|
PR ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$2,691.00
|
|
|
Service Code
|
HCPCS 27310
|
| Min. Negotiated Rate |
$708.34 |
| Max. Negotiated Rate |
$1,749.15 |
| Rate for Payer: Aetna Commercial |
$949.18
|
| Rate for Payer: Aetna Medicare |
$708.34
|
| Rate for Payer: BCBS Complete |
$1,076.40
|
| Rate for Payer: BCBS MAPPO |
$708.34
|
| Rate for Payer: BCN Medicare Advantage |
$708.34
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Cofinity Commercial |
$949.18
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.34
|
| Rate for Payer: Healthscope Commercial |
$850.01
|
| Rate for Payer: Healthscope Whirlpool |
$850.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.76
|
| Rate for Payer: Nomi Health Commercial |
$850.01
|
| Rate for Payer: PACE SWMI |
$708.34
|
| Rate for Payer: PHP Medicare Advantage |
$708.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,749.15
|
| Rate for Payer: Priority Health Medicare |
$708.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.34
|
| Rate for Payer: UHC Medicare Advantage |
$708.34
|
| Rate for Payer: UHCCP DNSP |
$708.34
|
|
|
PR ARTHRT KNE W/EXPL DRG/RMVL FB
|
Facility
|
OP
|
$2,691.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
27310
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$2,421.90
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$2,610.27
|
| Rate for Payer: ASR Commercial |
$2,610.27
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,203.66
|
| Rate for Payer: BCN Commercial |
$2,086.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Cofinity Commercial |
$2,529.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,152.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$2,691.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,610.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$2,421.90
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,287.35
|
| Rate for Payer: Nomi Health Commercial |
$2,206.62
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,749.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,357.85
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,886.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,368.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR ARTHRT KNE W/EXPL DRG/RMVL FB
|
Facility
|
IP
|
$2,691.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
27310
|
| Min. Negotiated Rate |
$1,749.15 |
| Max. Negotiated Rate |
$2,691.00 |
| Rate for Payer: Aetna Commercial |
$2,421.90
|
| Rate for Payer: ASR ASR |
$2,610.27
|
| Rate for Payer: ASR Commercial |
$2,610.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,192.90
|
| Rate for Payer: BCN Commercial |
$2,086.33
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Cofinity Commercial |
$2,529.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,152.80
|
| Rate for Payer: Healthscope Commercial |
$2,691.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,610.27
|
| Rate for Payer: Mclaren Commercial |
$2,421.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,287.35
|
| Rate for Payer: Nomi Health Commercial |
$2,206.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,749.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,368.08
|
|
|
PR ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$2,691.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
27310
|
| Min. Negotiated Rate |
$708.34 |
| Max. Negotiated Rate |
$1,749.15 |
| Rate for Payer: Aetna Commercial |
$949.18
|
| Rate for Payer: Aetna Medicare |
$708.34
|
| Rate for Payer: BCBS Complete |
$1,076.40
|
| Rate for Payer: BCBS MAPPO |
$708.34
|
| Rate for Payer: BCN Medicare Advantage |
$708.34
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Cash Price |
$2,152.80
|
| Rate for Payer: Cofinity Commercial |
$949.18
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.34
|
| Rate for Payer: Healthscope Commercial |
$850.01
|
| Rate for Payer: Healthscope Whirlpool |
$850.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.76
|
| Rate for Payer: Nomi Health Commercial |
$850.01
|
| Rate for Payer: PACE SWMI |
$708.34
|
| Rate for Payer: PHP Medicare Advantage |
$708.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,749.15
|
| Rate for Payer: Priority Health Medicare |
$708.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.34
|
| Rate for Payer: UHC Medicare Advantage |
$708.34
|
| Rate for Payer: UHCCP DNSP |
$708.34
|
|
|
