|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$367.64 |
| Max. Negotiated Rate |
$1,112.94 |
| Rate for Payer: Aetna Commercial |
$760.52
|
| Rate for Payer: Aetna Medicare |
$590.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.27
|
| Rate for Payer: BCBS Complete |
$386.02
|
| Rate for Payer: BCBS MAPPO |
$567.55
|
| Rate for Payer: BCN Commercial |
$950.64
|
| Rate for Payer: BCN Medicare Advantage |
$567.55
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$817.27
|
| Rate for Payer: Cofinity Commercial |
$760.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.55
|
| Rate for Payer: Healthscope Commercial |
$908.08
|
| Rate for Payer: Healthscope Commercial |
$1,049.97
|
| Rate for Payer: Mclaren Medicaid |
$367.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.93
|
| Rate for Payer: Meridian Medicaid |
$386.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$624.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,110.98
|
| Rate for Payer: Nomi Health Commercial |
$681.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.50
|
| Rate for Payer: PACE SWMI |
$567.55
|
| Rate for Payer: PHP Medicare Advantage |
$567.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,035.55
|
| Rate for Payer: Priority Health Medicare |
$567.55
|
| Rate for Payer: Priority Health SBD |
$1,035.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,035.55
|
| Rate for Payer: Railroad Medicare Medicare |
$567.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.94
|
| Rate for Payer: UHC Core |
$1,112.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$567.55
|
| Rate for Payer: UHC Exchange |
$1,112.94
|
| Rate for Payer: UHC Medicaid |
$367.64
|
| Rate for Payer: UHCCP Medicaid |
$367.64
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,556.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$681.39 |
| Max. Negotiated Rate |
$2,109.77 |
| Rate for Payer: Aetna Commercial |
$1,416.61
|
| Rate for Payer: Aetna Medicare |
$1,099.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,416.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,522.32
|
| Rate for Payer: BCBS Complete |
$715.46
|
| Rate for Payer: BCBS MAPPO |
$1,057.17
|
| Rate for Payer: BCN Commercial |
$1,779.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.17
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cofinity Commercial |
$1,522.32
|
| Rate for Payer: Cofinity Commercial |
$1,416.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.17
|
| Rate for Payer: Healthscope Commercial |
$1,955.76
|
| Rate for Payer: Healthscope Commercial |
$1,691.47
|
| Rate for Payer: Mclaren Medicaid |
$681.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,110.03
|
| Rate for Payer: Meridian Medicaid |
$715.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,162.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,095.83
|
| Rate for Payer: Nomi Health Commercial |
$1,268.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.00
|
| Rate for Payer: PACE SWMI |
$1,057.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,938.76
|
| Rate for Payer: Priority Health Medicare |
$1,057.17
|
| Rate for Payer: Priority Health SBD |
$1,938.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,938.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,109.77
|
| Rate for Payer: UHC Core |
$2,109.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,057.17
|
| Rate for Payer: UHC Exchange |
$2,109.77
|
| Rate for Payer: UHC Medicaid |
$681.39
|
| Rate for Payer: UHCCP Medicaid |
$681.39
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,659.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$459.87 |
| Max. Negotiated Rate |
$1,994.25 |
| Rate for Payer: Aetna Commercial |
$964.97
|
| Rate for Payer: Aetna Medicare |
$748.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,036.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.97
|
| Rate for Payer: BCBS Complete |
$482.86
|
| Rate for Payer: BCBS MAPPO |
$720.13
|
| Rate for Payer: BCN Commercial |
$1,167.26
|
| Rate for Payer: BCN Medicare Advantage |
$720.13
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cofinity Commercial |
$964.97
|
| Rate for Payer: Cofinity Commercial |
$1,036.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.13
|
| Rate for Payer: Healthscope Commercial |
$1,332.24
|
| Rate for Payer: Healthscope Commercial |
$1,152.21
|
| Rate for Payer: Mclaren Medicaid |
$459.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$756.14
|
| Rate for Payer: Meridian Medicaid |
$482.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$792.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,400.98
|
| Rate for Payer: Nomi Health Commercial |
$864.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,994.25
|
| Rate for Payer: PACE SWMI |
$720.13
|
| Rate for Payer: PHP Medicare Advantage |
$720.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,247.77
|
| Rate for Payer: Priority Health Medicare |
$720.13
|
| Rate for Payer: Priority Health SBD |
$1,247.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,247.77
|
