|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
20611
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$188.18
|
| Rate for Payer: ASR Commercial |
$188.18
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$158.87
|
| Rate for Payer: BCN Commercial |
$150.41
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$182.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$194.00
|
| Rate for Payer: Healthscope Whirlpool |
$188.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$174.60
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.90
|
| Rate for Payer: Nomi Health Commercial |
$159.08
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.98
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$135.99
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 20600
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$62.04
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.45
|
| Rate for Payer: Priority Health Narrow Network |
$54.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.65
|
| Rate for Payer: UHC Exchange |
$45.65
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
|
|
PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 20604
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$61.98
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$31.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$31.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.20
|
| Rate for Payer: Priority Health Narrow Network |
$69.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.22
|
| Rate for Payer: UHC Exchange |
$58.22
|
| Rate for Payer: UHCCP Medicaid |
$29.61
|
|
|
PR ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$4,313.00
|
|
|
Service Code
|
HCPCS 27870
|
| Min. Negotiated Rate |
$621.84 |
| Max. Negotiated Rate |
$2,803.45 |
| Rate for Payer: Aetna Commercial |
$1,354.88
|
| Rate for Payer: Aetna Medicare |
$2,156.50
|
| Rate for Payer: BCBS Complete |
$684.82
|
| Rate for Payer: BCBS Trust/PPO |
$621.84
|
| Rate for Payer: BCN Commercial |
$1,477.76
|
| Rate for Payer: Cash Price |
$3,450.40
|
| Rate for Payer: Cash Price |
$3,450.40
|
| Rate for Payer: Meridian Medicaid |
$684.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,803.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,548.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,212.19
|
| Rate for Payer: UHC Exchange |
$1,212.19
|
| Rate for Payer: UHCCP Medicaid |
$652.21
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SGM
|
Professional
|
Both
|
$5,369.00
|
|
|
Service Code
|
HCPCS 22808
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$3,489.85 |
| Rate for Payer: Aetna Commercial |
$2,445.31
|
| Rate for Payer: Aetna Medicare |
$2,684.50
|
| Rate for Payer: BCBS Complete |
$1,234.55
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$2,943.79
|
| Rate for Payer: Cash Price |
$4,295.20
|
| Rate for Payer: Cash Price |
$4,295.20
|
| Rate for Payer: Meridian Medicaid |
$1,234.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,175.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,489.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,812.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,812.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,141.00
|
| Rate for Payer: UHC Exchange |
$2,141.00
|
| Rate for Payer: UHCCP Medicaid |
$1,175.76
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SGM
|
Professional
|
Both
|
$6,469.00
|
|
|
Service Code
|
HCPCS 22810
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$4,204.85 |
| Rate for Payer: Aetna Commercial |
$2,798.66
|
| Rate for Payer: Aetna Medicare |
$3,234.50
|
| Rate for Payer: BCBS Complete |
$1,357.10
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$2,926.69
|
| Rate for Payer: Cash Price |
$5,175.20
|
| Rate for Payer: Cash Price |
$5,175.20
|
| Rate for Payer: Meridian Medicaid |
$1,357.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,292.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,204.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,064.87
|
| Rate for Payer: Priority Health Narrow Network |
$3,064.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,394.66
|
| Rate for Payer: UHC Exchange |
$2,394.66
|
| Rate for Payer: UHCCP Medicaid |
$1,292.48
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 8+ VRT SGM
|
Professional
|
Both
|
$7,504.00
|
|
|
Service Code
|
HCPCS 22812
|
| Min. Negotiated Rate |
$1,416.45 |
| Max. Negotiated Rate |
$5,139.76 |
| Rate for Payer: Aetna Commercial |
$2,950.14
|
| Rate for Payer: Aetna Medicare |
$3,752.00
|
| Rate for Payer: BCBS Complete |
$1,487.27
|
| Rate for Payer: BCBS Trust/PPO |
$5,139.76
|
| Rate for Payer: BCN Commercial |
$3,207.19
|
| Rate for Payer: Cash Price |
$6,003.20
|
| Rate for Payer: Cash Price |
$6,003.20
|
| Rate for Payer: Meridian Medicaid |
