|
PR ARTHRODESIS POSTERIOR SPINAL DFRM <6 VRT SGM
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 22800
|
| Min. Negotiated Rate |
$1,124.80 |
| Max. Negotiated Rate |
$1,919.74 |
| Rate for Payer: Aetna Commercial |
$1,786.42
|
| Rate for Payer: Aetna Medicare |
$1,386.48
|
| Rate for Payer: BCBS Complete |
$1,124.80
|
| Rate for Payer: BCBS MAPPO |
$1,333.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,333.15
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Cofinity Commercial |
$1,919.74
|
| Rate for Payer: Cofinity Commercial |
$1,786.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,333.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,399.81
|
| Rate for Payer: Nomi Health Commercial |
$1,599.78
|
| Rate for Payer: PACE SWMI |
$1,333.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,333.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.80
|
| Rate for Payer: Priority Health Medicare |
$1,346.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,333.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,333.15
|
| Rate for Payer: UHC Exchange |
$1,333.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,333.15
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SGM
|
Professional
|
Both
|
$4,380.00
|
|
|
Service Code
|
HCPCS 22802
|
| Min. Negotiated Rate |
$1,752.00 |
| Max. Negotiated Rate |
$2,949.98 |
| Rate for Payer: Aetna Commercial |
$2,745.12
|
| Rate for Payer: Aetna Medicare |
$2,130.54
|
| Rate for Payer: BCBS Complete |
$1,752.00
|
| Rate for Payer: BCBS MAPPO |
$2,048.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,048.60
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Cofinity Commercial |
$2,949.98
|
| Rate for Payer: Cofinity Commercial |
$2,745.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,048.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,151.03
|
| Rate for Payer: Nomi Health Commercial |
$2,458.32
|
| Rate for Payer: PACE SWMI |
$2,048.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,048.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.00
|
| Rate for Payer: Priority Health Medicare |
$2,069.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,048.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,048.60
|
| Rate for Payer: UHC Exchange |
$2,048.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,048.60
|
|
|
PR ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 22614
|
| Min. Negotiated Rate |
$382.59 |
| Max. Negotiated Rate |
$1,218.75 |
| Rate for Payer: Aetna Commercial |
$512.67
|
| Rate for Payer: Aetna Medicare |
$397.89
|
| Rate for Payer: BCBS Complete |
$750.00
|
| Rate for Payer: BCBS MAPPO |
$382.59
|
| Rate for Payer: BCN Medicare Advantage |
$382.59
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cofinity Commercial |
$550.93
|
| Rate for Payer: Cofinity Commercial |
$512.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.72
|
| Rate for Payer: Nomi Health Commercial |
$459.11
|
| Rate for Payer: PACE SWMI |
$382.59
|
| Rate for Payer: PHP Medicare Advantage |
$382.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.75
|
| Rate for Payer: Priority Health Medicare |
$386.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.59
|
| Rate for Payer: UHC Exchange |
$382.59
|
| Rate for Payer: UHC Medicare Advantage |
$382.59
|
|
|
PR ARTHRODESIS SI JOINT PERCUTANEOUS/MIN INVASIVE
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 27279
|
| Min. Negotiated Rate |
$526.40 |
| Max. Negotiated Rate |
$1,116.95 |
| Rate for Payer: Aetna Commercial |
$1,039.38
|
| Rate for Payer: Aetna Medicare |
$806.69
|
| Rate for Payer: BCBS Complete |
$526.40
|
| Rate for Payer: BCBS MAPPO |
$775.66
|
| Rate for Payer: BCN Medicare Advantage |
$775.66
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,116.95
|
| Rate for Payer: Cofinity Commercial |
$1,039.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.44
|
| Rate for Payer: Nomi Health Commercial |
$930.79
|
| Rate for Payer: PACE SWMI |
$775.66
|
| Rate for Payer: PHP Medicare Advantage |
$775.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$855.40
|
| Rate for Payer: Priority Health Medicare |
$783.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$775.66
|
| Rate for Payer: UHC Exchange |
$775.66
|
| Rate for Payer: UHC Medicare Advantage |
$775.66
|
|
|
PR ARTHRODESIS SI JT OPN W/OBTAINING B1 GRF INSTRMJ
