Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

26123 Dupuytrens

Professional

Both

$2,979.00

Service Code	CPT 26123
Hospital Charge Code	8981173
Hospital Revenue Code	975
Min. Negotiated Rate	$1,263.09
Max. Negotiated Rate	$2,234.25
Rate for Payer: Cash Price	$2,383.20
Rate for Payer: Cash Price	$2,383.20
Rate for Payer: Medical Associates Commercial	$2,234.25
Rate for Payer: Midlands Choice Commercial	$2,085.30
Rate for Payer: Partners Health Alliance Commercial	$2,234.25
Rate for Payer: United Healthcare Commercial	$1,263.09

26125 Dupuytrens additional fingers

Professional

Both

$933.00

Service Code	CPT 26125
Hospital Charge Code	8981174
Hospital Revenue Code	975
Min. Negotiated Rate	$414.02
Max. Negotiated Rate	$699.75
Rate for Payer: Cash Price	$746.40
Rate for Payer: Cash Price	$746.40
Rate for Payer: Medical Associates Commercial	$699.75
Rate for Payer: Midlands Choice Commercial	$653.10
Rate for Payer: Partners Health Alliance Commercial	$699.75
Rate for Payer: United Healthcare Commercial	$414.02

26160 Ganglion Cyst removal of fingers/hand

Professional

Both

$2,170.00

Service Code	CPT 26160
Hospital Charge Code	8981171
Hospital Revenue Code	975
Min. Negotiated Rate	$857.38
Max. Negotiated Rate	$1,627.50
Rate for Payer: Cash Price	$1,736.00
Rate for Payer: Cash Price	$1,736.00
Rate for Payer: Medical Associates Commercial	$1,627.50
Rate for Payer: Midlands Choice Commercial	$1,519.00
Rate for Payer: Partners Health Alliance Commercial	$1,627.50
Rate for Payer: United Healthcare Commercial	$857.38

26480 CMC arthroplasty tendon interposition with separate incision

Professional

Both

$2,784.00

Service Code	CPT 26480
Hospital Charge Code	8981180
Hospital Revenue Code	975
Min. Negotiated Rate	$1,149.97
Max. Negotiated Rate	$2,088.00
Rate for Payer: Cash Price	$2,227.20
Rate for Payer: Cash Price	$2,227.20
Rate for Payer: Medical Associates Commercial	$2,088.00
Rate for Payer: Midlands Choice Commercial	$1,948.80
Rate for Payer: Partners Health Alliance Commercial	$2,088.00
Rate for Payer: United Healthcare Commercial	$1,149.97

26605 Closed treatment of metacarpal fx; single with manipulation

Professional

Both

$1,078.00

Service Code	CPT 26605
Hospital Charge Code	8799119
Hospital Revenue Code	983
Min. Negotiated Rate	$489.30
Max. Negotiated Rate	$808.50
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Medical Associates Commercial	$808.50
Rate for Payer: Midlands Choice Commercial	$754.60
Rate for Payer: Partners Health Alliance Commercial	$808.50
Rate for Payer: United Healthcare Commercial	$489.30

26608 Closed reduction perc Pinning of it

Professional

Both

$1,731.00

Service Code	CPT 26608
Hospital Charge Code	8981170
Hospital Revenue Code	975
Min. Negotiated Rate	$724.11
Max. Negotiated Rate	$1,298.25
Rate for Payer: Cash Price	$1,384.80
Rate for Payer: Cash Price	$1,384.80
Rate for Payer: Medical Associates Commercial	$1,298.25
Rate for Payer: Midlands Choice Commercial	$1,211.70
Rate for Payer: Partners Health Alliance Commercial	$1,298.25
Rate for Payer: United Healthcare Commercial	$724.11

26615 ORIF metacarpal fracture

Professional

Both

$2,056.00

Service Code	CPT 26615
Hospital Charge Code	8981169
Hospital Revenue Code	975
Min. Negotiated Rate	$868.77
Max. Negotiated Rate	$1,542.00
Rate for Payer: Cash Price	$1,644.80
Rate for Payer: Cash Price	$1,644.80
Rate for Payer: Medical Associates Commercial	$1,542.00
Rate for Payer: Midlands Choice Commercial	$1,439.20
Rate for Payer: Partners Health Alliance Commercial	$1,542.00
Rate for Payer: United Healthcare Commercial	$868.77

26727 Treat finger fracture each

Professional

Both

$1,706.00

Service Code	CPT 26727
Hospital Charge Code	8981181
Hospital Revenue Code	975
Min. Negotiated Rate	$712.24
Max. Negotiated Rate	$1,279.50
Rate for Payer: Cash Price	$1,364.80
Rate for Payer: Cash Price	$1,364.80
Rate for Payer: Medical Associates Commercial	$1,279.50
Rate for Payer: Midlands Choice Commercial	$1,194.20
Rate for Payer: Partners Health Alliance Commercial	$1,279.50
Rate for Payer: United Healthcare Commercial	$712.24

