|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$321.20 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.65
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$250.01
|
| Rate for Payer: Cofinity Commercial |
$232.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$277.79
|
| Rate for Payer: Healthscope Commercial |
$321.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.70
|
| Rate for Payer: Nomi Health Commercial |
$208.34
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
IP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.51 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.19
|
| Rate for Payer: Priority Health SBD |
$84.51
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
OP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna Medicare |
$67.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: BCBS Complete |
$53.66
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.19
|
| Rate for Payer: Priority Health SBD |
$84.51
|
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$552.06 |
| Max. Negotiated Rate |
$1,034.15 |
| Rate for Payer: Aetna Commercial |
$739.76
|
| Rate for Payer: Aetna Medicare |
$574.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.76
|
| Rate for Payer: BCBS Complete |
$636.40
|
| Rate for Payer: BCBS MAPPO |
$552.06
|
| Rate for Payer: BCN Medicare Advantage |
$552.06
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$794.97
|
| Rate for Payer: Cofinity Commercial |
$739.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.06
|
| Rate for Payer: Healthscope Commercial |
$883.30
|
| Rate for Payer: Healthscope Commercial |
$1,021.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.15
|
| Rate for Payer: Nomi Health Commercial |
$662.47
|
| Rate for Payer: PACE SWMI |
$552.06
|
| Rate for Payer: PHP Medicare Advantage |
$552.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.15
|
| Rate for Payer: Priority Health Medicare |
$552.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.06
|
| Rate for Payer: UHC Medicare Advantage |
$552.06
|
|
|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$595.69 |
| Max. Negotiated Rate |
$1,102.03 |
| Rate for Payer: Aetna Commercial |
$798.22
|
| Rate for Payer: Aetna Medicare |
$619.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.22
|
| Rate for Payer: BCBS Complete |
$646.40
|
| Rate for Payer: BCBS MAPPO |
$595.69
|
| Rate for Payer: BCN Medicare Advantage |
$595.69
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$857.79
|
| Rate for Payer: Cofinity Commercial |
$798.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.69
|
| Rate for Payer: Healthscope Commercial |
$1,102.03
|
| Rate for Payer: Healthscope Commercial |
$953.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.40
|
| Rate for Payer: Nomi Health Commercial |
$714.83
|
| Rate for Payer: PACE SWMI |
$595.69
|
| Rate for Payer: PHP Medicare Advantage |
$595.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health Medicare |
$595.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.69
|
| Rate for Payer: UHC Medicare Advantage |
$595.69
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$679.25 |
| Max. Negotiated Rate |
$1,256.61 |
| Rate for Payer: Aetna Commercial |
$910.20
|
| Rate for Payer: Aetna Medicare |
$706.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.20
|
| Rate for Payer: BCBS Complete |
$768.00
|
| Rate for Payer: BCBS MAPPO |
$679.25
|
| Rate for Payer: BCN Medicare Advantage |
$679.25
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cofinity Commercial |
$978.12
|
| Rate for Payer: Cofinity Commercial |
$910.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.25
|
| Rate for Payer: Healthscope Commercial |
$1,256.61
|
| Rate for Payer: Healthscope Commercial |
$1,086.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.00
|
| Rate for Payer: Nomi Health Commercial |
$815.10
|
| Rate for Payer: PACE SWMI |
$679.25
|
| Rate for Payer: PHP Medicare Advantage |
$679.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.00
|
| Rate for Payer: Priority Health Medicare |
$679.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.25
|
| Rate for Payer: UHC Medicare Advantage |
$679.25
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$1,228.71 |
| Rate for Payer: Aetna Commercial |
$889.99
|
| Rate for Payer: Aetna Medicare |
$690.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.99
|
| Rate for Payer: BCBS Complete |
$494.80
|
| Rate for Payer: BCBS MAPPO |
$664.17
|
| Rate for Payer: BCN Medicare Advantage |
$664.17
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cofinity Commercial |
$956.40
|