$1,487.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,416.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,877.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,358.99
|
| Rate for Payer: Priority Health Narrow Network |
$3,358.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,571.28
|
| Rate for Payer: UHC Exchange |
$2,571.28
|
| Rate for Payer: UHCCP Medicaid |
$1,416.45
|
|
|
PR ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL
|
Professional
|
Both
|
$1,977.00
|
|
|
Service Code
|
HCPCS 22634
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$1,285.05 |
| Rate for Payer: Aetna Commercial |
$667.05
|
| Rate for Payer: Aetna Medicare |
$988.50
|
| Rate for Payer: BCBS Complete |
$325.64
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$704.67
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Meridian Medicaid |
$325.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.35
|
| Rate for Payer: Priority Health Narrow Network |
$737.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.89
|
| Rate for Payer: UHC Exchange |
$654.89
|
| Rate for Payer: UHCCP Medicaid |
$310.13
|
|
|
PR ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$3,863.00
|
|
|
Service Code
|
HCPCS 22633
|
| Min. Negotiated Rate |
$950.50 |
| Max. Negotiated Rate |
$2,782.95 |
| Rate for Payer: Aetna Commercial |
$2,484.90
|
| Rate for Payer: Aetna Medicare |
$1,931.50
|
| Rate for Payer: BCBS Complete |
$1,231.42
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$2,652.05
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Meridian Medicaid |
$1,231.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,172.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,510.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,782.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,782.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,418.20
|
| Rate for Payer: UHC Exchange |
$2,418.20
|
| Rate for Payer: UHCCP Medicaid |
$1,172.78
|
|
|
PR ARTHRODESIS ELBOW JOINT LOCAL
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 24800
|
| Min. Negotiated Rate |
$544.22 |
| Max. Negotiated Rate |
$1,289.46 |
| Rate for Payer: Aetna Commercial |
$1,111.63
|
| Rate for Payer: Aetna Medicare |
$840.00
|
| Rate for Payer: BCBS Complete |
$571.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$1,227.07
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Meridian Medicaid |
$571.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,289.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$923.60
|
| Rate for Payer: UHC Exchange |
$923.60
|
| Rate for Payer: UHCCP Medicaid |
$544.22
|
|
|
PR ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$4,775.00
|
|
|
Service Code
|
HCPCS 24802
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$3,103.75 |
| Rate for Payer: Aetna Commercial |
$1,339.86
|
| Rate for Payer: Aetna Medicare |
$2,387.50
|
| Rate for Payer: BCBS Complete |
$684.37
|
| Rate for Payer: BCBS Trust/PPO |
$343.40
|
| Rate for Payer: BCN Commercial |
$1,471.41
|
| Rate for Payer: Cash Price |
$3,820.00
|
| Rate for Payer: Cash Price |
$3,820.00
|
| Rate for Payer: Meridian Medicaid |
$684.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$651.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,103.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,543.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,543.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.17
|
| Rate for Payer: UHC Exchange |
$1,149.17
|
| Rate for Payer: UHCCP Medicaid |
$651.78
|
|
|
PR ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 28755
|
| Min. Negotiated Rate |
$219.18 |
| Max. Negotiated Rate |
$983.69 |
| Rate for Payer: Aetna Commercial |
$441.02
|
| Rate for Payer: Aetna Medicare |
$700.00
|
| Rate for Payer: BCBS Complete |
$230.14
|
| Rate for Payer: BCBS Trust/PPO |
$983.69
|
| Rate for Payer: BCN Commercial |
$734.48
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Meridian Medicaid |
$230.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$516.50
|
| Rate for Payer: Priority Health Narrow Network |
$516.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.82
|
| Rate for Payer: UHC Exchange |
$384.82
|
| Rate for Payer: UHCCP Medicaid |
$219.18
|
|
|
PR ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 28750
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,283.75 |
| Rate for Payer: Aetna Commercial |
$771.32
|
| Rate for Payer: Aetna Medicare |
$987.50
|
| Rate for Payer: BCBS Complete |
$391.39
|
| Rate for Payer: BCBS Trust/PPO |
$808.30
|
| Rate for Payer: BCN Commercial |
$1,141.06
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Meridian Medicaid |
$391.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,283.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$886.94
|
| Rate for Payer: Priority Health Narrow Network |
