|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
20611
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna American Axle |
$123.50
|
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.50
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: UMR Bronson Commercial |
$83.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.50
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
20611
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$11,952.59 |
| Rate for Payer: Aetna Commercial |
$80.62
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.90
|
| Rate for Payer: Priority Health Narrow Network |
$90.90
|
| Rate for Payer: Priority Health SBD |
$90.90
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 20600
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.62
|
| Rate for Payer: Priority Health Narrow Network |
$53.62
|
| Rate for Payer: Priority Health SBD |
$53.62
|
| Rate for Payer: UMR Bronson Commercial |
$57.96
|
|
|
PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 20604
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$61.98
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.45
|
| Rate for Payer: Priority Health Narrow Network |
$69.45
|
| Rate for Payer: Priority Health SBD |
$69.45
|
| Rate for Payer: UMR Bronson Commercial |
$55.20
|
|
|
PR ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$4,228.00
|
|
|
Service Code
|
HCPCS 27870
|
| Min. Negotiated Rate |
$621.84 |
| Max. Negotiated Rate |
$2,959.60 |
| Rate for Payer: Aetna Commercial |
$1,354.88
|
| Rate for Payer: BCBS Complete |
$680.57
|
| Rate for Payer: BCBS Trust/PPO |
$621.84
|
| Rate for Payer: Cash Price |
$3,382.40
|
| Rate for Payer: Cash Price |
$3,382.40
|
| Rate for Payer: Meridian Medicaid |
$680.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$648.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,959.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.21
|
| Rate for Payer: Priority Health SBD |
$1,544.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,944.88
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SGM
|
Professional
|
Both
|
$5,264.00
|
|
|
Service Code
|
HCPCS 22808
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$3,684.80 |
| Rate for Payer: Aetna Commercial |
$2,445.31
|
| Rate for Payer: BCBS Complete |
$1,236.33
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: Cash Price |
$4,211.20
|
| Rate for Payer: Cash Price |
$4,211.20
|
| Rate for Payer: Meridian Medicaid |
$1,236.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,177.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,684.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,793.77
|
| Rate for Payer: Priority Health Narrow Network |
$2,793.77
|
| Rate for Payer: Priority Health SBD |
$2,793.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,421.44
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SGM
|
Professional
|
Both
|
$6,342.00
|
|
|
Service Code
|
HCPCS 22810
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$4,439.40 |
| Rate for Payer: Aetna Commercial |
$2,798.66
|
| Rate for Payer: BCBS Complete |
$1,347.04
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: Cash Price |
$5,073.60
|
| Rate for Payer: Cash Price |
$5,073.60
|
| Rate for Payer: Meridian Medicaid |
$1,347.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,282.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,439.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,058.28
|
| Rate for Payer: Priority Health Narrow Network |
$3,058.28
|
| Rate for Payer: Priority Health SBD |
$3,058.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,917.32
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 8+ VRT SGM
|
Professional
|
Both
|
$7,357.00
|
|
|
Service Code
|
HCPCS 22812
|
| Min. Negotiated Rate |
$1,406.01 |
| Max. Negotiated Rate |
$5,149.90 |
| Rate for Payer: Aetna Commercial |
$2,950.14
|
| Rate for Payer: BCBS Complete |
$1,476.31
|
| Rate for Payer: BCBS Trust/PPO |
$5,139.76
|
| Rate for Payer: Cash Price |
$5,885.60
|
| Rate for Payer: Cash Price |
$5,885.60
|
| Rate for Payer: Meridian Medicaid |
$1,476.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,406.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,149.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,351.40
|
| Rate for Payer: Priority Health Narrow Network |
$3,351.40
|
| Rate for Payer: Priority Health SBD |
$3,351.40
|
| Rate for Payer: UMR Bronson Commercial |
$3,384.22
|
|
|
PR ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 22634
|
| Min. Negotiated Rate |
$308.64 |
| Max. Negotiated Rate |
$1,356.60 |
| Rate for Payer: Aetna Commercial |
$667.05
|
| Rate for Payer: BCBS Complete |
$324.07
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Meridian Medicaid |
$324.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.35
|
| Rate for Payer: Priority Health Narrow Network |
$736.35
|
| Rate for Payer: Priority Health SBD |
$736.35
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
|
PR ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$3,787.32
|
|
|
Service Code
|
HCPCS 22633
|
| Min. Negotiated Rate |
$950.50 |
| Max. Negotiated Rate |
$2,771.30 |
| Rate for Payer: Aetna Commercial |
$2,484.90
|
| Rate for Payer: BCBS Complete |
$1,223.14