| Rate for Payer: Cofinity Commercial |
$889.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.17
|
| Rate for Payer: Healthscope Commercial |
$1,062.67
|
| Rate for Payer: Healthscope Commercial |
$1,228.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$797.00
|
| Rate for Payer: PACE SWMI |
$664.17
|
| Rate for Payer: PHP Medicare Advantage |
$664.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.05
|
| Rate for Payer: Priority Health Medicare |
$664.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$664.17
|
| Rate for Payer: UHC Medicare Advantage |
$664.17
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$641.42 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Medicare |
$667.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.50
|
| Rate for Payer: BCBS Complete |
$880.00
|
| Rate for Payer: BCBS MAPPO |
$641.42
|
| Rate for Payer: BCN Medicare Advantage |
$641.42
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cofinity Commercial |
$923.64
|
| Rate for Payer: Cofinity Commercial |
$859.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.42
|
| Rate for Payer: Healthscope Commercial |
$1,186.63
|
| Rate for Payer: Healthscope Commercial |
$1,026.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,430.00
|
| Rate for Payer: Nomi Health Commercial |
$769.70
|
| Rate for Payer: PACE SWMI |
$641.42
|
| Rate for Payer: PHP Medicare Advantage |
$641.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health Medicare |
$641.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.42
|
| Rate for Payer: UHC Medicare Advantage |
$641.42
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$657.53 |
| Max. Negotiated Rate |
$1,216.43 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Aetna Medicare |
$683.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.09
|
| Rate for Payer: BCBS Complete |
$660.00
|
| Rate for Payer: BCBS MAPPO |
$657.53
|
| Rate for Payer: BCN Medicare Advantage |
$657.53
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$946.84
|
| Rate for Payer: Cofinity Commercial |
$881.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.53
|
| Rate for Payer: Healthscope Commercial |
$1,052.05
|
| Rate for Payer: Healthscope Commercial |
$1,216.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,072.50
|
| Rate for Payer: Nomi Health Commercial |
$789.04
|
| Rate for Payer: PACE SWMI |
$657.53
|
| Rate for Payer: PHP Medicare Advantage |
$657.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.50
|
| Rate for Payer: Priority Health Medicare |
$657.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.53
|
| Rate for Payer: UHC Medicare Advantage |
$657.53
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.74
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Cofinity Commercial |
$0.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$0.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$0.66
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$1,295.45 |
| Rate for Payer: Aetna Commercial |
$837.47
|
| Rate for Payer: Aetna Medicare |
$649.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.47
|
| Rate for Payer: BCBS Complete |
$797.20
|
| Rate for Payer: BCBS MAPPO |
$624.98
|
| Rate for Payer: BCN Medicare Advantage |
$624.98
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cofinity Commercial |
$899.97
|
| Rate for Payer: Cofinity Commercial |
$837.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.98
|
| Rate for Payer: Healthscope Commercial |
$1,156.21
|
| Rate for Payer: Healthscope Commercial |
$999.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.45
|
| Rate for Payer: Nomi Health Commercial |
$749.98
|
| Rate for Payer: PACE SWMI |
$624.98
|
| Rate for Payer: PHP Medicare Advantage |
$624.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.45
|
| Rate for Payer: Priority Health Medicare |
$624.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.98
|
| Rate for Payer: UHC Medicare Advantage |
$624.98
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,721.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$557.73 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Aetna Medicare |
$580.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.36
|
| Rate for Payer: BCBS Complete |
$688.40
|
| Rate for Payer: BCBS MAPPO |
$557.73
|
| Rate for Payer: BCN Medicare Advantage |
$557.73
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Cofinity Commercial |
$803.13
|
| Rate for Payer: Cofinity Commercial |
$747.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.73
|
| Rate for Payer: Healthscope Commercial |
$892.37
|
| Rate for Payer: Healthscope Commercial |
