|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 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 |
$645.89
|
| Rate for Payer: Healthscope Commercial |
$746.81
|
| 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 PENIS COMPLETE
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$620.80 |
| Max. Negotiated Rate |
$1,464.76 |
| Rate for Payer: Aetna Commercial |
$1,060.96
|
| Rate for Payer: Aetna Medicare |
$823.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,140.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,060.96
|
| Rate for Payer: BCBS Complete |
$620.80
|
| Rate for Payer: BCBS MAPPO |
$791.76
|
| Rate for Payer: BCN Medicare Advantage |
$791.76
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Cofinity Commercial |
$1,140.13
|
| Rate for Payer: Cofinity Commercial |
$1,060.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$791.76
|
| Rate for Payer: Healthscope Commercial |
$1,464.76
|
| Rate for Payer: Healthscope Commercial |
$1,266.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$831.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.80
|
| Rate for Payer: Nomi Health Commercial |
$950.11
|
| Rate for Payer: PACE SWMI |
$791.76
|
| Rate for Payer: PHP Medicare Advantage |
$791.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.80
|
| Rate for Payer: Priority Health Medicare |
$791.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$791.76
|
| Rate for Payer: UHC Medicare Advantage |
$791.76
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$1,120.49 |
| Rate for Payer: Aetna Commercial |
$811.60
|
| Rate for Payer: Aetna Medicare |
$629.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$811.60
|
| Rate for Payer: BCBS Complete |
$480.80
|
| Rate for Payer: BCBS MAPPO |
$605.67
|
| Rate for Payer: BCN Medicare Advantage |
$605.67
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cofinity Commercial |
$872.16
|
| Rate for Payer: Cofinity Commercial |
$811.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.67
|
| Rate for Payer: Healthscope Commercial |
$1,120.49
|
| Rate for Payer: Healthscope Commercial |
$969.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$635.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.30
|
| Rate for Payer: Nomi Health Commercial |
$726.80
|
| Rate for Payer: PACE SWMI |
$605.67
|
| Rate for Payer: PHP Medicare Advantage |
$605.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health Medicare |
$605.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.67
|
| Rate for Payer: UHC Medicare Advantage |
$605.67
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,482.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$992.80 |
| Max. Negotiated Rate |
$2,106.08 |
| Rate for Payer: Aetna Commercial |
$1,525.48
|
| Rate for Payer: Aetna Medicare |
$1,183.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,525.48
|
| Rate for Payer: BCBS Complete |
$992.80
|
| Rate for Payer: BCBS MAPPO |
$1,138.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,138.42
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Cofinity Commercial |
$1,639.32
|
| Rate for Payer: Cofinity Commercial |
$1,525.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,138.42
|
| Rate for Payer: Healthscope Commercial |
$2,106.08
|
| Rate for Payer: Healthscope Commercial |
$1,821.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,195.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,613.30
|
| Rate for Payer: Nomi Health Commercial |
$1,366.10
|
| Rate for Payer: PACE SWMI |
$1,138.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,138.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,613.30
|
| Rate for Payer: Priority Health Medicare |
$1,138.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,138.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,138.42
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$756.87 |
| Max. Negotiated Rate |
$1,678.30 |
| Rate for Payer: Aetna Commercial |
$1,014.21
|
| Rate for Payer: Aetna Medicare |
$787.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.21
|
| Rate for Payer: BCBS Complete |
$1,032.80
|
| Rate for Payer: BCBS MAPPO |
$756.87
|
| Rate for Payer: BCN Medicare Advantage |
$756.87
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.89
|
| Rate for Payer: Cofinity Commercial |
$1,014.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.87
|
| Rate for Payer: Healthscope Commercial |
$1,210.99
|
| Rate for Payer: Healthscope Commercial |
$1,400.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,678.30
|
| Rate for Payer: Nomi Health Commercial |
$908.24
|
| Rate for Payer: PACE SWMI |
$756.87
|
| Rate for Payer: PHP Medicare Advantage |
$756.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health Medicare |
$756.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.87
|
| Rate for Payer: UHC Medicare Advantage |
$756.87
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$685.69 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: Aetna Commercial |
$918.82
|
| Rate for Payer: Aetna Medicare |
$713.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.82
