|
PR ARTHRODESIS PANTALAR
|
Professional
|
Both
|
$3,938.00
|
|
|
Service Code
|
HCPCS 28705
|
| Min. Negotiated Rate |
$644.53 |
| Max. Negotiated Rate |
$2,559.70 |
| Rate for Payer: Aetna Commercial |
$1,631.30
|
| Rate for Payer: Aetna Medicare |
$1,969.00
|
| Rate for Payer: BCBS Complete |
$826.61
|
| Rate for Payer: BCBS Trust/PPO |
$644.53
|
| Rate for Payer: BCN Commercial |
$1,779.76
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: Meridian Medicaid |
$826.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$787.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,559.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,868.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,868.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,525.25
|
| Rate for Payer: UHC Exchange |
$1,525.25
|
| Rate for Payer: UHCCP Medicaid |
$787.25
|
|
|
PR ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2
|
Professional
|
Both
|
$5,175.00
|
|
|
Service Code
|
HCPCS 22595
|
| Min. Negotiated Rate |
$992.58 |
| Max. Negotiated Rate |
$3,363.75 |
| Rate for Payer: Aetna Commercial |
$2,020.20
|
| Rate for Payer: Aetna Medicare |
$2,587.50
|
| Rate for Payer: BCBS Complete |
$1,042.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,976.66
|
| Rate for Payer: BCN Commercial |
$2,460.60
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Meridian Medicaid |
$1,042.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$992.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,363.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,356.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,356.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,721.06
|
| Rate for Payer: UHC Exchange |
$1,721.06
|
| Rate for Payer: UHCCP Medicaid |
$992.58
|
|
|
PR ARTHRODESIS POSTERIOR CRANIOCERVICAL
|
Professional
|
Both
|
$5,337.00
|
|
|
Service Code
|
HCPCS 22590
|
| Min. Negotiated Rate |
$1,039.01 |
| Max. Negotiated Rate |
$3,469.05 |
| Rate for Payer: Aetna Commercial |
$2,118.13
|
| Rate for Payer: Aetna Medicare |
$2,668.50
|
| Rate for Payer: BCBS Complete |
$1,090.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.44
|
| Rate for Payer: BCN Commercial |
$2,579.52
|
| Rate for Payer: Cash Price |
$4,269.60
|
| Rate for Payer: Cash Price |
$4,269.60
|
| Rate for Payer: Meridian Medicaid |
$1,090.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,039.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,469.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,464.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,464.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,811.23
|
| Rate for Payer: UHC Exchange |
$1,811.23
|
| Rate for Payer: UHCCP Medicaid |
$1,039.01
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 22632
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$820.30 |
| Rate for Payer: Aetna Commercial |
$430.92
|
| Rate for Payer: Aetna Medicare |
$631.00
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS Trust/PPO |
$650.50
|
| Rate for Payer: BCN Commercial |
$514.40
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Meridian Medicaid |
$215.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$489.53
|
| Rate for Payer: Priority Health Narrow Network |
$489.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.14
|
| Rate for Payer: UHC Exchange |
$384.14
|
| Rate for Payer: UHCCP Medicaid |
$205.33
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,749.00
|
|
|
Service Code
|
HCPCS 22630
|
| Min. Negotiated Rate |
$650.50 |
| Max. Negotiated Rate |
$4,386.85 |
| Rate for Payer: Aetna Commercial |
$2,114.75
|
| Rate for Payer: Aetna Medicare |
$3,374.50
|
| Rate for Payer: BCBS Complete |
$1,067.70
|
| Rate for Payer: BCBS Trust/PPO |
$650.50
|
| Rate for Payer: BCN Commercial |
$2,524.64
|
| Rate for Payer: Cash Price |
$5,399.20
|
| Rate for Payer: Cash Price |
$5,399.20
|
| Rate for Payer: Meridian Medicaid |
$1,067.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,016.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,386.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,411.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,411.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,786.18
|
| Rate for Payer: UHC Exchange |
$1,786.18
|
| Rate for Payer: UHCCP Medicaid |
$1,016.86
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$3,299.00
|
|
|
Service Code
|
HCPCS 22612
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$2,556.92 |
| Rate for Payer: Aetna Commercial |
$2,128.06
|
| Rate for Payer: Aetna Medicare |
$1,649.50
|
| Rate for Payer: BCBS Complete |
$1,074.19
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$2,556.92
|
| Rate for Payer: Cash Price |
$2,639.20
|
| Rate for Payer: Cash Price |
$2,639.20
|
| Rate for Payer: Meridian Medicaid |
$1,074.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,023.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,144.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,431.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,431.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,856.54