$1,031.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,118.65
|
| Rate for Payer: Nomi Health Commercial |
$669.28
|
| Rate for Payer: PACE SWMI |
$557.73
|
| Rate for Payer: PHP Medicare Advantage |
$557.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.65
|
| Rate for Payer: Priority Health Medicare |
$557.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.73
|
| Rate for Payer: UHC Medicare Advantage |
$557.73
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$717.40 |
| Max. Negotiated Rate |
$1,608.75 |
| Rate for Payer: Aetna Commercial |
$961.32
|
| Rate for Payer: Aetna Medicare |
$746.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.06
|
| Rate for Payer: BCBS Complete |
$990.00
|
| Rate for Payer: BCBS MAPPO |
$717.40
|
| Rate for Payer: BCN Medicare Advantage |
$717.40
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$961.32
|
| Rate for Payer: Cofinity Commercial |
$1,033.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.40
|
| Rate for Payer: Healthscope Commercial |
$1,147.84
|
| Rate for Payer: Healthscope Commercial |
$1,327.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,608.75
|
| Rate for Payer: Nomi Health Commercial |
$860.88
|
| Rate for Payer: PACE SWMI |
$717.40
|
| Rate for Payer: PHP Medicare Advantage |
$717.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health Medicare |
$717.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.40
|
| Rate for Payer: UHC Medicare Advantage |
$717.40
|
|
|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$900.41 |
| Rate for Payer: Aetna Commercial |
$652.19
|
| Rate for Payer: Aetna Medicare |
$506.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.19
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS MAPPO |
$486.71
|
| Rate for Payer: BCN Medicare Advantage |
$486.71
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cofinity Commercial |
$700.86
|
| Rate for Payer: Cofinity Commercial |
$652.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.71
|
| Rate for Payer: Healthscope Commercial |
$900.41
|
| Rate for Payer: Healthscope Commercial |
$778.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.80
|
| Rate for Payer: Nomi Health Commercial |
$584.05
|
| Rate for Payer: PACE SWMI |
$486.71
|
| Rate for Payer: PHP Medicare Advantage |
$486.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Medicare |
$486.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.71
|
| Rate for Payer: UHC Medicare Advantage |
$486.71
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$1,313.32 |
| Rate for Payer: Aetna Commercial |
$951.27
|
| Rate for Payer: Aetna Medicare |
$738.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.26
|
| Rate for Payer: BCBS Complete |
$505.20
|
| Rate for Payer: BCBS MAPPO |
$709.90
|
| Rate for Payer: BCN Medicare Advantage |
$709.90
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$951.27
|
| Rate for Payer: Cofinity Commercial |
$1,022.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.90
|
| Rate for Payer: Healthscope Commercial |
$1,135.84
|
| Rate for Payer: Healthscope Commercial |
$1,313.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$745.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.95
|
| Rate for Payer: Nomi Health Commercial |
$851.88
|
| Rate for Payer: PACE SWMI |
$709.90
|
| Rate for Payer: PHP Medicare Advantage |
$709.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health Medicare |
$709.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.90
|
| Rate for Payer: UHC Medicare Advantage |
$709.90
|
|
|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$2,374.00
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$748.38 |
| Max. Negotiated Rate |
$1,543.10 |
| Rate for Payer: Aetna Commercial |
$1,002.83
|
| Rate for Payer: Aetna Medicare |
$778.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.83
|
| Rate for Payer: BCBS Complete |
$949.60
|
| Rate for Payer: BCBS MAPPO |
$748.38
|
| Rate for Payer: BCN Medicare Advantage |
$748.38
|
| Rate for Payer: Cash Price |
$1,899.20
|
| Rate for Payer: Cash Price |
$1,899.20
|
| Rate for Payer: Cofinity Commercial |
$1,077.67
|
| Rate for Payer: Cofinity Commercial |
$1,002.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.38
|
| Rate for Payer: Healthscope Commercial |
$1,384.50
|
| Rate for Payer: Healthscope Commercial |
$1,197.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,543.10
|
| Rate for Payer: Nomi Health Commercial |
$898.06
|
| Rate for Payer: PACE SWMI |
$748.38
|
| Rate for Payer: PHP Medicare Advantage |
$748.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,543.10
|