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 27280
|
| Min. Negotiated Rate |
$1,296.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna Commercial |
$1,784.09
|
| Rate for Payer: Aetna Medicare |
$1,384.67
|
| Rate for Payer: BCBS Complete |
$1,296.00
|
| Rate for Payer: BCBS MAPPO |
$1,331.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,331.41
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,917.23
|
| Rate for Payer: Cofinity Commercial |
$1,784.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,331.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,397.98
|
| Rate for Payer: Nomi Health Commercial |
$1,597.69
|
| Rate for Payer: PACE SWMI |
$1,331.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,331.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.00
|
| Rate for Payer: Priority Health Medicare |
$1,344.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,331.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,331.41
|
| Rate for Payer: UHC Exchange |
$1,331.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,331.41
|
|
|
PR ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 28725
|
| Min. Negotiated Rate |
$746.91 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Aetna Commercial |
$1,000.86
|
| Rate for Payer: Aetna Medicare |
$776.79
|
| Rate for Payer: BCBS Complete |
$1,310.40
|
| Rate for Payer: BCBS MAPPO |
$746.91
|
| Rate for Payer: BCN Medicare Advantage |
$746.91
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cofinity Commercial |
$1,075.55
|
| Rate for Payer: Cofinity Commercial |
$1,000.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.26
|
| Rate for Payer: Nomi Health Commercial |
$896.29
|
| Rate for Payer: PACE SWMI |
$746.91
|
| Rate for Payer: PHP Medicare Advantage |
$746.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health Medicare |
$754.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.91
|
| Rate for Payer: UHC Exchange |
$746.91
|
| Rate for Payer: UHC Medicare Advantage |
$746.91
|
|
|
PR ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 27282
|
| Min. Negotiated Rate |
$601.20 |
| Max. Negotiated Rate |
$1,194.54 |
| Rate for Payer: Aetna Commercial |
$1,111.58
|
| Rate for Payer: Aetna Medicare |
$862.72
|
| Rate for Payer: BCBS Complete |
$601.20
|
| Rate for Payer: BCBS MAPPO |
$829.54
|
| Rate for Payer: BCN Medicare Advantage |
$829.54
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cofinity Commercial |
$1,194.54
|
| Rate for Payer: Cofinity Commercial |
$1,111.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$829.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$871.02
|
| Rate for Payer: Nomi Health Commercial |
$995.45
|
| Rate for Payer: PACE SWMI |
$829.54
|
| Rate for Payer: PHP Medicare Advantage |
$829.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health Medicare |
$837.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$829.54
|
| Rate for Payer: UHC Exchange |
$829.54
|
| Rate for Payer: UHC Medicare Advantage |
$829.54
|
|
|
PR ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27871
|
| Min. Negotiated Rate |
$663.31 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$888.84
|
| Rate for Payer: Aetna Medicare |
$689.84
|
| Rate for Payer: BCBS Complete |
$1,202.00
|
| Rate for Payer: BCBS MAPPO |
$663.31
|
| Rate for Payer: BCN Medicare Advantage |
$663.31
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$955.17
|
| Rate for Payer: Cofinity Commercial |
$888.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.48
|
| Rate for Payer: Nomi Health Commercial |
$795.97
|
| Rate for Payer: PACE SWMI |
$663.31
|
| Rate for Payer: PHP Medicare Advantage |
$663.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health Medicare |
$669.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$663.31
|
| Rate for Payer: UHC Exchange |
$663.31
|
| Rate for Payer: UHC Medicare Advantage |
$663.31
|
|
|
PR ARTHRODESIS TRIPLE
|
Professional
|
Both
|
$4,084.00
|
|
|
Service Code
|
HCPCS 28715
|
| Min. Negotiated Rate |
$903.64 |
| Max. Negotiated Rate |
$2,654.60 |
| Rate for Payer: Aetna Commercial |
$1,210.88
|
| Rate for Payer: Aetna Medicare |
$939.79
|
| Rate for Payer: BCBS Complete |
$1,633.60
|
| Rate for Payer: BCBS MAPPO |
$903.64
|
| Rate for Payer: BCN Medicare Advantage |
$903.64
|
| Rate for Payer: Cash Price |
$3,267.20
|
| Rate for Payer: Cash Price |
$3,267.20
|