PR ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 27331
|
| Min. Negotiated Rate |
$463.29 |
| Max. Negotiated Rate |
$1,136.85 |
| Rate for Payer: Aetna Commercial |
$620.81
|
| Rate for Payer: Aetna Medicare |
$463.29
|
| Rate for Payer: BCBS Complete |
$699.60
|
| Rate for Payer: BCBS MAPPO |
$463.29
|
| Rate for Payer: BCN Medicare Advantage |
$463.29
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$667.14
|
| Rate for Payer: Cofinity Commercial |
$620.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.29
|
| Rate for Payer: Healthscope Commercial |
$555.95
|
| Rate for Payer: Healthscope Whirlpool |
$555.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$486.45
|
| Rate for Payer: Nomi Health Commercial |
$555.95
|
| Rate for Payer: PACE SWMI |
$463.29
|
| Rate for Payer: PHP Medicare Advantage |
$463.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.85
|
| Rate for Payer: Priority Health Medicare |
$463.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$463.29
|
| Rate for Payer: UHC Medicare Advantage |
$463.29
|
| Rate for Payer: UHCCP DNSP |
$463.29
|
|
|
PR ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 28052
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$351.04 |
| Rate for Payer: Aetna Commercial |
$326.67
|
| Rate for Payer: Aetna Medicare |
$243.78
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$243.78
|
| Rate for Payer: BCN Medicare Advantage |
$243.78
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$351.04
|
| Rate for Payer: Cofinity Commercial |
$326.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.78
|
| Rate for Payer: Healthscope Commercial |
$292.54
|
| Rate for Payer: Healthscope Whirlpool |
$292.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.97
|
| Rate for Payer: Nomi Health Commercial |
$292.54
|
| Rate for Payer: PACE SWMI |
$243.78
|
| Rate for Payer: PHP Medicare Advantage |
$243.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$243.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.78
|
| Rate for Payer: UHC Medicare Advantage |
$243.78
|
| Rate for Payer: UHCCP DNSP |
$243.78
|
|
|
PR ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 27612
|
| Min. Negotiated Rate |
$552.77 |
| Max. Negotiated Rate |
$1,409.85 |
| Rate for Payer: Aetna Commercial |
$740.71
|
| Rate for Payer: Aetna Medicare |
$552.77
|
| Rate for Payer: BCBS Complete |
$867.60
|
| Rate for Payer: BCBS MAPPO |
$552.77
|
| Rate for Payer: BCN Medicare Advantage |
$552.77
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$795.99
|
| Rate for Payer: Cofinity Commercial |
$740.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.77
|
| Rate for Payer: Healthscope Commercial |
$663.32
|
| Rate for Payer: Healthscope Whirlpool |
$663.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.41
|
| Rate for Payer: Nomi Health Commercial |
$663.32
|
| Rate for Payer: PACE SWMI |
$552.77
|
| Rate for Payer: PHP Medicare Advantage |
$552.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health Medicare |
$552.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.77
|
| Rate for Payer: UHC Medicare Advantage |
$552.77
|
| Rate for Payer: UHCCP DNSP |
$552.77
|
|
|
PR ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 25040
|
| Min. Negotiated Rate |
$542.28 |
| Max. Negotiated Rate |
$1,227.20 |
| Rate for Payer: Aetna Commercial |
$726.66
|
| Rate for Payer: Aetna Medicare |
$542.28
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$542.28
|
| Rate for Payer: BCN Medicare Advantage |
$542.28
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$780.88
|
| Rate for Payer: Cofinity Commercial |
$726.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$542.28
|
| Rate for Payer: Healthscope Commercial |
$650.74
|
| Rate for Payer: Healthscope Whirlpool |
$650.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$569.39
|
| Rate for Payer: Nomi Health Commercial |
$650.74
|
| Rate for Payer: PACE SWMI |
$542.28
|
| Rate for Payer: PHP Medicare Advantage |
$542.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$542.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$542.28
|
| Rate for Payer: UHC Medicare Advantage |
$542.28
|
| Rate for Payer: UHCCP DNSP |
$542.28
|
|
|
PR ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 27332
|
| Min. Negotiated Rate |
$625.72 |
| Max. Negotiated Rate |
$1,552.85 |
| Rate for Payer: Aetna Commercial |
$838.46
|
| Rate for Payer: Aetna Medicare |
