|
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 |
$707.23
|
| 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: Healthscope Commercial |
$848.68
|
| Rate for Payer: Healthscope Whirlpool |
$848.68
|
| 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 |
$707.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.23
|
| Rate for Payer: UHC Medicare Advantage |
$707.23
|
| Rate for Payer: UHCCP DNSP |
$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 |
$621.74
|
| 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: Healthscope Commercial |
$746.09
|
| Rate for Payer: Healthscope Whirlpool |
$746.09
|
| 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 |
$621.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.74
|
| Rate for Payer: UHC Medicare Advantage |
$621.74
|
| Rate for Payer: UHCCP DNSP |
$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 |
$838.11
|
| 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: Healthscope Commercial |
$1,005.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,005.73
|
| 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 |
$838.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$838.11
|
| Rate for Payer: UHC Medicare Advantage |
$838.11
|
| Rate for Payer: UHCCP DNSP |
$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 |
$759.51
|
| 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: Healthscope Commercial |
$911.41
|
| Rate for Payer: Healthscope Whirlpool |
$911.41
|
| 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 |
$759.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.51
|
| Rate for Payer: UHC Medicare Advantage |
$759.51
|
| Rate for Payer: UHCCP DNSP |
$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 |
$819.00
|
| 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: Healthscope Commercial |
$982.80
|
| Rate for Payer: Healthscope Whirlpool |
$982.80
|
| 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 |
$819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$819.00
|
| Rate for Payer: UHC Medicare Advantage |
$819.00
|
| Rate for Payer: UHCCP DNSP |
$819.00
|
|
|
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 |
$81.57
|
| 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: Healthscope Commercial |
$97.88
|
| Rate for Payer: Healthscope Whirlpool |
$97.88
|
| 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 |
$81.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.57
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
| Rate for Payer: UHCCP DNSP |
$81.57
|
|
|
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
|
|
|
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
|
| 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 |
$81.57
|
| 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: Healthscope Commercial |
$97.88
|
| Rate for Payer: Healthscope Whirlpool |
$97.88
|
| 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 |
$81.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.57
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
| Rate for Payer: UHCCP DNSP |
$81.57
|
|
|
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 |
$687.87
|
| 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: Healthscope Commercial |
$825.44
|
| Rate for Payer: Healthscope Whirlpool |
$825.44
|
| 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 |
$687.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.87
|
| Rate for Payer: UHC Medicare Advantage |
$687.87
|
| Rate for Payer: UHCCP DNSP |
$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 |
$1,071.72
|
| 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: Healthscope Commercial |
$1,286.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,286.06
|
| 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 |
$1,071.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.72
|
| Rate for Payer: UHCCP DNSP |
$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 |
$925.18
|
| 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: Healthscope Commercial |
$1,110.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.22
|
| 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 |
$925.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$925.18
|
| Rate for Payer: UHC Medicare Advantage |
$925.18
|
| Rate for Payer: UHCCP DNSP |
$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 |
$842.20
|
| 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: Healthscope Commercial |
$1,010.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,010.64