| Rate for Payer: Railroad Medicare Medicare |
$720.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,410.93
|
| Rate for Payer: UHC Core |
$1,410.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$720.13
|
| Rate for Payer: UHC Exchange |
$1,410.93
|
| Rate for Payer: UHC Medicaid |
$459.87
|
| Rate for Payer: UHCCP Medicaid |
$459.87
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,501.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,875.75 |
| Rate for Payer: Aetna Commercial |
$875.85
|
| Rate for Payer: Aetna Medicare |
$679.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$875.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.21
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCBS MAPPO |
$653.62
|
| Rate for Payer: BCN Commercial |
$1,066.18
|
| Rate for Payer: BCN Medicare Advantage |
$653.62
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cofinity Commercial |
$941.21
|
| Rate for Payer: Cofinity Commercial |
$875.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.62
|
| Rate for Payer: Healthscope Commercial |
$1,209.20
|
| Rate for Payer: Healthscope Commercial |
$1,045.79
|
| Rate for Payer: Mclaren Medicaid |
$420.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.30
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$718.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,270.21
|
| Rate for Payer: Nomi Health Commercial |
$784.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.75
|
| Rate for Payer: PACE SWMI |
$653.62
|
| Rate for Payer: PHP Medicare Advantage |
$653.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,139.72
|
| Rate for Payer: Priority Health Medicare |
$653.62
|
| Rate for Payer: Priority Health SBD |
$1,139.72
|
| Rate for Payer: Priority Health Tiered Network |
$1,139.72
|
| Rate for Payer: Railroad Medicare Medicare |
$653.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,262.53
|
| Rate for Payer: UHC Core |
$1,262.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$653.62
|
| Rate for Payer: UHC Exchange |
$1,262.53
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$400.65 |
| Max. Negotiated Rate |
$2,392.50 |
| Rate for Payer: Aetna Commercial |
$835.57
|
| Rate for Payer: Aetna Medicare |
$648.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.93
|
| Rate for Payer: BCBS Complete |
$420.68
|
| Rate for Payer: BCBS MAPPO |
$623.56
|
| Rate for Payer: BCN Commercial |
$1,011.40
|
| Rate for Payer: BCN Medicare Advantage |
$623.56
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cofinity Commercial |
$897.93
|
| Rate for Payer: Cofinity Commercial |
$835.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.56
|
| Rate for Payer: Healthscope Commercial |
$997.70
|
| Rate for Payer: Healthscope Commercial |
$1,153.59
|
| Rate for Payer: Mclaren Medicaid |
$400.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.74
|
| Rate for Payer: Meridian Medicaid |
$420.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$685.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.07
|
| Rate for Payer: Nomi Health Commercial |
$748.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,392.50
|
| Rate for Payer: PACE SWMI |
$623.56
|
| Rate for Payer: PHP Medicare Advantage |
$623.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,081.16
|
| Rate for Payer: Priority Health Medicare |
$623.56
|
| Rate for Payer: Priority Health SBD |
$1,081.16
|
| Rate for Payer: Priority Health Tiered Network |
$1,081.16
|
| Rate for Payer: Railroad Medicare Medicare |
$623.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,196.77
|
| Rate for Payer: UHC Core |
$1,196.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$623.56
|
| Rate for Payer: UHC Exchange |
$1,196.77
|
| Rate for Payer: UHC Medicaid |
$400.65
|
| Rate for Payer: UHCCP Medicaid |
$400.65
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: PHP Medicare Advantage |
$155.18
|
| Rate for Payer: Aetna Commercial |
$207.94
|
| Rate for Payer: Aetna Medicare |
$161.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.46
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$155.18
|
| Rate for Payer: BCN Commercial |
$258.95
|
| Rate for Payer: BCN Medicare Advantage |
$155.18
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cofinity Commercial |
$223.46
|
| Rate for Payer: Cofinity Commercial |
$207.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.18
|
| Rate for Payer: Healthscope Commercial |
$287.08
|
| Rate for Payer: Healthscope Commercial |
$248.29
|
| Rate for Payer: Mclaren Medicaid |
$99.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.94
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.29
|
| Rate for Payer: Nomi Health Commercial |
$186.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,039.50
|
| Rate for Payer: PACE SWMI |
$155.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$276.81
|
| Rate for Payer: Priority Health Medicare |
$155.18
|
| Rate for Payer: Priority Health SBD |
$276.81
|
| Rate for Payer: Priority Health Tiered Network |
$276.81
|
| Rate for Payer: Railroad Medicare Medicare |