$625.72
|
| Rate for Payer: BCBS Complete |
$955.60
|
| Rate for Payer: BCBS MAPPO |
$625.72
|
| Rate for Payer: BCN Medicare Advantage |
$625.72
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cofinity Commercial |
$901.04
|
| Rate for Payer: Cofinity Commercial |
$838.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.72
|
| Rate for Payer: Healthscope Commercial |
$750.86
|
| Rate for Payer: Healthscope Whirlpool |
$750.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$657.01
|
| Rate for Payer: Nomi Health Commercial |
$750.86
|
| Rate for Payer: PACE SWMI |
$625.72
|
| Rate for Payer: PHP Medicare Advantage |
$625.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.85
|
| Rate for Payer: Priority Health Medicare |
$625.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.72
|
| Rate for Payer: UHC Medicare Advantage |
$625.72
|
| Rate for Payer: UHCCP DNSP |
$625.72
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 28024
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$476.45 |
| Rate for Payer: Aetna Commercial |
$398.52
|
| Rate for Payer: Aetna Medicare |
$297.40
|
| Rate for Payer: BCBS Complete |
$293.20
|
| Rate for Payer: BCBS MAPPO |
$297.40
|
| Rate for Payer: BCN Medicare Advantage |
$297.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cofinity Commercial |
$428.26
|
| Rate for Payer: Cofinity Commercial |
$398.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.40
|
| Rate for Payer: Healthscope Commercial |
$356.88
|
| Rate for Payer: Healthscope Whirlpool |
$356.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.27
|
| Rate for Payer: Nomi Health Commercial |
$356.88
|
| Rate for Payer: PACE SWMI |
$297.40
|
| Rate for Payer: PHP Medicare Advantage |
$297.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.45
|
| Rate for Payer: Priority Health Medicare |
$297.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.40
|
| Rate for Payer: UHC Medicare Advantage |
$297.40
|
| Rate for Payer: UHCCP DNSP |
$297.40
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
HCPCS 28022
|
| Min. Negotiated Rate |
$313.23 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$419.73
|
| Rate for Payer: Aetna Medicare |
$313.23
|
| Rate for Payer: BCBS Complete |
$334.40
|
| Rate for Payer: BCBS MAPPO |
$313.23
|
| Rate for Payer: BCN Medicare Advantage |
$313.23
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cofinity Commercial |
$451.05
|
| Rate for Payer: Cofinity Commercial |
$419.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.23
|
| Rate for Payer: Healthscope Commercial |
$375.88
|
| Rate for Payer: Healthscope Whirlpool |
$375.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.89
|
| Rate for Payer: Nomi Health Commercial |
$375.88
|
| Rate for Payer: PACE SWMI |
$313.23
|
| Rate for Payer: PHP Medicare Advantage |
$313.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.40
|
| Rate for Payer: Priority Health Medicare |
$313.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.23
|
| Rate for Payer: UHC Medicare Advantage |
$313.23
|
| Rate for Payer: UHCCP DNSP |
$313.23
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 28020
|
| Min. Negotiated Rate |
$346.59 |
| Max. Negotiated Rate |
$597.35 |
| Rate for Payer: Aetna Commercial |
$464.43
|
| Rate for Payer: Aetna Medicare |
$346.59
|
| Rate for Payer: BCBS Complete |
$367.60
|
| Rate for Payer: BCBS MAPPO |
$346.59
|
| Rate for Payer: BCN Medicare Advantage |
$346.59
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$499.09
|
| Rate for Payer: Cofinity Commercial |
$464.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.59
|
| Rate for Payer: Healthscope Commercial |
$415.91
|
| Rate for Payer: Healthscope Whirlpool |
$415.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.92
|
| Rate for Payer: Nomi Health Commercial |
$415.91
|
| Rate for Payer: PACE SWMI |
$346.59
|
| Rate for Payer: PHP Medicare Advantage |
$346.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health Medicare |
$346.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.59
|
| Rate for Payer: UHC Medicare Advantage |
$346.59
|
| Rate for Payer: UHCCP DNSP |
$346.59
|
|
|
PR ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 25101
|
| Min. Negotiated Rate |
$393.79 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Aetna Commercial |
$527.68
|
| Rate for Payer: Aetna Medicare |
$393.79
|
| Rate for Payer: BCBS Complete |