|
| Rate for Payer: UHC Exchange |
$1,856.54
|
| Rate for Payer: UHCCP Medicaid |
$1,023.04
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC THORACIC
|
Professional
|
Both
|
$4,286.00
|
|
|
Service Code
|
HCPCS 22610
|
| Min. Negotiated Rate |
$837.94 |
| Max. Negotiated Rate |
$4,702.18 |
| Rate for Payer: Aetna Commercial |
$1,703.50
|
| Rate for Payer: Aetna Medicare |
$2,143.00
|
| Rate for Payer: BCBS Complete |
$879.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,702.18
|
| Rate for Payer: BCN Commercial |
$2,076.42
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Cash Price |
$3,428.80
|
| Rate for Payer: Meridian Medicaid |
$879.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,984.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,984.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,439.23
|
| Rate for Payer: UHC Exchange |
$1,439.23
|
| Rate for Payer: UHCCP Medicaid |
$837.94
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 13+ VRT SGM
|
Professional
|
Both
|
$5,067.00
|
|
|
Service Code
|
HCPCS 22804
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$3,730.46 |
| Rate for Payer: Aetna Commercial |
$3,267.61
|
| Rate for Payer: Aetna Medicare |
$2,533.50
|
| Rate for Payer: BCBS Complete |
$1,639.81
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$3,559.04
|
| Rate for Payer: Cash Price |
$4,053.60
|
| Rate for Payer: Cash Price |
$4,053.60
|
| Rate for Payer: Meridian Medicaid |
$1,639.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,561.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,293.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,730.46
|
| Rate for Payer: Priority Health Narrow Network |
$3,730.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,846.82
|
| Rate for Payer: UHC Exchange |
$2,846.82
|
| Rate for Payer: UHCCP Medicaid |
$1,561.72
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM <6 VRT SGM
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 22800
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$2,106.68 |
| Rate for Payer: Aetna Commercial |
$1,815.55
|
| Rate for Payer: Aetna Medicare |
$1,406.00
|
| Rate for Payer: BCBS Complete |
$933.51
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$2,007.97
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Meridian Medicaid |
$933.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$889.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,106.68
|
| Rate for Payer: Priority Health Narrow Network |
$2,106.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,568.69
|
| Rate for Payer: UHC Exchange |
$1,568.69
|
| Rate for Payer: UHCCP Medicaid |
$889.06
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SGM
|
Professional
|
Both
|
$4,380.00
|
|
|
Service Code
|
HCPCS 22802
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$3,252.64 |
| Rate for Payer: Aetna Commercial |
$2,838.39
|
| Rate for Payer: Aetna Medicare |
$2,190.00
|
| Rate for Payer: BCBS Complete |
$1,428.90
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$3,100.66
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Cash Price |
$3,504.00
|
| Rate for Payer: Meridian Medicaid |
$1,428.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,360.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,252.64
|
| Rate for Payer: Priority Health Narrow Network |
$3,252.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,467.67
|
| Rate for Payer: UHC Exchange |
$2,467.67
|
| Rate for Payer: UHCCP Medicaid |
$1,360.86
|
|
|
PR ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 22614
|
| Min. Negotiated Rate |
$250.49 |
| Max. Negotiated Rate |
$1,218.75 |
| Rate for Payer: Aetna Commercial |
$526.48
|
| Rate for Payer: Aetna Medicare |
$937.50
|
| Rate for Payer: BCBS Complete |
$263.01
|
| Rate for Payer: BCBS Trust/PPO |
$934.38
|
| Rate for Payer: BCN Commercial |
$626.32
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Meridian Medicaid |
$263.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$595.36
|
| Rate for Payer: Priority Health Narrow Network |
$595.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.10
|
| Rate for Payer: UHC Exchange |
$471.10
|
| Rate for Payer: UHCCP Medicaid |
$250.49
|
|
|
PR ARTHRODESIS SI JOINT PERCUTANEOUS/MIN INVASIVE
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 27279
|
| Min. Negotiated Rate |
$520.36 |
| Max. Negotiated Rate |
$3,376.37 |
| Rate for Payer: Aetna Commercial |
$1,152.73
|
| Rate for Payer: Aetna Medicare |
$658.00
|
| Rate for Payer: BCBS Complete |
$546.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,376.37
|
| Rate for Payer: BCN Commercial |
$1,192.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Meridian Medicaid |
$546.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$855.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,229.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,229.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.47