| Rate for Payer: Cofinity Commercial |
$1,301.24
|
| Rate for Payer: Cofinity Commercial |
$1,210.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.82
|
| Rate for Payer: Nomi Health Commercial |
$1,084.37
|
| Rate for Payer: PACE SWMI |
$903.64
|
| Rate for Payer: PHP Medicare Advantage |
$903.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,654.60
|
| Rate for Payer: Priority Health Medicare |
$912.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$903.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$903.64
|
| Rate for Payer: UHC Exchange |
$903.64
|
| Rate for Payer: UHC Medicare Advantage |
$903.64
|
|
|
PR ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 25800
|
| Min. Negotiated Rate |
$707.23 |
| Max. Negotiated Rate |
$1,598.35 |
| Rate for Payer: Aetna Commercial |
$947.69
|
| Rate for Payer: Aetna Medicare |
$735.52
|
| Rate for Payer: BCBS Complete |
$983.60
|
| Rate for Payer: BCBS MAPPO |
$707.23
|
| Rate for Payer: BCN Medicare Advantage |
$707.23
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cofinity Commercial |
$947.69
|
| Rate for Payer: Cofinity Commercial |
$1,018.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$742.59
|
| Rate for Payer: Nomi Health Commercial |
$848.68
|
| Rate for Payer: PACE SWMI |
$707.23
|
| Rate for Payer: PHP Medicare Advantage |
$707.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.35
|
| Rate for Payer: Priority Health Medicare |
$714.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.23
|
| Rate for Payer: UHC Exchange |
$707.23
|
| Rate for Payer: UHC Medicare Advantage |
$707.23
|
|
|
PR ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 25820
|
| Min. Negotiated Rate |
$621.74 |
| Max. Negotiated Rate |
$1,844.05 |
| Rate for Payer: Aetna Commercial |
$833.13
|
| Rate for Payer: Aetna Medicare |
$646.61
|
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: BCBS MAPPO |
$621.74
|
| Rate for Payer: BCN Medicare Advantage |
$621.74
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Cofinity Commercial |
$895.31
|
| Rate for Payer: Cofinity Commercial |
$833.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.83
|
| Rate for Payer: Nomi Health Commercial |
$746.09
|
| Rate for Payer: PACE SWMI |
$621.74
|
| Rate for Payer: PHP Medicare Advantage |
$621.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.05
|
| Rate for Payer: Priority Health Medicare |
$627.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$621.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.74
|
| Rate for Payer: UHC Exchange |
$621.74
|
| Rate for Payer: UHC Medicare Advantage |
$621.74
|
|
|
PR ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$3,412.00
|
|
|
Service Code
|
HCPCS 25810
|
| Min. Negotiated Rate |
$838.11 |
| Max. Negotiated Rate |
$2,217.80 |
| Rate for Payer: Aetna Commercial |
$1,123.07
|
| Rate for Payer: Aetna Medicare |
$871.63
|
| Rate for Payer: BCBS Complete |
$1,364.80
|
| Rate for Payer: BCBS MAPPO |
$838.11
|
| Rate for Payer: BCN Medicare Advantage |
$838.11
|
| Rate for Payer: Cash Price |
$2,729.60
|
| Rate for Payer: Cash Price |
$2,729.60
|
| Rate for Payer: Cofinity Commercial |
$1,206.88
|
| Rate for Payer: Cofinity Commercial |
$1,123.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$880.02
|
| Rate for Payer: Nomi Health Commercial |
$1,005.73
|
| Rate for Payer: PACE SWMI |
$838.11
|
| Rate for Payer: PHP Medicare Advantage |
$838.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,217.80
|
| Rate for Payer: Priority Health Medicare |
$846.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$838.11
|
| Rate for Payer: UHC Exchange |
$838.11
|
| Rate for Payer: UHC Medicare Advantage |
$838.11
|
|
|
PR ARTHRODESIS WRIST WITH AUTOGRAFT
|
Professional
|
Both
|
$14,088.00
|
|
|
Service Code
|
HCPCS 25825
|
| Min. Negotiated Rate |
$759.51 |
| Max. Negotiated Rate |
$9,157.20 |
| Rate for Payer: Aetna Commercial |
$1,017.74
|
| Rate for Payer: Aetna Medicare |
$789.89
|
| Rate for Payer: BCBS Complete |
$5,635.20
|
| Rate for Payer: BCBS MAPPO |
$759.51
|
| Rate for Payer: BCN Medicare Advantage |
$759.51
|
| Rate for Payer: Cash Price |
$11,270.40
|
| Rate for Payer: Cash Price |
$11,270.40
|
| Rate for Payer: Cofinity Commercial |
$1,093.69
|
| Rate for Payer: Cofinity Commercial |
$1,017.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.49
|
| Rate for Payer: Nomi Health Commercial |