|
| 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 |
$842.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$842.20
|
| Rate for Payer: UHC Medicare Advantage |
$842.20
|
| Rate for Payer: UHCCP DNSP |
$842.20
|
|
|
PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
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 |
$1,389.40
|
| 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: Healthscope Commercial |
$1,667.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,667.28
|
| 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 |
$1,389.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.40
|
| Rate for Payer: UHCCP DNSP |
$1,389.40
|
|
|
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 |
$1,389.40
|
| 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: Healthscope Commercial |
$1,667.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,667.28
|
| 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 |
$1,389.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.40
|
| Rate for Payer: UHCCP DNSP |
$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 |
$2,973.75 |
| Max. Negotiated Rate |
$27,799.95 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Aetna Medicare |
$17,935.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,419.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,419.31
|
| Rate for Payer: ASR ASR |
$4,437.75
|
| Rate for Payer: ASR Commercial |
$4,437.75
|
| Rate for Payer: BCBS Complete |
$10,094.07
|
| Rate for Payer: BCBS MAPPO |
$17,935.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,746.47
|
| Rate for Payer: BCN Commercial |
$3,547.00
|
| Rate for Payer: BCN Medicare Advantage |
$17,935.45
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,660.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,935.45
|
| Rate for Payer: Healthscope Commercial |
$4,575.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,437.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,935.45
|
| Rate for Payer: Mclaren Commercial |
$4,117.50
|
| Rate for Payer: Mclaren Medicaid |
$9,613.40
|
| Rate for Payer: Mclaren Medicare |
$17,935.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,832.22
|
| Rate for Payer: Meridian Medicaid |
$10,094.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,625.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,888.75
|
| Rate for Payer: Nomi Health Commercial |
$3,751.50
|
| Rate for Payer: PACE Medicare |
$17,038.68
|
| Rate for Payer: PACE SWMI |
$17,935.45
|
| Rate for Payer: PHP Commercial |
$19,728.99
|
| Rate for Payer: PHP Medicaid |
$9,613.40
|
| Rate for Payer: PHP Medicare Advantage |
$17,935.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,613.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,008.61
|
| Rate for Payer: Priority Health Medicare |
$17,935.45
|
| Rate for Payer: Priority Health Narrow Network |
$3,207.07
|
| Rate for Payer: Railroad Medicare Medicare |
$17,935.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,026.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,935.45
|
| Rate for Payer: UHC Exchange |
$27,799.95
|
| Rate for Payer: UHC Medicare Advantage |
$17,935.45
|
| Rate for Payer: UHCCP DNSP |
$17,935.45
|
| Rate for Payer: UHCCP Medicaid |
$9,613.40
|
| Rate for Payer: VA VA |
$17,935.45
|
|
|
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 |
$4,575.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: ASR ASR |
$4,437.75
|
| Rate for Payer: ASR Commercial |
$4,437.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,728.17
|
| Rate for Payer: BCN Commercial |
$3,547.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,660.00
|
| Rate for Payer: Healthscope Commercial |
$4,575.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,437.75
|
| Rate for Payer: Mclaren Commercial |
$4,117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,888.75
|
| Rate for Payer: Nomi Health Commercial |
$3,751.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,026.00
|
|
|
PR ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY
|
Professional
|
Both
|
$3,466.00
|
|
|
Service Code
|
HCPCS 23470
|
| Min. Negotiated Rate |
$1,152.31 |
| Max. Negotiated Rate |
$2,252.90 |
| Rate for Payer: Aetna Commercial |
$1,544.10
|
| Rate for Payer: Aetna Medicare |
$1,152.31
|
| Rate for Payer: BCBS Complete |
$1,386.40
|
| Rate for Payer: BCBS MAPPO |
$1,152.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,152.31