|
| Rate for Payer: UHC Exchange |
$704.47
|
| Rate for Payer: UHCCP Medicaid |
$520.36
|
|
|
PR ARTHRODESIS SI JT OPN W/OBTAINING B1 GRF INSTRMJ
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 27280
|
| Min. Negotiated Rate |
$884.38 |
| Max. Negotiated Rate |
$3,839.22 |
| Rate for Payer: Aetna Commercial |
$1,822.56
|
| Rate for Payer: Aetna Medicare |
$1,620.00
|
| Rate for Payer: BCBS Complete |
$928.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,839.22
|
| Rate for Payer: BCN Commercial |
$1,997.71
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Meridian Medicaid |
$928.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$884.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,093.46
|
| Rate for Payer: Priority Health Narrow Network |
$2,093.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,185.41
|
| Rate for Payer: UHC Exchange |
$1,185.41
|
| Rate for Payer: UHCCP Medicaid |
$884.38
|
|
|
PR ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 28725
|
| Min. Negotiated Rate |
$505.45 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Aetna Commercial |
$1,034.26
|
| Rate for Payer: Aetna Medicare |
$1,638.00
|
| Rate for Payer: BCBS Complete |
$530.72
|
| Rate for Payer: BCBS Trust/PPO |
$526.19
|
| Rate for Payer: BCN Commercial |
$1,138.62
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Meridian Medicaid |
$530.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,198.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,198.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$923.88
|
| Rate for Payer: UHC Exchange |
$923.88
|
| Rate for Payer: UHCCP Medicaid |
$505.45
|
|
|
PR ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 27282
|
| Min. Negotiated Rate |
$560.19 |
| Max. Negotiated Rate |
$2,399.54 |
| Rate for Payer: Aetna Commercial |
$1,146.38
|
| Rate for Payer: Aetna Medicare |
$751.50
|
| Rate for Payer: BCBS Complete |
$588.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,399.54
|
| Rate for Payer: BCN Commercial |
$1,265.19
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Meridian Medicaid |
$588.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$560.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,327.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,327.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.49
|
| Rate for Payer: UHC Exchange |
$942.49
|
| Rate for Payer: UHCCP Medicaid |
$560.19
|
|
|
PR ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27871
|
| Min. Negotiated Rate |
$448.58 |
| Max. Negotiated Rate |
$2,282.01 |
| Rate for Payer: Aetna Commercial |
$918.06
|
| Rate for Payer: Aetna Medicare |
$1,502.50
|
| Rate for Payer: BCBS Complete |
$471.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,282.01
|
| Rate for Payer: BCN Commercial |
$1,016.94
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Meridian Medicaid |
$471.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,067.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,067.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.90
|
| Rate for Payer: UHC Exchange |
$795.90
|
| Rate for Payer: UHCCP Medicaid |
$448.58
|
|
|
PR ARTHRODESIS TRIPLE
|
Professional
|
Both
|
$4,084.00
|
|
|
Service Code
|
HCPCS 28715
|
| Min. Negotiated Rate |
$611.10 |
| Max. Negotiated Rate |
$2,654.60 |
| Rate for Payer: Aetna Commercial |
$1,252.63
|
| Rate for Payer: Aetna Medicare |
$2,042.00
|
| Rate for Payer: BCBS Complete |
$641.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.92
|
| Rate for Payer: BCN Commercial |
$1,376.60
|
| Rate for Payer: Cash Price |
$3,267.20
|
| Rate for Payer: Cash Price |
$3,267.20
|
| Rate for Payer: Meridian Medicaid |
$641.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$611.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,654.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,444.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,444.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,132.50
|
| Rate for Payer: UHC Exchange |
$1,132.50
|
| Rate for Payer: UHCCP Medicaid |
$611.10
|
|
|
PR ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 25800
|
| Min. Negotiated Rate |
$478.61 |
| Max. Negotiated Rate |
$1,598.35 |
| Rate for Payer: Aetna Commercial |
$976.75
|
| Rate for Payer: Aetna Medicare |
$1,229.50
|
| Rate for Payer: BCBS Complete |
$502.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,424.30
|
| Rate for Payer: BCN Commercial |
$1,079.97
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Meridian Medicaid |
$502.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,131.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$843.02
|
| Rate for Payer: UHC Exchange |
$843.02
|
| Rate for Payer: UHCCP Medicaid |
$478.61
|
|
|
PR ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 25820
|
| Min. Negotiated Rate |
$424.51 |
| Max. Negotiated Rate |
$1,844.05 |
| Rate for Payer: Aetna Commercial |
$857.48
|
| Rate for Payer: Aetna Medicare |
$1,418.50
|
| Rate for Payer: BCBS Complete |