$911.41
|
| Rate for Payer: PACE SWMI |
$759.51
|
| Rate for Payer: PHP Medicare Advantage |
$759.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,157.20
|
| Rate for Payer: Priority Health Medicare |
$767.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.51
|
| Rate for Payer: UHC Exchange |
$759.51
|
| Rate for Payer: UHC Medicare Advantage |
$759.51
|
|
|
PR ARTHRODESIS WRIST W/SLIDING GRAFT
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25805
|
| Min. Negotiated Rate |
$819.00 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna Commercial |
$1,097.46
|
| Rate for Payer: Aetna Medicare |
$851.76
|
| Rate for Payer: BCBS Complete |
$1,190.00
|
| Rate for Payer: BCBS MAPPO |
$819.00
|
| Rate for Payer: BCN Medicare Advantage |
$819.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,179.36
|
| Rate for Payer: Cofinity Commercial |
$1,097.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$859.95
|
| Rate for Payer: Nomi Health Commercial |
$982.80
|
| Rate for Payer: PACE SWMI |
$819.00
|
| Rate for Payer: PHP Medicare Advantage |
$819.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health Medicare |
$827.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$819.00
|
| Rate for Payer: UHC Exchange |
$819.00
|
| Rate for Payer: UHC Medicare Advantage |
$819.00
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$53.67 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna Commercial |
$192.10
|
| Rate for Payer: Aetna Medicare |
$58.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.62
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS MAPPO |
$56.50
|
| Rate for Payer: BCBS Trust/PPO |
$185.79
|
| Rate for Payer: BCN Commercial |
$175.72
|
| Rate for Payer: BCN Medicare Advantage |
$56.50
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$194.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.50
|
| Rate for Payer: Healthscope Commercial |
$203.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.10
|
| Rate for Payer: Nomi Health Commercial |
$185.32
|
| Rate for Payer: PACE Senior Care Partners |
$53.67
|
| Rate for Payer: PACE SWMI |
$56.50
|
| Rate for Payer: PHP Commercial |
$192.10
|
| Rate for Payer: PHP Medicare Advantage |
$56.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health HMO/PPO |
$196.62
|
| Rate for Payer: Priority Health Medicare |
$57.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.42
|
| Rate for Payer: Railroad Medicare Medicare |
$56.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.88
|
| Rate for Payer: UHC Core |
$188.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.50
|
| Rate for Payer: UHC Exchange |
$56.50
|
| Rate for Payer: UHC Medicare Advantage |
$56.50
|
| Rate for Payer: VA VA |
$56.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.50
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$109.30
|
| Rate for Payer: Aetna Medicare |
$84.83
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS MAPPO |
$81.57
|
| Rate for Payer: BCN Medicare Advantage |
$81.57
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$117.46
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.65
|
| Rate for Payer: Nomi Health Commercial |
$97.88
|
| Rate for Payer: PACE SWMI |
$81.57
|
| Rate for Payer: PHP Medicare Advantage |
$81.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health Medicare |
$82.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.57
|
| Rate for Payer: UHC Exchange |
$81.57
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Aetna Commercial |
$109.30
|
| Rate for Payer: Aetna Medicare |
$84.83
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS MAPPO |
$81.57
|
| Rate for Payer: BCN Medicare Advantage |
$81.57
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$117.46
|
| Rate for Payer: Cofinity Commercial |
$109.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.65
|
| Rate for Payer: Nomi Health Commercial |
$97.88
|
| Rate for Payer: PACE SWMI |
$81.57
|
| Rate for Payer: PHP Medicare Advantage |
$81.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health Medicare |
$82.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.57
|
| Rate for Payer: UHC Exchange |
$81.57
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Aetna Commercial |
$192.10
|
| Rate for Payer: BCBS Trust/PPO |
$184.48
|
| Rate for Payer: BCN Commercial |
$174.65