$155.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.10
|
| Rate for Payer: UHC Core |
$641.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.18
|
| Rate for Payer: UHC Exchange |
$641.10
|
| Rate for Payer: UHC Medicaid |
$99.68
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna Commercial |
$215.15
|
| Rate for Payer: Aetna Medicare |
$166.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.21
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS MAPPO |
$160.56
|
| Rate for Payer: BCN Commercial |
$265.43
|
| Rate for Payer: BCN Medicare Advantage |
$160.56
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$215.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.56
|
| Rate for Payer: Healthscope Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$256.90
|
| Rate for Payer: Mclaren Medicaid |
$103.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.59
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.67
|
| Rate for Payer: Nomi Health Commercial |
$192.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE SWMI |
$160.56
|
| Rate for Payer: PHP Medicare Advantage |
$160.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$283.74
|
| Rate for Payer: Priority Health Medicare |
$160.56
|
| Rate for Payer: Priority Health SBD |
$283.74
|
| Rate for Payer: Priority Health Tiered Network |
$283.74
|
| Rate for Payer: Railroad Medicare Medicare |
$160.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.83
|
| Rate for Payer: UHC Core |
$684.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.56
|
| Rate for Payer: UHC Exchange |
$684.83
|
| Rate for Payer: UHC Medicaid |
$103.09
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna Commercial |
$215.15
|
| Rate for Payer: Aetna Medicare |
$166.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.21
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS MAPPO |
$160.56
|
| Rate for Payer: BCN Commercial |
$265.43
|
| Rate for Payer: BCN Medicare Advantage |
$160.56
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$215.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.56
|
| Rate for Payer: Healthscope Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$256.90
|
| Rate for Payer: Mclaren Medicaid |
$103.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.59
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.67
|
| Rate for Payer: Nomi Health Commercial |
$192.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE SWMI |
$160.56
|
| Rate for Payer: PHP Medicare Advantage |
$160.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$283.74
|
| Rate for Payer: Priority Health Medicare |
$160.56
|
| Rate for Payer: Priority Health SBD |
$283.74
|
| Rate for Payer: Priority Health Tiered Network |
$283.74
|
| Rate for Payer: Railroad Medicare Medicare |
$160.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.83
|
| Rate for Payer: UHC Core |
$684.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.56
|
| Rate for Payer: UHC Exchange |
$684.83
|
| Rate for Payer: UHC Medicaid |
$103.09
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,010.52 |
| Max. Negotiated Rate |
$1,443.60 |
| Rate for Payer: Aetna Commercial |
$1,363.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.60
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Advantage |
$1,122.80
|
| Rate for Payer: Cofinity Commercial |
$1,379.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,283.20
|
| Rate for Payer: Healthscope Commercial |
$1,443.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,363.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PHP Commercial |
$1,363.40
|
| Rate for Payer: Priority Health SBD |
$1,010.52
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,010.52 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$1,363.40
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.99
|
| Rate for Payer: BCN Commercial |
$1,872.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Advantage |
$1,122.80
|
| Rate for Payer: Cofinity Commercial |
$1,379.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,283.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$1,443.60
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,363.40
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$1,363.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$1,010.52
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 92603
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna Commercial |
$126.13
|
| Rate for Payer: Aetna Medicare |
$97.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.55
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS MAPPO |
$94.13
|
| Rate for Payer: BCN Commercial |
$176.28
|
| Rate for Payer: BCN Medicare Advantage |
$94.13
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$135.55
|
| Rate for Payer: Cofinity Commercial |
$126.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.13
|
| Rate for Payer: Healthscope Commercial |
$174.14
|
| Rate for Payer: Healthscope Commercial |
$150.61
|
| Rate for Payer: Mclaren Medicaid |
$61.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.84