$445.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.07
|
| Rate for Payer: BCN Commercial |
$962.20
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Meridian Medicaid |
$445.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,007.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$690.37
|
| Rate for Payer: UHC Exchange |
$690.37
|
| Rate for Payer: UHCCP Medicaid |
$424.51
|
|
|
PR ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$3,412.00
|
|
|
Service Code
|
HCPCS 25810
|
| Min. Negotiated Rate |
$567.22 |
| Max. Negotiated Rate |
$2,217.80 |
| Rate for Payer: Aetna Commercial |
$1,152.99
|
| Rate for Payer: Aetna Medicare |
$1,706.00
|
| Rate for Payer: BCBS Complete |
$595.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,598.11
|
| Rate for Payer: BCN Commercial |
$1,276.43
|
| Rate for Payer: Cash Price |
$2,729.60
|
| Rate for Payer: Cash Price |
$2,729.60
|
| Rate for Payer: Meridian Medicaid |
$595.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,217.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,340.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,340.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.86
|
| Rate for Payer: UHC Exchange |
$990.86
|
| Rate for Payer: UHCCP Medicaid |
$567.22
|
|
|
PR ARTHRODESIS WRIST WITH AUTOGRAFT
|
Professional
|
Both
|
$14,088.00
|
|
|
Service Code
|
HCPCS 25825
|
| Min. Negotiated Rate |
$517.80 |
| Max. Negotiated Rate |
$9,157.20 |
| Rate for Payer: Aetna Commercial |
$1,048.19
|
| Rate for Payer: Aetna Medicare |
$7,044.00
|
| Rate for Payer: BCBS Complete |
$543.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,865.96
|
| Rate for Payer: BCN Commercial |
$1,172.34
|
| Rate for Payer: Cash Price |
$11,270.40
|
| Rate for Payer: Cash Price |
$11,270.40
|
| Rate for Payer: Meridian Medicaid |
$543.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,157.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,228.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.97
|
| Rate for Payer: UHC Exchange |
$852.97
|
| Rate for Payer: UHCCP Medicaid |
$517.80
|
|
|
PR ARTHRODESIS WRIST W/SLIDING GRAFT
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 25805
|
| Min. Negotiated Rate |
$552.95 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Aetna Commercial |
$1,131.59
|
| Rate for Payer: Aetna Medicare |
$1,487.50
|
| Rate for Payer: BCBS Complete |
$580.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,451.24
|
| Rate for Payer: BCN Commercial |
$1,248.08
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Meridian Medicaid |
$580.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,933.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,310.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,310.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$977.15
|
| Rate for Payer: UHC Exchange |
$977.15
|
| Rate for Payer: UHCCP Medicaid |
$552.95
|
|
|
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 |
$226.00 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: ASR ASR |
$219.22
|
| Rate for Payer: ASR Commercial |
$219.22
|
| Rate for Payer: BCBS Trust/PPO |
$184.17
|
| Rate for Payer: BCN Commercial |
$175.22
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$212.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.80
|
| Rate for Payer: Healthscope Commercial |
$226.00
|
| Rate for Payer: Healthscope Whirlpool |
$219.22
|
| Rate for Payer: Mclaren Commercial |
$203.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.10
|
| Rate for Payer: Nomi Health Commercial |
$185.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.88
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Min. Negotiated Rate |
$85.90 |
| Max. Negotiated Rate |
$561.05 |
| Rate for Payer: Aetna Commercial |
$85.90
|
| Rate for Payer: Aetna Medicare |
$113.00
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS Trust/PPO |
$561.05
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.25
|
| Rate for Payer: Priority Health Narrow Network |
$129.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.92
|
| Rate for Payer: UHC Exchange |
$104.92
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS G0289
|
| Hospital Charge Code |
G0289
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Medicare |
$113.00
|
| Rate for Payer: ASR ASR |
$219.22
|
| Rate for Payer: ASR Commercial |
$219.22
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS Trust/PPO |
$185.07
|
| Rate for Payer: BCN Commercial |
$175.22
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$212.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.80
|
| Rate for Payer: Healthscope Commercial |
$226.00
|
| Rate for Payer: Healthscope Whirlpool |
$219.22
|
| Rate for Payer: Mclaren Commercial |
$203.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.10
|
| Rate for Payer: Nomi Health Commercial |
$185.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.02
|
| Rate for Payer: Priority Health Narrow Network |
$158.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.88
|
|