| Rate for Payer: Priority Health Medicare |
$748.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$748.38
|
| Rate for Payer: UHC Medicare Advantage |
$748.38
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$737.83 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$988.69
|
| Rate for Payer: Aetna Medicare |
$767.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.48
|
| Rate for Payer: BCBS Complete |
$925.20
|
| Rate for Payer: BCBS MAPPO |
$737.83
|
| Rate for Payer: BCN Medicare Advantage |
$737.83
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$988.69
|
| Rate for Payer: Cofinity Commercial |
$1,062.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$737.83
|
| Rate for Payer: Healthscope Commercial |
$1,180.53
|
| Rate for Payer: Healthscope Commercial |
$1,364.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$774.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.45
|
| Rate for Payer: Nomi Health Commercial |
$885.40
|
| Rate for Payer: PACE SWMI |
$737.83
|
| Rate for Payer: PHP Medicare Advantage |
$737.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health Medicare |
$737.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$737.83
|
| Rate for Payer: UHC Medicare Advantage |
$737.83
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$504.80 |
| Max. Negotiated Rate |
$1,061.45 |
| Rate for Payer: Aetna Commercial |
$676.43
|
| Rate for Payer: Aetna Medicare |
$524.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.43
|
| Rate for Payer: BCBS Complete |
$653.20
|
| Rate for Payer: BCBS MAPPO |
$504.80
|
| Rate for Payer: BCN Medicare Advantage |
$504.80
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cofinity Commercial |
$726.91
|
| Rate for Payer: Cofinity Commercial |
$676.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$504.80
|
| Rate for Payer: Healthscope Commercial |
$933.88
|
| Rate for Payer: Healthscope Commercial |
$807.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$530.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,061.45
|
| Rate for Payer: Nomi Health Commercial |
$605.76
|
| Rate for Payer: PACE SWMI |
$504.80
|
| Rate for Payer: PHP Medicare Advantage |
$504.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.45
|
| Rate for Payer: Priority Health Medicare |
$504.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$504.80
|
| Rate for Payer: UHC Medicare Advantage |
$504.80
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$676.63 |
| Max. Negotiated Rate |
$1,254.50 |
| Rate for Payer: Aetna Commercial |
$906.68
|
| Rate for Payer: Aetna Medicare |
$703.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.68
|
| Rate for Payer: BCBS Complete |
$772.00
|
| Rate for Payer: BCBS MAPPO |
$676.63
|
| Rate for Payer: BCN Medicare Advantage |
$676.63
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cofinity Commercial |
$974.35
|
| Rate for Payer: Cofinity Commercial |
$906.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.63
|
| Rate for Payer: Healthscope Commercial |
$1,082.61
|
| Rate for Payer: Healthscope Commercial |
$1,251.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,254.50
|
| Rate for Payer: Nomi Health Commercial |
$811.96
|
| Rate for Payer: PACE SWMI |
$676.63
|
| Rate for Payer: PHP Medicare Advantage |
$676.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.50
|
| Rate for Payer: Priority Health Medicare |
$676.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.63
|
| Rate for Payer: UHC Medicare Advantage |
$676.63
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$932.37
|
| Rate for Payer: Aetna Medicare |
$723.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.95
|
| Rate for Payer: BCBS Complete |
$952.40
|
| Rate for Payer: BCBS MAPPO |
$695.80
|
| Rate for Payer: BCN Medicare Advantage |
$695.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cofinity Commercial |
$932.37
|
| Rate for Payer: Cofinity Commercial |
$1,001.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.80
|
| Rate for Payer: Healthscope Commercial |
$1,287.23
|
| Rate for Payer: Healthscope Commercial |
$1,113.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,547.65
|
| Rate for Payer: Nomi Health Commercial |
$834.96
|
| Rate for Payer: PACE SWMI |
$695.80
|
| Rate for Payer: PHP Medicare Advantage |
$695.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.65
|
| Rate for Payer: Priority Health Medicare |
$695.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.80
|
| Rate for Payer: UHC Medicare Advantage |
$695.80
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$2,710.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$867.61 |
