539.34
|
| Rate for Payer: Cash Price |
$2,639.20
|
| Rate for Payer: Cash Price |
$2,639.20
|
| Rate for Payer: Cofinity Commercial |
$2,216.65
|
| Rate for Payer: Cofinity Commercial |
$2,062.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,539.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,616.31
|
| Rate for Payer: Nomi Health Commercial |
$1,847.21
|
| Rate for Payer: PACE SWMI |
$1,539.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,539.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,144.35
|
| Rate for Payer: Priority Health Medicare |
$1,554.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,539.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,539.34
|
| Rate for Payer: UHC Exchange |
$1,539.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,539.34
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC THORACIC
|
Professional
|
Both
|
$4,286.00
|
|
|
Service Code
|
HCPCS 22610
|
| Min. Negotiated Rate |
$1,257.65 |
| Max. Negotiated Rate |
$2,785.90 |
| Rate for Payer: Aetna Commercial |
$1,685.25
|
| Rate for Payer: Aetna Medicare |
$1,307.96
|
| Rate for Payer: BCBS Complete |
$1,714.40
|
| Rate for Payer: BCBS MAPPO |
$1,257.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.65
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cofinity Commercial |
$1,811.02
|
| Rate for Payer: Cofinity Commercial |
$1,685.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,320.53
|
| Rate for Payer: Nomi Health Commercial |
$1,509.18
|
| Rate for Payer: PACE SWMI |
$1,257.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.90
|
| Rate for Payer: Priority Health Medicare |
$1,270.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,257.65
|
| Rate for Payer: UHC Exchange |
$1,257.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,257.65
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 13+ VRT SGM
|
Professional
|
Both
|
$5,067.00
|
|
|
Service Code
|
HCPCS 22804
|
| Min. Negotiated Rate |
$2,026.80 |
| Max. Negotiated Rate |
$3,388.46 |
| Rate for Payer: Aetna Commercial |
$3,153.15
|
| Rate for Payer: Aetna Medicare |
$2,447.22
|
| Rate for Payer: BCBS Complete |
$2,026.80
|
| Rate for Payer: BCBS MAPPO |
$2,353.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,353.10
|
| Rate for Payer: Cash Price |
$4,053.60
|
| Rate for Payer: Cash Price |
$4,053.60
|
| Rate for Payer: Cofinity Commercial |
$3,388.46
|
| Rate for Payer: Cofinity Commercial |
$3,153.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,353.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,470.76
|
| Rate for Payer: Nomi Health Commercial |
$2,823.72
|
| Rate for Payer: PACE SWMI |
$2,353.10
|
| Rate for Payer: PHP Medicare Advantage |
$2,353.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,293.55
|
| Rate for Payer: Priority Health Medicare |
$2,376.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,353.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,353.10
|
| Rate for Payer: UHC Exchange |
$2,353.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,353.10
|
|