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cofinity Commercial |
$1,659.33
|
| Rate for Payer: Cofinity Commercial |
$1,544.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,152.31
|
| Rate for Payer: Healthscope Commercial |
$1,382.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,382.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,209.93
|
| Rate for Payer: Nomi Health Commercial |
$1,382.77
|
| Rate for Payer: PACE SWMI |
$1,152.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,152.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.90
|
| Rate for Payer: Priority Health Medicare |
$1,152.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,152.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.31
|
| Rate for Payer: UHCCP DNSP |
$1,152.31
|
|
|
PR ARTHROPLASTY INTERPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 26535
|
| Min. Negotiated Rate |
$427.29 |
| Max. Negotiated Rate |
$1,098.50 |
| Rate for Payer: Aetna Commercial |
$572.57
|
| Rate for Payer: Aetna Medicare |
$427.29
|
| Rate for Payer: BCBS Complete |
$676.00
|
| Rate for Payer: BCBS MAPPO |
$427.29
|
| Rate for Payer: BCN Medicare Advantage |
$427.29
|
| Rate for Payer: Cash Price |
$1,352.00
|
| Rate for Payer: Cash Price |
$1,352.00
|
| Rate for Payer: Cofinity Commercial |
$615.30
|
| Rate for Payer: Cofinity Commercial |
$572.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.29
|
| Rate for Payer: Healthscope Commercial |
$512.75
|
| Rate for Payer: Healthscope Whirlpool |
$512.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$448.65
|
| Rate for Payer: Nomi Health Commercial |
$512.75
|
| Rate for Payer: PACE SWMI |
$427.29
|
| Rate for Payer: PHP Medicare Advantage |
$427.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.50
|
| Rate for Payer: Priority Health Medicare |
$427.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.29
|
| Rate for Payer: UHC Medicare Advantage |
$427.29
|
| Rate for Payer: UHCCP DNSP |
$427.29
|
|
|
PR ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA
|
Professional
|
Both
|
$2,481.00
|
|
|
Service Code
|
HCPCS 26536
|
| Min. Negotiated Rate |
$698.31 |
| Max. Negotiated Rate |
$1,612.65 |
| Rate for Payer: Aetna Commercial |
$935.74
|
| Rate for Payer: Aetna Medicare |
$698.31
|
| Rate for Payer: BCBS Complete |
$992.40
|
| Rate for Payer: BCBS MAPPO |
$698.31
|
| Rate for Payer: BCN Medicare Advantage |
$698.31
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cofinity Commercial |
$935.74
|
| Rate for Payer: Cofinity Commercial |
$1,005.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$698.31
|
| Rate for Payer: Healthscope Commercial |
$837.97
|
| Rate for Payer: Healthscope Whirlpool |
$837.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$733.23
|
| Rate for Payer: Nomi Health Commercial |
$837.97
|
| Rate for Payer: PACE SWMI |
$698.31
|
| Rate for Payer: PHP Medicare Advantage |
$698.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.65
|
| Rate for Payer: Priority Health Medicare |
$698.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$698.31
|
| Rate for Payer: UHC Medicare Advantage |
$698.31
|
| Rate for Payer: UHCCP DNSP |
$698.31
|
|
|
PR ARTHROPLASTY KNEE TIBIAL PLATEAU
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
HCPCS 27440
|
| Min. Negotiated Rate |
$710.80 |
| Max. Negotiated Rate |
$1,155.05 |
| Rate for Payer: Aetna Commercial |
$1,034.01
|
| Rate for Payer: Aetna Medicare |
$771.65
|
| Rate for Payer: BCBS Complete |
$710.80
|
| Rate for Payer: BCBS MAPPO |
$771.65
|
| Rate for Payer: BCN Medicare Advantage |
$771.65
|
| Rate for Payer: Cash Price |
$1,421.60
|
| Rate for Payer: Cash Price |
$1,421.60
|
| Rate for Payer: Cofinity Commercial |
$1,111.18
|
| Rate for Payer: Cofinity Commercial |
$1,034.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.65
|
| Rate for Payer: Healthscope Commercial |
$925.98
|
| Rate for Payer: Healthscope Whirlpool |
$925.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.23
|
| Rate for Payer: Nomi Health Commercial |
$925.98
|
| Rate for Payer: PACE SWMI |
$771.65
|
| Rate for Payer: PHP Medicare Advantage |
$771.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.05
|
| Rate for Payer: Priority Health Medicare |
$771.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.65
|
| Rate for Payer: UHC Medicare Advantage |
$771.65
|
| Rate for Payer: UHCCP DNSP |
$771.65
|
|
|
PR ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,806.00
|
|
|
Service Code
|
HCPCS 26530
|