$886.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.20
|
| Rate for Payer: UHC Exchange |
$697.20
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
|
|
PR ARTHRODESIS HIP JOINT W/OBTAINING GRAFT
|
Professional
|
Both
|
$4,757.00
|
|
|
Service Code
|
HCPCS 27284
|
| Min. Negotiated Rate |
$1,032.41 |
| Max. Negotiated Rate |
$3,092.05 |
| Rate for Payer: Aetna Commercial |
$2,150.84
|
| Rate for Payer: Aetna Medicare |
$2,378.50
|
| Rate for Payer: BCBS Complete |
$1,084.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,679.54
|
| Rate for Payer: BCN Commercial |
$2,337.35
|
| Rate for Payer: Cash Price |
$3,805.60
|
| Rate for Payer: Cash Price |
$3,805.60
|
| Rate for Payer: Meridian Medicaid |
$1,084.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,032.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,092.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,448.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,448.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,831.52
|
| Rate for Payer: UHC Exchange |
$1,831.52
|
| Rate for Payer: UHCCP Medicaid |
$1,032.41
|
|
|
PR ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 26860
|
| Min. Negotiated Rate |
$395.33 |
| Max. Negotiated Rate |
$6,184.28 |
| Rate for Payer: Aetna Commercial |
$801.26
|
| Rate for Payer: Aetna Medicare |
$1,031.00
|
| Rate for Payer: BCBS Complete |
$415.10
|
| Rate for Payer: BCBS Trust/PPO |
$6,184.28
|
| Rate for Payer: BCN Commercial |
$913.34
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Meridian Medicaid |
$415.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.05
|
| Rate for Payer: Priority Health Narrow Network |
$950.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.98
|
| Rate for Payer: UHC Exchange |
$612.98
|
| Rate for Payer: UHCCP Medicaid |
$395.33
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 26861
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$3,233.72 |
| Rate for Payer: Aetna Commercial |
$137.49
|
| Rate for Payer: Aetna Medicare |
$515.50
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,233.72
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Meridian Medicaid |
$68.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.18
|
| Rate for Payer: Priority Health Narrow Network |
$154.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.35
|
| Rate for Payer: UHC Exchange |
$123.35
|
| Rate for Payer: UHCCP Medicaid |
$64.97
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 26863
|
| Min. Negotiated Rate |
$144.63 |
| Max. Negotiated Rate |
$3,239.54 |
| Rate for Payer: Aetna Commercial |
$303.69
|
| Rate for Payer: Aetna Medicare |
$210.50
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,239.54
|
| Rate for Payer: BCN Commercial |
$330.35
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.98
|
| Rate for Payer: Priority Health Narrow Network |
$343.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.80
|
| Rate for Payer: UHC Exchange |
$276.80
|
| Rate for Payer: UHCCP Medicaid |
$144.63
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
HCPCS 26862
|
| Min. Negotiated Rate |
$495.44 |
| Max. Negotiated Rate |
$2,794.18 |
| Rate for Payer: Aetna Commercial |
$1,012.26
|
| Rate for Payer: Aetna Medicare |
$1,306.00
|
| Rate for Payer: BCBS Complete |
$520.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,794.18
|
| Rate for Payer: BCN Commercial |
$1,138.62
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Meridian Medicaid |
$520.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$495.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,697.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,187.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,187.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$801.49
|
| Rate for Payer: UHC Exchange |
$801.49
|
| Rate for Payer: UHCCP Medicaid |
$495.44
|
|
|
PR ARTHRODESIS KNEE ANY TECHNIQUE
|
Professional
|
Both
|
$3,222.00
|
|
|
Service Code
|
HCPCS 27580
|
| Min. Negotiated Rate |
$951.47 |
| Max. Negotiated Rate |
$2,425.95 |
| Rate for Payer: Aetna Commercial |
$1,960.49
|
| Rate for Payer: Aetna Medicare |
$1,611.00
|
| Rate for Payer: BCBS Complete |
$999.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.95
|
| Rate for Payer: BCN Commercial |
$2,158.98
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Meridian Medicaid |
$999.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$951.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,094.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,264.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,264.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,671.02
|
| Rate for Payer: UHC Exchange |
$1,671.02
|
| Rate for Payer: UHCCP Medicaid |
$951.47
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR
|
Professional
|
Both
|
$6,054.00
|
|
|
Service Code
|
HCPCS 22533
|
| Min. Negotiated Rate |
$1,076.08 |
| Max. Negotiated Rate |
$3,935.10 |
| Rate for Payer: Aetna Commercial |
$2,219.33
|
| Rate for Payer: Aetna Medicare |
$3,027.00
|
| Rate for Payer: BCBS Complete |
$1,129.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.44
|
| Rate for Payer: BCN Commercial |
$2,422.86
|
| Rate for Payer: Cash Price |
$4,843.20
|
| Rate for Payer: Cash Price |
$4,843.20
|
| Rate for Payer: Meridian Medicaid |
$1,129.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,076.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,935.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,552.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,552.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,949.92
|
| Rate for Payer: UHC Exchange |
$1,949.92
|
| Rate for Payer: UHCCP Medicaid |
$1,076.08
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY THORACIC
|
Professional
|
Both
|
$6,049.00
|
|
|
Service Code
|
HCPCS 22532
|
| Min. Negotiated Rate |
$1,161.70 |
| Max. Negotiated Rate |
$3,931.85 |
| Rate for Payer: Aetna Commercial |
$2,409.30
|
| Rate for Payer: Aetna Medicare |
$3,024.50
|
| Rate for Payer: BCBS Complete |
$1,219.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.50
|
| Rate for Payer: BCN Commercial |
$2,638.86
|
| Rate for Payer: Cash Price |
$4,839.20
|
| Rate for Payer: Cash Price |
$4,839.20
|
| Rate for Payer: Meridian Medicaid |
$1,219.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,161.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,764.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,764.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,065.14
|
| Rate for Payer: UHC Exchange |
$2,065.14
|
| Rate for Payer: UHCCP Medicaid |
$1,161.70
|
|
|
PR ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$3,010.00
|
|
|
Service Code
|
HCPCS 22534
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$1,956.50 |
| Rate for Payer: Aetna Commercial |
$483.90
|
| Rate for Payer: Aetna Medicare |
$1,505.00
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,499.55
|
| Rate for Payer: BCN Commercial |
$523.37
|
| Rate for Payer: Cash Price |
$2,408.00
|
| Rate for Payer: Cash Price |
$2,408.00
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,956.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.05
|
| Rate for Payer: Priority Health Narrow Network |
$548.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.46
|
| Rate for Payer: UHC Exchange |
$436.46
|
| Rate for Payer: UHCCP Medicaid |
$230.89
|
|
|
PR ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,310.00
|
|
|
Service Code
|
HCPCS 26850
|
| Min. Negotiated Rate |
$474.78 |
| Max. Negotiated Rate |
$4,317.80 |
| Rate for Payer: Aetna Commercial |
$970.00
|
| Rate for Payer: Aetna Medicare |
$1,155.00
|
| Rate for Payer: BCBS Complete |
$498.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,317.80
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Meridian Medicaid |
$498.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,501.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$766.46
|
| Rate for Payer: UHC Exchange |
$766.46
|
| Rate for Payer: UHCCP Medicaid |
$474.78
|
|
|
PR ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$2,154.00
|
|
|
Service Code
|
HCPCS 28740
|
| Min. Negotiated Rate |
$399.16 |
| Max. Negotiated Rate |
$1,400.10 |
| Rate for Payer: Aetna Commercial |
$820.54
|
| Rate for Payer: Aetna Medicare |
$1,077.00
|
| Rate for Payer: BCBS Complete |
$419.12
|
| Rate for Payer: BCBS Trust/PPO |
$673.58
|
| Rate for Payer: BCN Commercial |
$1,207.52
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Meridian Medicaid |
$419.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$949.02
|
| Rate for Payer: Priority Health Narrow Network |
$949.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$731.83
|
| Rate for Payer: UHC Exchange |
$731.83
|
| Rate for Payer: UHCCP Medicaid |
$399.16
|
|
|
PR ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT
|
Professional
|
Both
|
$2,860.00
|
|
|
Service Code
|
HCPCS 26852
|
| Min. Negotiated Rate |
$539.74 |
| Max. Negotiated Rate |
$5,128.74 |
| Rate for Payer: Aetna Commercial |
$1,103.16
|
| Rate for Payer: Aetna Medicare |
$1,430.00
|
| Rate for Payer: BCBS Complete |
$566.73
|
| Rate for Payer: BCBS Trust/PPO |
$5,128.74
|
| Rate for Payer: BCN Commercial |
$1,237.34
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Cash Price |
$2,288.00
|
| Rate for Payer: Meridian Medicaid |
$566.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,859.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,289.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$881.96
|
| Rate for Payer: UHC Exchange |
$881.96
|
| Rate for Payer: UHCCP Medicaid |
$539.74
|
|