|
| Rate for Payer: BCBS Complete |
$971.20
|
| Rate for Payer: BCBS MAPPO |
$685.69
|
| Rate for Payer: BCN Medicare Advantage |
$685.69
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cofinity Commercial |
$987.39
|
| Rate for Payer: Cofinity Commercial |
$918.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.69
|
| Rate for Payer: Healthscope Commercial |
$1,268.53
|
| Rate for Payer: Healthscope Commercial |
$1,097.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,578.20
|
| Rate for Payer: Nomi Health Commercial |
$822.83
|
| Rate for Payer: PACE SWMI |
$685.69
|
| Rate for Payer: PHP Medicare Advantage |
$685.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.20
|
| Rate for Payer: Priority Health Medicare |
$685.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.69
|
| Rate for Payer: UHC Medicare Advantage |
$685.69
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$652.05 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$873.75
|
| Rate for Payer: Aetna Medicare |
$678.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$938.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.75
|
| Rate for Payer: BCBS Complete |
$1,238.80
|
| Rate for Payer: BCBS MAPPO |
$652.05
|
| Rate for Payer: BCN Medicare Advantage |
$652.05
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$938.95
|
| Rate for Payer: Cofinity Commercial |
$873.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.05
|
| Rate for Payer: Healthscope Commercial |
$1,043.28
|
| Rate for Payer: Healthscope Commercial |
$1,206.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,013.05
|
| Rate for Payer: Nomi Health Commercial |
$782.46
|
| Rate for Payer: PACE SWMI |
$652.05
|
| Rate for Payer: PHP Medicare Advantage |
$652.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health Medicare |
$652.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.05
|
| Rate for Payer: UHC Medicare Advantage |
$652.05
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$874.90 |
| Rate for Payer: Aetna Commercial |
$222.91
|
| Rate for Payer: Aetna Medicare |
$173.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.91
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS MAPPO |
$166.35
|
| Rate for Payer: BCN Medicare Advantage |
$166.35
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$239.54
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.35
|
| Rate for Payer: Healthscope Commercial |
$307.75
|
| Rate for Payer: Healthscope Commercial |
$266.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$874.90
|
| Rate for Payer: Nomi Health Commercial |
$199.62
|
| Rate for Payer: PACE SWMI |
$166.35
|
| Rate for Payer: PHP Medicare Advantage |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health Medicare |
$166.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.35
|
| Rate for Payer: UHC Medicare Advantage |
$166.35
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$228.55
|
| Rate for Payer: Aetna Medicare |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.55
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$170.56
|
| Rate for Payer: BCN Medicare Advantage |
$170.56
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.56
|
| Rate for Payer: Healthscope Commercial |
$272.90
|
| Rate for Payer: Healthscope Commercial |
$315.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.05
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE SWMI |
$170.56
|
| Rate for Payer: PHP Medicare Advantage |
$170.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$170.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.56
|
| Rate for Payer: UHC Medicare Advantage |
$170.56
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$1,557.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$980.91 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Commercial |
$1,323.45
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,012.05
|
| 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 |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,339.02
|
| Rate for Payer: Cofinity Commercial |
$1,089.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,089.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,401.30
|
| 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 |
$1,323.45
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$1,323.45
|
| 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 |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$980.91
|
| 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 TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$228.55
|
| Rate for Payer: Aetna Medicare |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.55
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$170.56
|
| Rate for Payer: BCN Medicare Advantage |
$170.56
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.56
|
| Rate for Payer: Healthscope Commercial |
$272.90
|
| Rate for Payer: Healthscope Commercial |
$315.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.05
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE SWMI |
$170.56
|
| Rate for Payer: PHP Medicare Advantage |