$550.80
|
| Rate for Payer: BCBS MAPPO |
$393.79
|
| Rate for Payer: BCN Medicare Advantage |
$393.79
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$567.06
|
| Rate for Payer: Cofinity Commercial |
$527.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.79
|
| Rate for Payer: Healthscope Commercial |
$472.55
|
| Rate for Payer: Healthscope Whirlpool |
$472.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.48
|
| Rate for Payer: Nomi Health Commercial |
$472.55
|
| Rate for Payer: PACE SWMI |
$393.79
|
| Rate for Payer: PHP Medicare Advantage |
$393.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health Medicare |
$393.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.79
|
| Rate for Payer: UHC Medicare Advantage |
$393.79
|
| Rate for Payer: UHCCP DNSP |
$393.79
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Facility
|
OP
|
$2,781.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$1,807.65 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$2,502.90
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$2,697.57
|
| Rate for Payer: ASR Commercial |
$2,697.57
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,277.36
|
| Rate for Payer: BCN Commercial |
$2,156.11
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cofinity Commercial |
$2,614.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,781.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,697.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$2,502.90
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.85
|
| Rate for Payer: Nomi Health Commercial |
$2,280.42
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,436.71
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,949.48
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,447.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$2,781.00
|
|
|
Service Code
|
HCPCS 27335
|
| Min. Negotiated Rate |
$740.70 |
| Max. Negotiated Rate |
$1,807.65 |
| Rate for Payer: Aetna Commercial |
$992.54
|
| Rate for Payer: Aetna Medicare |
$740.70
|
| Rate for Payer: BCBS Complete |
$1,112.40
|
| Rate for Payer: BCBS MAPPO |
$740.70
|
| Rate for Payer: BCN Medicare Advantage |
$740.70
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cofinity Commercial |
$992.54
|
| Rate for Payer: Cofinity Commercial |
$1,066.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$740.70
|
| Rate for Payer: Healthscope Commercial |
$888.84
|
| Rate for Payer: Healthscope Whirlpool |
$888.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$777.74
|
| Rate for Payer: Nomi Health Commercial |
$888.84
|
| Rate for Payer: PACE SWMI |
$740.70
|
| Rate for Payer: PHP Medicare Advantage |
$740.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: Priority Health Medicare |
$740.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$740.70
|
| Rate for Payer: UHC Medicare Advantage |
$740.70
|
| Rate for Payer: UHCCP DNSP |
$740.70
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Facility
|
IP
|
$2,781.00
|
|
|
Service Code
|
CPT 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$1,807.65 |
| Max. Negotiated Rate |
$2,781.00 |
| Rate for Payer: Aetna Commercial |
$2,502.90
|
| Rate for Payer: ASR ASR |
$2,697.57
|
| Rate for Payer: ASR Commercial |
$2,697.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,266.24
|
| Rate for Payer: BCN Commercial |
$2,156.11
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cofinity Commercial |
$2,614.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.80
|
| Rate for Payer: Healthscope Commercial |
$2,781.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,697.57
|
| Rate for Payer: Mclaren Commercial |
$2,502.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.85
|
| Rate for Payer: Nomi Health Commercial |
$2,280.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,447.28
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$2,781.00
|
|
|
Service Code
|
HCPCS 27335
|
| Hospital Charge Code |
27335
|
| Min. Negotiated Rate |
$740.70 |
| Max. Negotiated Rate |
$1,807.65 |
| Rate for Payer: Aetna Commercial |
$992.54
|
| Rate for Payer: Aetna Medicare |
$740.70
|
| Rate for Payer: BCBS Complete |
$1,112.40
|
| Rate for Payer: BCBS MAPPO |
$740.70
|
| Rate for Payer: BCN Medicare Advantage |
$740.70
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cofinity Commercial |
$992.54
|
| Rate for Payer: Cofinity Commercial |