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: Cash Price |
$3,029.86
|
| Rate for Payer: Cash Price |
$3,029.86
|
| Rate for Payer: Meridian Medicaid |
$1,223.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,164.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,771.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,771.30
|
| Rate for Payer: Priority Health SBD |
$2,771.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,742.17
|
|
|
PR ARTHRODESIS ELBOW JOINT LOCAL
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 24800
|
| Min. Negotiated Rate |
$539.74 |
| Max. Negotiated Rate |
$1,282.25 |
| Rate for Payer: Aetna Commercial |
$1,111.63
|
| Rate for Payer: BCBS Complete |
$566.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Meridian Medicaid |
$566.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,282.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,282.25
|
| Rate for Payer: Priority Health SBD |
$1,282.25
|
| Rate for Payer: UMR Bronson Commercial |
$757.62
|
|
|
PR ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$4,681.00
|
|
|
Service Code
|
HCPCS 24802
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$3,276.70 |
| Rate for Payer: Aetna Commercial |
$1,339.86
|
| Rate for Payer: BCBS Complete |
$678.33
|
| Rate for Payer: BCBS Trust/PPO |
$343.40
|
| Rate for Payer: Cash Price |
$3,744.80
|
| Rate for Payer: Cash Price |
$3,744.80
|
| Rate for Payer: Meridian Medicaid |
$678.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$646.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,276.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,537.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,537.56
|
| Rate for Payer: Priority Health SBD |
$1,537.56
|
| Rate for Payer: UMR Bronson Commercial |
$2,153.26
|
|
|
PR ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 28755
|
| Min. Negotiated Rate |
$216.20 |
| Max. Negotiated Rate |
$983.69 |
| Rate for Payer: Aetna Commercial |
$441.02
|
| Rate for Payer: BCBS Complete |
$227.01
|
| Rate for Payer: BCBS Trust/PPO |
$983.69
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Meridian Medicaid |
$227.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$509.12
|
| Rate for Payer: Priority Health Narrow Network |
$509.12
|
| Rate for Payer: Priority Health SBD |
$509.12
|
| Rate for Payer: UMR Bronson Commercial |
$631.58
|
|
|
PR ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,936.00
|
|
|
Service Code
|
HCPCS 28750
|
| Min. Negotiated Rate |
$371.26 |
| Max. Negotiated Rate |
$1,355.20 |
| Rate for Payer: Aetna Commercial |
$771.32
|
| Rate for Payer: BCBS Complete |
$389.82
|
| Rate for Payer: BCBS Trust/PPO |
$808.30
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Meridian Medicaid |
$389.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$371.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.38
|
| Rate for Payer: Priority Health Narrow Network |
$881.38
|
| Rate for Payer: Priority Health SBD |
$881.38
|
| Rate for Payer: UMR Bronson Commercial |
$890.56
|
|
|
PR ARTHRODESIS HIP JOINT W/OBTAINING GRAFT
|
Professional
|
Both
|
$4,664.00
|
|
|
Service Code
|
HCPCS 27284
|
| Min. Negotiated Rate |
$1,024.74 |
| Max. Negotiated Rate |
$3,264.80 |
| Rate for Payer: Aetna Commercial |
$2,150.84
|
| Rate for Payer: BCBS Complete |
$1,075.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,679.54
|
| Rate for Payer: Cash Price |
$3,731.20
|
| Rate for Payer: Cash Price |
$3,731.20
|
| Rate for Payer: Meridian Medicaid |
$1,075.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,024.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,264.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,442.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,442.43
|
| Rate for Payer: Priority Health SBD |
$2,442.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,145.44
|
|
|
PR ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,022.00
|
|
|
Service Code
|
HCPCS 26860
|
| Min. Negotiated Rate |
$397.67 |
| Max. Negotiated Rate |
$6,184.28 |
| Rate for Payer: Aetna Commercial |
$801.26
|
| Rate for Payer: BCBS Complete |
$417.55
|
| Rate for Payer: BCBS Trust/PPO |
$6,184.28
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Meridian Medicaid |
$417.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,415.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$954.40
|
| Rate for Payer: Priority Health Narrow Network |
$954.40
|
| Rate for Payer: Priority Health SBD |
$954.40
|
| Rate for Payer: UMR Bronson Commercial |
$930.12
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 26861
|
| Min. Negotiated Rate |
$64.54 |
| Max. Negotiated Rate |
$3,233.72 |
| Rate for Payer: Aetna Commercial |
$137.49
|
| Rate for Payer: BCBS Complete |
$67.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,233.72
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Meridian Medicaid |
$67.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.19
|
| Rate for Payer: Priority Health Narrow Network |
$153.19
|
| Rate for Payer: Priority Health SBD |
$153.19
|
| Rate for Payer: UMR Bronson Commercial |
$465.06
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 26863
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$3,239.54 |
| Rate for Payer: Aetna Commercial |