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$194.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.80
|
| Rate for Payer: Healthscope Commercial |
$203.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.10
|
| Rate for Payer: Nomi Health Commercial |
$185.32
|
| Rate for Payer: PHP Commercial |
$192.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health HMO/PPO |
$196.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.88
|
| Rate for Payer: UHC Core |
$188.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.50
|
|
|
PR ARTHROPLASTY ANKLE
|
Professional
|
Both
|
$2,703.00
|
|
|
Service Code
|
HCPCS 27700
|
| Min. Negotiated Rate |
$687.87 |
| Max. Negotiated Rate |
$1,756.95 |
| Rate for Payer: Aetna Commercial |
$921.75
|
| Rate for Payer: Aetna Medicare |
$715.38
|
| Rate for Payer: BCBS Complete |
$1,081.20
|
| Rate for Payer: BCBS MAPPO |
$687.87
|
| Rate for Payer: BCN Medicare Advantage |
$687.87
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cofinity Commercial |
$990.53
|
| Rate for Payer: Cofinity Commercial |
$921.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$722.26
|
| Rate for Payer: Nomi Health Commercial |
$825.44
|
| Rate for Payer: PACE SWMI |
$687.87
|
| Rate for Payer: PHP Medicare Advantage |
$687.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,756.95
|
| Rate for Payer: Priority Health Medicare |
$694.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.87
|
| Rate for Payer: UHC Exchange |
$687.87
|
| Rate for Payer: UHC Medicare Advantage |
$687.87
|
|
|
PR ARTHROPLASTY ANKLE REVISION TOTAL ANKLE
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 27703
|
| Min. Negotiated Rate |
$817.60 |
| Max. Negotiated Rate |
$1,543.28 |
| Rate for Payer: Aetna Commercial |
$1,436.10
|
| Rate for Payer: Aetna Medicare |
$1,114.59
|
| Rate for Payer: BCBS Complete |
$817.60
|
| Rate for Payer: BCBS MAPPO |
$1,071.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.72
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,543.28
|
| Rate for Payer: Cofinity Commercial |
$1,436.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.31
|
| Rate for Payer: Nomi Health Commercial |
$1,286.06
|
| Rate for Payer: PACE SWMI |
$1,071.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health Medicare |
$1,082.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,071.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.72
|
| Rate for Payer: UHC Exchange |
$1,071.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.72
|
|
|
PR ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$1,976.00
|
|
|
Service Code
|
HCPCS 27702
|
| Min. Negotiated Rate |
$790.40 |
| Max. Negotiated Rate |
$1,332.26 |
| Rate for Payer: Aetna Commercial |
$1,239.74
|
| Rate for Payer: Aetna Medicare |
$962.19
|
| Rate for Payer: BCBS Complete |
$790.40
|
| Rate for Payer: BCBS MAPPO |
$925.18
|
| Rate for Payer: BCN Medicare Advantage |
$925.18
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cofinity Commercial |
$1,332.26
|
| Rate for Payer: Cofinity Commercial |
$1,239.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$971.44
|
| Rate for Payer: Nomi Health Commercial |
$1,110.22
|
| Rate for Payer: PACE SWMI |
$925.18
|
| Rate for Payer: PHP Medicare Advantage |
$925.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.40
|
| Rate for Payer: Priority Health Medicare |
$934.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$925.18
|
| Rate for Payer: UHC Exchange |
$925.18
|
| Rate for Payer: UHC Medicare Advantage |
$925.18
|
|
|
PR ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$1,554.00
|
|
|
Service Code
|
HCPCS 27442
|
| Min. Negotiated Rate |
$621.60 |
| Max. Negotiated Rate |
$1,212.77 |
| Rate for Payer: Aetna Commercial |
$1,128.55
|
| Rate for Payer: Aetna Medicare |
$875.89
|
| Rate for Payer: BCBS Complete |
$621.60
|
| Rate for Payer: BCBS MAPPO |
$842.20
|
| Rate for Payer: BCN Medicare Advantage |
$842.20
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Cofinity Commercial |
$1,212.77
|
| Rate for Payer: Cofinity Commercial |
$1,128.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$842.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$884.31
|
| Rate for Payer: Nomi Health Commercial |
$1,010.64
|
| Rate for Payer: PACE SWMI |
$842.20
|
| Rate for Payer: PHP Medicare Advantage |
$842.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,010.10
|
| Rate for Payer: Priority Health Medicare |