$1,066.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$740.70
|
| Rate for Payer: Healthscope Commercial |
$888.84
|
| Rate for Payer: Healthscope Whirlpool |
$888.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$777.74
|
| Rate for Payer: Nomi Health Commercial |
$888.84
|
| Rate for Payer: PACE SWMI |
$740.70
|
| Rate for Payer: PHP Medicare Advantage |
$740.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.65
|
| Rate for Payer: Priority Health Medicare |
$740.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$740.70
|
| Rate for Payer: UHC Medicare Advantage |
$740.70
|
| Rate for Payer: UHCCP DNSP |
$740.70
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 58321
|
| Min. Negotiated Rate |
$46.44 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Commercial |
$62.23
|
| Rate for Payer: Aetna Medicare |
$46.44
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS MAPPO |
$46.44
|
| Rate for Payer: BCN Medicare Advantage |
$46.44
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$66.87
|
| Rate for Payer: Cofinity Commercial |
$62.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.44
|
| Rate for Payer: Healthscope Commercial |
$55.73
|
| Rate for Payer: Healthscope Whirlpool |
$55.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.76
|
| Rate for Payer: Nomi Health Commercial |
$55.73
|
| Rate for Payer: PACE SWMI |
$46.44
|
| Rate for Payer: PHP Medicare Advantage |
$46.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: Priority Health Medicare |
$46.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.44
|
| Rate for Payer: UHC Medicare Advantage |
$46.44
|
| Rate for Payer: UHCCP DNSP |
$46.44
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 58322
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$159.25 |
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: BCBS MAPPO |
$55.08
|
| Rate for Payer: BCN Medicare Advantage |
$55.08
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$79.32
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.08
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Healthscope Whirlpool |
$66.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.83
|
| Rate for Payer: Nomi Health Commercial |
$66.10
|
| Rate for Payer: PACE SWMI |
$55.08
|
| Rate for Payer: PHP Medicare Advantage |
$55.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health Medicare |
$55.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.08
|
| Rate for Payer: UHC Medicare Advantage |
$55.08
|
| Rate for Payer: UHCCP DNSP |
$55.08
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 36625
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$133.96
|
| Rate for Payer: Aetna Medicare |
$99.97
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$99.97
|
| Rate for Payer: BCN Medicare Advantage |
$99.97
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$143.96
|
| Rate for Payer: Cofinity Commercial |
$133.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.97
|
| Rate for Payer: Healthscope Commercial |
$119.96
|
| Rate for Payer: Healthscope Whirlpool |
$119.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.97
|
| Rate for Payer: Nomi Health Commercial |
$119.96
|
| Rate for Payer: PACE SWMI |
$99.97
|
| Rate for Payer: PHP Medicare Advantage |
$99.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$99.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.97
|
| Rate for Payer: UHC Medicare Advantage |
$99.97
|
| Rate for Payer: UHCCP DNSP |
$99.97
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 36620
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$55.70
|
| Rate for Payer: Aetna Medicare |
$41.57
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$41.57
|
| Rate for Payer: BCN Medicare Advantage |
$41.57
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$59.86
|
| Rate for Payer: Cofinity Commercial |
$55.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.57
|
| Rate for Payer: Healthscope Commercial |
$49.88
|
| Rate for Payer: Healthscope Whirlpool |
$49.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.65
|
| Rate for Payer: Nomi Health Commercial |
$49.88
|
| Rate for Payer: PACE SWMI |
$41.57
|
| Rate for Payer: PHP Medicare Advantage |
$41.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$41.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.57
|
| Rate for Payer: UHC Medicare Advantage |
$41.57
|
| Rate for Payer: UHCCP DNSP |