26735 Treat finger fracture each

Professional

Both

$2,125.00

Service Code	CPT 26735
Hospital Charge Code	8981182
Hospital Revenue Code	975
Min. Negotiated Rate	$898.58
Max. Negotiated Rate	$1,593.75
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Medical Associates Commercial	$1,593.75
Rate for Payer: Midlands Choice Commercial	$1,487.50
Rate for Payer: Partners Health Alliance Commercial	$1,593.75
Rate for Payer: United Healthcare Commercial	$898.58

26746 Treat finger fracture each

Professional

Both

$2,635.00

Service Code	CPT 26746
Hospital Charge Code	8981183
Hospital Revenue Code	975
Min. Negotiated Rate	$1,123.28
Max. Negotiated Rate	$1,976.25
Rate for Payer: Cash Price	$2,108.00
Rate for Payer: Cash Price	$2,108.00
Rate for Payer: Medical Associates Commercial	$1,976.25
Rate for Payer: Midlands Choice Commercial	$1,844.50
Rate for Payer: Partners Health Alliance Commercial	$1,976.25
Rate for Payer: United Healthcare Commercial	$1,123.28

26756 Pin finger fracture each

Professional

Both

$1,528.00

Service Code	CPT 26756
Hospital Charge Code	8981184
Hospital Revenue Code	975
Min. Negotiated Rate	$636.50
Max. Negotiated Rate	$1,146.00
Rate for Payer: Cash Price	$1,222.40
Rate for Payer: Cash Price	$1,222.40
Rate for Payer: Medical Associates Commercial	$1,146.00
Rate for Payer: Midlands Choice Commercial	$1,069.60
Rate for Payer: Partners Health Alliance Commercial	$1,146.00
Rate for Payer: United Healthcare Commercial	$636.50

26765 Treat finger fracture each

Professional

Both

$1,806.00

Service Code	CPT 26765
Hospital Charge Code	8981185
Hospital Revenue Code	975
Min. Negotiated Rate	$757.41
Max. Negotiated Rate	$1,354.50
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Medical Associates Commercial	$1,354.50
Rate for Payer: Midlands Choice Commercial	$1,264.20
Rate for Payer: Partners Health Alliance Commercial	$1,354.50
Rate for Payer: United Healthcare Commercial	$757.41

27130-Total Hip Arthoplasty

Professional

Both

$2,900.00

Service Code	CPT 27130
Hospital Charge Code	8998301
Hospital Revenue Code	975
Min. Negotiated Rate	$2,030.00
Max. Negotiated Rate	$2,175.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Medical Associates Commercial	$2,175.00
Rate for Payer: Midlands Choice Commercial	$2,030.00
Rate for Payer: Partners Health Alliance Commercial	$2,175.00
Rate for Payer: United Healthcare Commercial	$2,050.19

27134-Revision Hip Joint Replacement Both Components

Professional

Both

$4,300.00

Service Code	CPT 27134
Hospital Charge Code	8998302
Hospital Revenue Code	975
Min. Negotiated Rate	$2,897.34
Max. Negotiated Rate	$3,225.00
Rate for Payer: Cash Price	$3,440.00
Rate for Payer: Cash Price	$3,440.00
Rate for Payer: Medical Associates Commercial	$3,225.00
Rate for Payer: Midlands Choice Commercial	$3,010.00
Rate for Payer: Partners Health Alliance Commercial	$3,225.00
Rate for Payer: United Healthcare Commercial	$2,897.34

27137-Revision Hip Joint Replacement Acetabular only

Professional

Both

$3,300.00

Service Code	CPT 27137
Hospital Charge Code	8998305
Hospital Revenue Code	975
Min. Negotiated Rate	$2,226.21
Max. Negotiated Rate	$2,475.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Medical Associates Commercial	$2,475.00
Rate for Payer: Midlands Choice Commercial	$2,310.00
Rate for Payer: Partners Health Alliance Commercial	$2,475.00
Rate for Payer: United Healthcare Commercial	$2,226.21

27138-Revision Hip Joint Replacement Femoral only

Professional

Both

$3,400.00

Service Code	CPT 27138
Hospital Charge Code	8998464
Hospital Revenue Code	975
Min. Negotiated Rate	$2,314.54
Max. Negotiated Rate	$2,550.00
Rate for Payer: Cash Price	$2,720.00
Rate for Payer: Cash Price	$2,720.00
Rate for Payer: Medical Associates Commercial	$2,550.00
Rate for Payer: Midlands Choice Commercial	$2,380.00
Rate for Payer: Partners Health Alliance Commercial	$2,550.00
Rate for Payer: United Healthcare Commercial	$2,314.54