| Min. Negotiated Rate |
$525.88 |
| Max. Negotiated Rate |
$1,173.90 |
| Rate for Payer: Aetna Commercial |
$704.68
|
| Rate for Payer: Aetna Medicare |
$525.88
|
| Rate for Payer: BCBS Complete |
$722.40
|
| Rate for Payer: BCBS MAPPO |
$525.88
|
| Rate for Payer: BCN Medicare Advantage |
$525.88
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cofinity Commercial |
$757.27
|
| Rate for Payer: Cofinity Commercial |
$704.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$525.88
|
| Rate for Payer: Healthscope Commercial |
$631.06
|
| Rate for Payer: Healthscope Whirlpool |
$631.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$552.17
|
| Rate for Payer: Nomi Health Commercial |
$631.06
|
| Rate for Payer: PACE SWMI |
$525.88
|
| Rate for Payer: PHP Medicare Advantage |
$525.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.90
|
| Rate for Payer: Priority Health Medicare |
$525.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$525.88
|
| Rate for Payer: UHC Medicare Advantage |
$525.88
|
| Rate for Payer: UHCCP DNSP |
$525.88
|
|
|
PR ARTHROPLASTY PATELLA W/O PROSTHESIS
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
HCPCS 27437
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$921.24 |
| Rate for Payer: Aetna Commercial |
$857.26
|
| Rate for Payer: Aetna Medicare |
$639.75
|
| Rate for Payer: BCBS Complete |
$470.40
|
| Rate for Payer: BCBS MAPPO |
$639.75
|
| Rate for Payer: BCN Medicare Advantage |
$639.75
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cofinity Commercial |
$921.24
|
| Rate for Payer: Cofinity Commercial |
$857.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$639.75
|
| Rate for Payer: Healthscope Commercial |
$767.70
|
| Rate for Payer: Healthscope Whirlpool |
$767.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$671.74
|
| Rate for Payer: Nomi Health Commercial |
$767.70
|
| Rate for Payer: PACE SWMI |
$639.75
|
| Rate for Payer: PHP Medicare Advantage |
$639.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health Medicare |
$639.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$639.75
|
| Rate for Payer: UHC Medicare Advantage |
$639.75
|
| Rate for Payer: UHCCP DNSP |
$639.75
|
|
|
PR ARTHROPLASTY PATELLA W/PROSTHESIS
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 27438
|
| Min. Negotiated Rate |
$812.69 |
| Max. Negotiated Rate |
$1,517.75 |
| Rate for Payer: Aetna Commercial |
$1,089.00
|
| Rate for Payer: Aetna Medicare |
$812.69
|
| Rate for Payer: BCBS Complete |
$934.00
|
| Rate for Payer: BCBS MAPPO |
$812.69
|
| Rate for Payer: BCN Medicare Advantage |
$812.69
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cofinity Commercial |
$1,170.27
|
| Rate for Payer: Cofinity Commercial |
$1,089.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.69
|
| Rate for Payer: Healthscope Commercial |
$975.23
|
| Rate for Payer: Healthscope Whirlpool |
$975.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$853.32
|
| Rate for Payer: Nomi Health Commercial |
$975.23
|
| Rate for Payer: PACE SWMI |
$812.69
|
| Rate for Payer: PHP Medicare Advantage |
$812.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.75
|
| Rate for Payer: Priority Health Medicare |
$812.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.69
|
| Rate for Payer: UHC Medicare Advantage |
$812.69
|
| Rate for Payer: UHCCP DNSP |
$812.69
|
|
|
PR ARTHROPLASTY RADIAL HEAD
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 24365
|
| Min. Negotiated Rate |
$621.51 |
| Max. Negotiated Rate |
$1,084.20 |
| Rate for Payer: Aetna Commercial |
$832.82
|
| Rate for Payer: Aetna Medicare |
$621.51
|
| Rate for Payer: BCBS Complete |
$667.20
|
| Rate for Payer: BCBS MAPPO |
$621.51
|
| Rate for Payer: BCN Medicare Advantage |
$621.51
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$894.97
|
| Rate for Payer: Cofinity Commercial |
$832.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.51
|
| Rate for Payer: Healthscope Commercial |
$745.81
|
| Rate for Payer: Healthscope Whirlpool |
$745.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.59
|
| Rate for Payer: Nomi Health Commercial |
$745.81
|
| Rate for Payer: PACE SWMI |
$621.51
|
| Rate for Payer: PHP Medicare Advantage |
$621.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.20
|
| Rate for Payer: Priority Health Medicare |
$621.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.51
|
| Rate for Payer: UHC Medicare Advantage |
$621.51
|
| Rate for Payer: UHCCP DNSP |
$621.51
|
|