$850.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$842.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$842.20
|
| Rate for Payer: UHC Exchange |
$842.20
|
| Rate for Payer: UHC Medicare Advantage |
$842.20
|
|
|
PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
23472
|
| Min. Negotiated Rate |
$2,973.75 |
| Max. Negotiated Rate |
$4,117.50 |
| Rate for Payer: Aetna Commercial |
$3,888.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,734.57
|
| Rate for Payer: BCN Commercial |
$3,535.56
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$3,934.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,660.00
|
| Rate for Payer: Healthscope Commercial |
$4,117.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,431.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,888.75
|
| Rate for Payer: Nomi Health Commercial |
$3,751.50
|
| Rate for Payer: PHP Commercial |
$3,888.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3,980.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,065.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,026.00
|
| Rate for Payer: UHC Core |
$3,820.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,431.25
|
|
|
PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 23472
|
| Min. Negotiated Rate |
$1,389.40 |
| Max. Negotiated Rate |
$2,973.75 |
| Rate for Payer: Aetna Commercial |
$1,861.80
|
| Rate for Payer: Aetna Medicare |
$1,444.98
|
| Rate for Payer: BCBS Complete |
$1,830.00
|
| Rate for Payer: BCBS MAPPO |
$1,389.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,389.40
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$2,000.74
|
| Rate for Payer: Cofinity Commercial |
$1,861.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,389.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,458.87
|
| Rate for Payer: Nomi Health Commercial |
$1,667.28
|
| Rate for Payer: PACE SWMI |
$1,389.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,389.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health Medicare |
$1,403.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,389.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.40
|
| Rate for Payer: UHC Exchange |
$1,389.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.40
|
|
|
PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
23472
|
| Min. Negotiated Rate |
$1,086.56 |
| Max. Negotiated Rate |
$13,961.73 |
| Rate for Payer: Aetna Commercial |
$3,888.75
|
| Rate for Payer: Aetna Medicare |
$1,189.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,429.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,429.69
|
| Rate for Payer: BCBS Complete |
$13,961.73
|
| Rate for Payer: BCBS MAPPO |
$1,143.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,761.11
|
| Rate for Payer: BCN Commercial |
$3,557.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,143.75
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$3,934.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,660.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,143.75
|
| Rate for Payer: Healthscope Commercial |
$4,117.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,431.25
|
| Rate for Payer: Mclaren Medicaid |
$13,296.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,200.94
|
| Rate for Payer: Meridian Medicaid |
$13,961.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,315.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,888.75
|
| Rate for Payer: Nomi Health Commercial |
$3,751.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,086.56
|
| Rate for Payer: PACE SWMI |
$1,143.75
|
| Rate for Payer: PHP Commercial |
$3,888.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,143.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,296.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3,980.25
|
| Rate for Payer: Priority Health Medicare |
$1,155.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,065.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,143.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,026.00
|
| Rate for Payer: UHC Core |
$3,820.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,143.75
|
| Rate for Payer: UHC Exchange |
$1,143.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,143.75
|
| Rate for Payer: UHCCP Medicaid |
$13,296.01
|
| Rate for Payer: VA VA |
$1,143.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,431.25
|
|