27232 CLOSED REDUCTION FEMUR FRACTURE

Professional

Both

$2,009.00

Service Code	CPT 27232
Hospital Charge Code	8069175
Hospital Revenue Code	975
Min. Negotiated Rate	$1,130.26
Max. Negotiated Rate	$1,506.75
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Medical Associates Commercial	$1,506.75
Rate for Payer: Midlands Choice Commercial	$1,406.30
Rate for Payer: Partners Health Alliance Commercial	$1,506.75
Rate for Payer: United Healthcare Commercial	$1,130.26

27331 Arthrotomy knee; inc exploration bx or removal of loose/foreign body

Professional

Both

$1,593.00

Service Code	CPT 27331
Hospital Charge Code	8799120
Hospital Revenue Code	975
Min. Negotiated Rate	$716.16
Max. Negotiated Rate	$1,194.75
Rate for Payer: Cash Price	$1,274.40
Rate for Payer: Cash Price	$1,274.40
Rate for Payer: Medical Associates Commercial	$1,194.75
Rate for Payer: Midlands Choice Commercial	$1,115.10
Rate for Payer: Partners Health Alliance Commercial	$1,194.75
Rate for Payer: United Healthcare Commercial	$716.16

27415 Open osteochondral knee allograft

Professional

Both

$4,627.00

Service Code	CPT 27415
Hospital Charge Code	8799121
Hospital Revenue Code	975
Min. Negotiated Rate	$2,074.32
Max. Negotiated Rate	$3,470.25
Rate for Payer: Cash Price	$3,701.60
Rate for Payer: Cash Price	$3,701.60
Rate for Payer: Medical Associates Commercial	$3,470.25
Rate for Payer: Midlands Choice Commercial	$3,238.90
Rate for Payer: Partners Health Alliance Commercial	$3,470.25
Rate for Payer: United Healthcare Commercial	$2,074.32

27427 Ligmamentous reconstruction knee; extra-articular

Professional

Both

$2,390.00

Service Code	CPT 27427
Hospital Charge Code	8799122
Hospital Revenue Code	975
Min. Negotiated Rate	$1,075.92
Max. Negotiated Rate	$1,792.50
Rate for Payer: Cash Price	$1,912.00
Rate for Payer: Cash Price	$1,912.00
Rate for Payer: Medical Associates Commercial	$1,792.50
Rate for Payer: Midlands Choice Commercial	$1,673.00
Rate for Payer: Partners Health Alliance Commercial	$1,792.50
Rate for Payer: United Healthcare Commercial	$1,075.92

27445-Revision of Knee Joint Hinge

Professional

Both

$2,900.00

Service Code	CPT 27445
Hospital Charge Code	8998308
Hospital Revenue Code	975
Min. Negotiated Rate	$1,897.63
Max. Negotiated Rate	$2,175.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Medical Associates Commercial	$2,175.00
Rate for Payer: Midlands Choice Commercial	$2,030.00
Rate for Payer: Partners Health Alliance Commercial	$2,175.00
Rate for Payer: United Healthcare Commercial	$1,897.63

27446-Revision of Knee Joint Condyle and Plateau

Professional

Both

$2,600.00

Service Code	CPT 27446
Hospital Charge Code	8996256
Hospital Revenue Code	975
Min. Negotiated Rate	$1,751.90
Max. Negotiated Rate	$1,950.00
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Medical Associates Commercial	$1,950.00
Rate for Payer: Midlands Choice Commercial	$1,820.00
Rate for Payer: Partners Health Alliance Commercial	$1,950.00
Rate for Payer: United Healthcare Commercial	$1,751.90

27447-Total Knee Arthroplasty

Professional

Both

$2,900.00

Service Code	CPT 27447
Hospital Charge Code	8996257
Hospital Revenue Code	975
Min. Negotiated Rate	$2,030.00
Max. Negotiated Rate	$2,175.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Medical Associates Commercial	$2,175.00
Rate for Payer: Midlands Choice Commercial	$2,030.00
Rate for Payer: Partners Health Alliance Commercial	$2,175.00
Rate for Payer: United Healthcare Commercial	$2,048.13

27487-Revision Total Knee Joint

Professional

Both

$3,900.00

Service Code	CPT 27487
Hospital Charge Code	8998211
Hospital Revenue Code	975
Min. Negotiated Rate	$2,661.12
Max. Negotiated Rate	$2,925.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Medical Associates Commercial	$2,925.00
Rate for Payer: Midlands Choice Commercial	$2,730.00
Rate for Payer: Partners Health Alliance Commercial	$2,925.00
Rate for Payer: United Healthcare Commercial	$2,661.12

27650 Repair primary ruptured Achilles tendon

Professional

Both

$2,210.00

Service Code	CPT 27650
Hospital Charge Code	8799123
Hospital Revenue Code	975
Min. Negotiated Rate	$1,002.61
Max. Negotiated Rate	$1,657.50
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Medical Associates Commercial	$1,657.50
Rate for Payer: Midlands Choice Commercial	$1,547.00
Rate for Payer: Partners Health Alliance Commercial	$1,657.50
Rate for Payer: United Healthcare Commercial	$1,002.61

Know your out-of-pocket cost for care.

All Charges