$170.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$170.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.56
|
| Rate for Payer: UHC Medicare Advantage |
$170.56
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$980.91 |
| Max. Negotiated Rate |
$1,401.30 |
| Rate for Payer: Aetna Commercial |
$1,323.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.90
|
| Rate for Payer: Cofinity Commercial |
$1,339.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,089.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Healthscope Commercial |
$1,401.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: PHP Commercial |
$1,323.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health SBD |
$980.91
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 92603
|
| Min. Negotiated Rate |
$111.22 |
| Max. Negotiated Rate |
$205.76 |
| Rate for Payer: Aetna Commercial |
$149.03
|
| Rate for Payer: Aetna Medicare |
$115.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.03
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$111.22
|
| Rate for Payer: BCN Medicare Advantage |
$111.22
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$160.16
|
| Rate for Payer: Cofinity Commercial |
$149.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.22
|
| Rate for Payer: Healthscope Commercial |
$205.76
|
| Rate for Payer: Healthscope Commercial |
$177.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.40
|
| Rate for Payer: Nomi Health Commercial |
$133.46
|
| Rate for Payer: PACE SWMI |
$111.22
|
| Rate for Payer: PHP Medicare Advantage |
$111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$111.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.22
|
| Rate for Payer: UHC Medicare Advantage |
$111.22
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 92604
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$82.95
|
| Rate for Payer: Aetna Medicare |
$64.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.95
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS MAPPO |
$61.90
|
| Rate for Payer: BCN Medicare Advantage |
$61.90
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.90
|
| Rate for Payer: Healthscope Commercial |
$114.52
|
| Rate for Payer: Healthscope Commercial |
$99.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.50
|
| Rate for Payer: Nomi Health Commercial |
$74.28
|
| Rate for Payer: PACE SWMI |
$61.90
|
| Rate for Payer: PHP Medicare Advantage |
$61.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health Medicare |
$61.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.90
|
| Rate for Payer: UHC Medicare Advantage |
$61.90
|
|
|
PR ANALYZE NEUROSTIM BRAIN, FIRST 1H
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 95978
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$329.55 |
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
|
|
PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 95979
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
|
|
PR ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES
|
Professional
|
Both
|
$7,866.00
|
|
|
Service Code
|
HCPCS 61711
|
| Min. Negotiated Rate |
$2,586.63 |
| Max. Negotiated Rate |
$5,112.90 |
| Rate for Payer: Aetna Commercial |
$3,466.08
|
| Rate for Payer: Aetna Medicare |
$2,690.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,724.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,466.08
|
| Rate for Payer: BCBS Complete |
$3,146.40
|
| Rate for Payer: BCBS MAPPO |
$2,586.63
|
| Rate for Payer: BCN Medicare Advantage |
$2,586.63
|
| Rate for Payer: Cash Price |
$6,292.80
|
| Rate for Payer: Cash Price |
$6,292.80
|
| Rate for Payer: Cofinity Commercial |
$3,466.08
|
| Rate for Payer: Cofinity Commercial |
$3,724.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,586.63
|
| Rate for Payer: Healthscope Commercial |
$4,785.27
|
| Rate for Payer: Healthscope Commercial |
$4,138.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,715.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,112.90
|
| Rate for Payer: Nomi Health Commercial |
$3,103.96
|
| Rate for Payer: PACE SWMI |
$2,586.63
|
| Rate for Payer: PHP Medicare Advantage |
$2,586.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,112.90
|
| Rate for Payer: Priority Health Medicare |
$2,586.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,586.63
|
| Rate for Payer: UHC Medicare Advantage |
$2,586.63
|
|
|
PR ANAST INTRAHEPATC DUCTS & GI TRACT
|
Professional
|
Both
|
$6,161.00
|
|
|
Service Code
|
HCPCS 47765
|
| Min. Negotiated Rate |
$2,464.40 |
| Max. Negotiated Rate |
$5,440.66 |
| Rate for Payer: Aetna Commercial |
$3,940.81
|
| Rate for Payer: Aetna Medicare |
$3,058.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,234.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,940.81
|
| Rate for Payer: BCBS Complete |
$2,464.40
|
| Rate for Payer: BCBS MAPPO |
$2,940.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,940.90
|
| Rate for Payer: Cash Price |
$4,928.80
|
| Rate for Payer: Cash Price |
$4,928.80
|
| Rate for Payer: Cofinity Commercial |
$4,234.90
|
| Rate for Payer: Cofinity Commercial |