$41.57
|
|
|
PR ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 36640
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Aetna Commercial |
$147.72
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$110.24
|
| Rate for Payer: BCN Medicare Advantage |
$110.24
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$147.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.24
|
| Rate for Payer: Healthscope Commercial |
$132.29
|
| Rate for Payer: Healthscope Whirlpool |
$132.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.75
|
| Rate for Payer: Nomi Health Commercial |
$132.29
|
| Rate for Payer: PACE SWMI |
$110.24
|
| Rate for Payer: PHP Medicare Advantage |
$110.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.70
|
| Rate for Payer: Priority Health Medicare |
$110.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.24
|
| Rate for Payer: UHC Medicare Advantage |
$110.24
|
| Rate for Payer: UHCCP DNSP |
$110.24
|
|
|
PR ARVEN ANAST OPN F/ARM VEIN TRPOS
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 36820
|
| Min. Negotiated Rate |
$609.60 |
| Max. Negotiated Rate |
$1,004.28 |
| Rate for Payer: Aetna Commercial |
$934.54
|
| Rate for Payer: Aetna Medicare |
$697.42
|
| Rate for Payer: BCBS Complete |
$609.60
|
| Rate for Payer: BCBS MAPPO |
$697.42
|
| Rate for Payer: BCN Medicare Advantage |
$697.42
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$934.54
|
| Rate for Payer: Cofinity Commercial |
$1,004.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.42
|
| Rate for Payer: Healthscope Commercial |
$836.90
|
| Rate for Payer: Healthscope Whirlpool |
$836.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.29
|
| Rate for Payer: Nomi Health Commercial |
$836.90
|
| Rate for Payer: PACE SWMI |
$697.42
|
| Rate for Payer: PHP Medicare Advantage |
$697.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health Medicare |
$697.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.42
|
| Rate for Payer: UHC Medicare Advantage |
$697.42
|
| Rate for Payer: UHCCP DNSP |
$697.42
|
|
|
PR ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
HCPCS 36819
|
| Min. Negotiated Rate |
$697.29 |
| Max. Negotiated Rate |
$1,582.75 |
| Rate for Payer: Aetna Commercial |
$934.37
|
| Rate for Payer: Aetna Medicare |
$697.29
|
| Rate for Payer: BCBS Complete |
$974.00
|
| Rate for Payer: BCBS MAPPO |
$697.29
|
| Rate for Payer: BCN Medicare Advantage |
$697.29
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Cash Price |
$1,948.00
|
| Rate for Payer: Cofinity Commercial |
$934.37
|
| Rate for Payer: Cofinity Commercial |
$1,004.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.29
|
| Rate for Payer: Healthscope Commercial |
$836.75
|
| Rate for Payer: Healthscope Whirlpool |
$836.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.15
|
| Rate for Payer: Nomi Health Commercial |
$836.75
|
| Rate for Payer: PACE SWMI |
$697.29
|
| Rate for Payer: PHP Medicare Advantage |
$697.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,582.75
|
| Rate for Payer: Priority Health Medicare |
$697.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.29
|
| Rate for Payer: UHC Medicare Advantage |
$697.29
|
| Rate for Payer: UHCCP DNSP |
$697.29
|
|
|
PR ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS
|
Professional
|
Both
|
$2,009.00
|
|
|
Service Code
|
HCPCS 36818
|
| Min. Negotiated Rate |
$658.49 |
| Max. Negotiated Rate |
$1,305.85 |
| Rate for Payer: Aetna Commercial |
$882.38
|
| Rate for Payer: Aetna Medicare |
$658.49
|
| Rate for Payer: BCBS Complete |
$803.60
|
| Rate for Payer: BCBS MAPPO |
$658.49
|
| Rate for Payer: BCN Medicare Advantage |
$658.49
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cofinity Commercial |
$948.23
|
| Rate for Payer: Cofinity Commercial |
$882.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.49
|
| Rate for Payer: Healthscope Commercial |
$790.19
|
| Rate for Payer: Healthscope Whirlpool |
$790.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.41
|
| Rate for Payer: Nomi Health Commercial |
$790.19
|
| Rate for Payer: PACE SWMI |
$658.49
|
| Rate for Payer: PHP Medicare Advantage |
$658.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.85
|
| Rate for Payer: Priority Health Medicare |
$658.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.49
|
| Rate for Payer: UHC Medicare Advantage |
$658.49
|
| Rate for Payer: UHCCP DNSP |
$658.49
|
|