| Max. Negotiated Rate |
$1,761.50 |
| Rate for Payer: Aetna Commercial |
$1,162.60
|
| Rate for Payer: Aetna Medicare |
$902.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,162.60
|
| Rate for Payer: BCBS Complete |
$1,084.00
|
| Rate for Payer: BCBS MAPPO |
$867.61
|
| Rate for Payer: BCN Medicare Advantage |
$867.61
|
| Rate for Payer: Cash Price |
$2,168.00
|
| Rate for Payer: Cash Price |
$2,168.00
|
| Rate for Payer: Cofinity Commercial |
$1,249.36
|
| Rate for Payer: Cofinity Commercial |
$1,162.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$867.61
|
| Rate for Payer: Healthscope Commercial |
$1,388.18
|
| Rate for Payer: Healthscope Commercial |
$1,605.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.50
|
| Rate for Payer: Nomi Health Commercial |
$1,041.13
|
| Rate for Payer: PACE SWMI |
$867.61
|
| Rate for Payer: PHP Medicare Advantage |
$867.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,761.50
|
| Rate for Payer: Priority Health Medicare |
$867.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.61
|
| Rate for Payer: UHC Medicare Advantage |
$867.61
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$571.07 |
| Max. Negotiated Rate |
$1,391.00 |
| Rate for Payer: Aetna Commercial |
$765.23
|
| Rate for Payer: Aetna Medicare |
$593.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.23
|
| Rate for Payer: BCBS Complete |
$856.00
|
| Rate for Payer: BCBS MAPPO |
$571.07
|
| Rate for Payer: BCN Medicare Advantage |
$571.07
|
| Rate for Payer: Cash Price |
$1,712.00
|
| Rate for Payer: Cash Price |
$1,712.00
|
| Rate for Payer: Cofinity Commercial |
$822.34
|
| Rate for Payer: Cofinity Commercial |
$765.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.07
|
| Rate for Payer: Healthscope Commercial |
$913.71
|
| Rate for Payer: Healthscope Commercial |
$1,056.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,391.00
|
| Rate for Payer: Nomi Health Commercial |
$685.28
|
| Rate for Payer: PACE SWMI |
$571.07
|
| Rate for Payer: PHP Medicare Advantage |
$571.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,391.00
|
| Rate for Payer: Priority Health Medicare |
$571.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.07
|
| Rate for Payer: UHC Medicare Advantage |
$571.07
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$403.68 |
| Max. Negotiated Rate |
$933.40 |
| Rate for Payer: Aetna Commercial |
$540.93
|
| Rate for Payer: Aetna Medicare |
$419.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.93
|
| Rate for Payer: BCBS Complete |
$574.40
|
| Rate for Payer: BCBS MAPPO |
$403.68
|
| Rate for Payer: BCN Medicare Advantage |
$403.68
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$581.30
|
| Rate for Payer: Cofinity Commercial |
$540.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.68
|
| Rate for Payer: Healthscope Commercial |
$746.81
|
| Rate for Payer: Healthscope Commercial |
$645.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$933.40
|
| Rate for Payer: Nomi Health Commercial |
$484.42
|
| Rate for Payer: PACE SWMI |
$403.68
|
| Rate for Payer: PHP Medicare Advantage |
$403.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health Medicare |
$403.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.68
|
| Rate for Payer: UHC Medicare Advantage |
$403.68
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$904.68 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Commercial |
$1,220.60
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.40
|
| 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: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,005.20
|
| Rate for Payer: Cofinity Commercial |
$1,234.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,292.40
|
| 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 |
$1,220.60
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$1,220.60
|
| 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 |
$933.40
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$904.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,781.56
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$904.68 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna Commercial |
$1,220.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.40
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,005.20
|
| Rate for Payer: Cofinity Commercial |
$1,234.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Healthscope Commercial |
$1,292.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.60
|
| Rate for Payer: PHP Commercial |
$1,220.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health SBD |
$904.68
|
|