$3,940.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,940.90
|
| Rate for Payer: Healthscope Commercial |
$5,440.66
|
| Rate for Payer: Healthscope Commercial |
$4,705.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,087.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,004.65
|
| Rate for Payer: Nomi Health Commercial |
$3,529.08
|
| Rate for Payer: PACE SWMI |
$2,940.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,940.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,004.65
|
| Rate for Payer: Priority Health Medicare |
$2,940.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,940.90
|
| Rate for Payer: UHC Medicare Advantage |
$2,940.90
|
|
|
PR ANASTOMOSIS FACIAL HYPOGLOSSAL
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
HCPCS 64868
|
| Min. Negotiated Rate |
$743.20 |
| Max. Negotiated Rate |
$1,738.56 |
| Rate for Payer: Aetna Commercial |
$1,259.28
|
| Rate for Payer: Aetna Medicare |
$977.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.28
|
| Rate for Payer: BCBS Complete |
$743.20
|
| Rate for Payer: BCBS MAPPO |
$939.76
|
| Rate for Payer: BCN Medicare Advantage |
$939.76
|
| Rate for Payer: Cash Price |
$1,486.40
|
| Rate for Payer: Cash Price |
$1,486.40
|
| Rate for Payer: Cofinity Commercial |
$1,353.25
|
| Rate for Payer: Cofinity Commercial |
$1,259.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.76
|
| Rate for Payer: Healthscope Commercial |
$1,503.62
|
| Rate for Payer: Healthscope Commercial |
$1,738.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.70
|
| Rate for Payer: Nomi Health Commercial |
$1,127.71
|
| Rate for Payer: PACE SWMI |
$939.76
|
| Rate for Payer: PHP Medicare Advantage |
$939.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.70
|
| Rate for Payer: Priority Health Medicare |
$939.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.76
|
| Rate for Payer: UHC Medicare Advantage |
$939.76
|
|
|
PR ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI
|
Professional
|
Both
|
$4,710.00
|
|
|
Service Code
|
HCPCS 47780
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$4,440.65 |
| Rate for Payer: Aetna Commercial |
$3,216.47
|
| Rate for Payer: Aetna Medicare |
$2,496.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,456.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,216.47
|
| Rate for Payer: BCBS Complete |
$1,884.00
|
| Rate for Payer: BCBS MAPPO |
$2,400.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,400.35
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cofinity Commercial |
$3,456.50
|
| Rate for Payer: Cofinity Commercial |
$3,216.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,400.35
|
| Rate for Payer: Healthscope Commercial |
$4,440.65
|
| Rate for Payer: Healthscope Commercial |
$3,840.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,520.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,061.50
|
| Rate for Payer: Nomi Health Commercial |
$2,880.42
|
| Rate for Payer: PACE SWMI |
$2,400.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,400.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.50
|
| Rate for Payer: Priority Health Medicare |
$2,400.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,400.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,400.35
|
|
|
PR ANAST XTRHEPATC BILIARY DUCTS & GI TRACT
|
Professional
|
Both
|
$4,268.00
|
|
|
Service Code
|
HCPCS 47760
|
| Min. Negotiated Rate |
$1,707.20 |
| Max. Negotiated Rate |
$4,034.35 |
| Rate for Payer: Aetna Commercial |
$2,922.18
|
| Rate for Payer: Aetna Medicare |
$2,267.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,922.18
|
| Rate for Payer: BCBS Complete |
$1,707.20
|
| Rate for Payer: BCBS MAPPO |
$2,180.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,180.73
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cofinity Commercial |
$3,140.25
|
| Rate for Payer: Cofinity Commercial |
$2,922.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,180.73
|
| Rate for Payer: Healthscope Commercial |
$3,489.17
|
| Rate for Payer: Healthscope Commercial |
$4,034.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,289.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,774.20
|
| Rate for Payer: Nomi Health Commercial |
$2,616.88
|
| Rate for Payer: PACE SWMI |
$2,180.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,180.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,774.20
|
| Rate for Payer: Priority Health Medicare |
$2,180.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,180.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,180.73
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG 4-9% TBSA
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01952
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG <4% TBSA
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01951
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG EA 9%TBSA
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS 01953
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
|
|
PR ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS 01842
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
|