$303.69
|
| Rate for Payer: BCBS Complete |
$151.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,239.54
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Meridian Medicaid |
$151.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.20
|
| Rate for Payer: Priority Health Narrow Network |
$345.20
|
| Rate for Payer: Priority Health SBD |
$345.20
|
| Rate for Payer: UMR Bronson Commercial |
$189.98
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT
|
Professional
|
Both
|
$2,561.00
|
|
|
Service Code
|
HCPCS 26862
|
| Min. Negotiated Rate |
$496.93 |
| Max. Negotiated Rate |
$2,794.18 |
| Rate for Payer: Aetna Commercial |
$1,012.26
|
| Rate for Payer: BCBS Complete |
$521.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,794.18
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Meridian Medicaid |
$521.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$496.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,792.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.81
|
| Rate for Payer: Priority Health SBD |
$1,189.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.06
|
|
|
PR ARTHRODESIS KNEE ANY TECHNIQUE
|
Professional
|
Both
|
$3,159.00
|
|
|
Service Code
|
HCPCS 27580
|
| Min. Negotiated Rate |
$947.85 |
| Max. Negotiated Rate |
$2,425.95 |
| Rate for Payer: Aetna Commercial |
$1,960.49
|
| Rate for Payer: BCBS Complete |
$995.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.95
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Meridian Medicaid |
$995.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$947.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,211.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,256.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,256.06
|
| Rate for Payer: Priority Health SBD |
$2,256.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,453.14
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR
|
Professional
|
Both
|
$5,935.00
|
|
|
Service Code
|
HCPCS 22533
|
| Min. Negotiated Rate |
$1,068.62 |
| Max. Negotiated Rate |
$4,154.50 |
| Rate for Payer: Aetna Commercial |
$2,219.33
|
| Rate for Payer: BCBS Complete |
$1,122.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.44
|
| Rate for Payer: Cash Price |
$4,748.00
|
| Rate for Payer: Cash Price |
$4,748.00
|
| Rate for Payer: Meridian Medicaid |
$1,122.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,068.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,154.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,531.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,531.81
|
| Rate for Payer: Priority Health SBD |
$2,531.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,730.10
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY THORACIC
|
Professional
|
Both
|
$5,930.00
|
|
|
Service Code
|
HCPCS 22532
|
| Min. Negotiated Rate |
$1,157.23 |
| Max. Negotiated Rate |
$4,151.00 |
| Rate for Payer: Aetna Commercial |
$2,409.30
|
| Rate for Payer: BCBS Complete |
$1,215.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.50
|
| Rate for Payer: Cash Price |
$4,744.00
|
| Rate for Payer: Cash Price |
$4,744.00
|
| Rate for Payer: Meridian Medicaid |
$1,215.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,151.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,757.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,757.51
|
| Rate for Payer: Priority Health SBD |
$2,757.51
|
| Rate for Payer: UMR Bronson Commercial |
$2,727.80
|
|
|
PR ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$2,951.00
|
|
|
Service Code
|
HCPCS 22534
|
| Min. Negotiated Rate |
$229.40 |
| Max. Negotiated Rate |
$2,065.70 |
| Rate for Payer: Aetna Commercial |
$483.90
|
| Rate for Payer: BCBS Complete |
$240.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,499.55
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Cash Price |
$2,360.80
|
| Rate for Payer: Meridian Medicaid |
$240.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.90
|
| Rate for Payer: Priority Health Narrow Network |
$546.90
|
| Rate for Payer: Priority Health SBD |
$546.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,357.46
|
|
|
PR ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 26850
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$4,317.80 |
| Rate for Payer: Aetna Commercial |
$970.00
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,317.80
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: Priority Health SBD |
$1,142.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,041.90
|
|
|
PR ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$2,112.00
|
|
|
Service Code
|
HCPCS 28740
|
| Min. Negotiated Rate |
$397.25 |
| Max. Negotiated Rate |
$1,478.40 |
| Rate for Payer: Aetna Commercial |
$820.54
|
| Rate for Payer: BCBS Complete |
$417.11
|
| Rate for Payer: BCBS Trust/PPO |
$673.58
|
| Rate for Payer: Cash Price |
$1,689.60
|
| Rate for Payer: Cash Price |
$1,689.60
|
| Rate for Payer: Meridian Medicaid |
$417.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,478.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$942.66
|
| Rate for Payer: Priority Health Narrow Network |
$942.66
|
| Rate for Payer: Priority Health SBD |
$942.66
|
| Rate for Payer: UMR Bronson Commercial |
$971.52
|
|