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.15
|
| Rate for Payer: Nomi Health Commercial |
$112.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PACE SWMI |
$94.13
|
| Rate for Payer: PHP Medicare Advantage |
$94.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$162.58
|
| Rate for Payer: Priority Health Medicare |
$94.13
|
| Rate for Payer: Priority Health SBD |
$162.58
|
| Rate for Payer: Priority Health Tiered Network |
$162.58
|
| Rate for Payer: Railroad Medicare Medicare |
$94.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.56
|
| Rate for Payer: UHC Core |
$196.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.13
|
| Rate for Payer: UHC Exchange |
$196.56
|
| Rate for Payer: UHC Medicaid |
$61.13
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 92604
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.60
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$98.10
|
| Rate for Payer: BCN Medicare Advantage |
$52.50
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$75.60
|
| Rate for Payer: Cofinity Commercial |
$70.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$97.12
|
| Rate for Payer: Healthscope Commercial |
$84.00
|
| Rate for Payer: Mclaren Medicaid |
$34.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.12
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.22
|
| Rate for Payer: Nomi Health Commercial |
$63.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.00
|
| Rate for Payer: PACE SWMI |
$52.50
|
| Rate for Payer: PHP Medicare Advantage |
$52.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90.47
|
| Rate for Payer: Priority Health Medicare |
$52.50
|
| Rate for Payer: Priority Health SBD |
$90.47
|
| Rate for Payer: Priority Health Tiered Network |
$90.47
|
| Rate for Payer: Railroad Medicare Medicare |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.56
|
| Rate for Payer: UHC Core |
$109.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.50
|
| Rate for Payer: UHC Exchange |
$109.56
|
| Rate for Payer: UHC Medicaid |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR ANALYZE NEUROSTIM BRAIN, FIRST 1H
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 95978
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna Medicare |
$261.00
|
| Rate for Payer: BCBS Complete |
$208.80
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.50
|
|
|
PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 95979
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Aetna Medicare |
$112.50
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.75
|
|
|
PR ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES
|
Professional
|
Both
|
$8,102.00
|
|
|
Service Code
|
HCPCS 61711
|
| Min. Negotiated Rate |
$1,590.90 |
| Max. Negotiated Rate |
$6,076.50 |
| Rate for Payer: Aetna Commercial |
$3,346.86
|
| Rate for Payer: Aetna Medicare |
$2,597.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,346.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,596.63
|
| Rate for Payer: BCBS Complete |
$1,670.44
|
| Rate for Payer: BCBS MAPPO |
$2,497.66
|
| Rate for Payer: BCN Commercial |
$5,472.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,497.66
|
| Rate for Payer: Cash Price |
$6,481.60
|
| Rate for Payer: Cash Price |
$6,481.60
|
| Rate for Payer: Cofinity Commercial |
$3,596.63
|
| Rate for Payer: Cofinity Commercial |
$3,346.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,497.66
|
| Rate for Payer: Healthscope Commercial |
$4,620.67
|
| Rate for Payer: Healthscope Commercial |
$3,996.26
|
| Rate for Payer: Mclaren Medicaid |
$1,590.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,622.54
|
| Rate for Payer: Meridian Medicaid |
$1,670.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,747.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,655.11
|
| Rate for Payer: Nomi Health Commercial |
$2,997.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.50
|
| Rate for Payer: PACE SWMI |
$2,497.66
|
| Rate for Payer: PHP Medicare Advantage |
$2,497.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,590.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,600.56
|
| Rate for Payer: Priority Health Medicare |
$2,497.66
|
| Rate for Payer: Priority Health SBD |
$4,600.56
|
| Rate for Payer: Priority Health Tiered Network |
$4,600.56
|
| Rate for Payer: Railroad Medicare Medicare |
$2,497.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,582.73
|
| Rate for Payer: UHC Core |
$4,582.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,497.66
|
| Rate for Payer: UHC Exchange |
$4,582.73
|
| Rate for Payer: UHC Medicaid |
$1,590.90
|
| Rate for Payer: UHCCP Medicaid |
$1,590.90
|
|
|
PR ANAST INTRAHEPATC DUCTS & GI TRACT
|
Professional
|
Both
|
$6,346.00
|
|
|
Service Code
|
HCPCS 47765
|
| Min. Negotiated Rate |
$1,781.32 |
| Max. Negotiated Rate |
$5,514.21 |
| Rate for Payer: Aetna Commercial |
$3,747.43
|
| Rate for Payer: Aetna Medicare |
$2,908.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,747.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,027.09
|
| Rate for Payer: BCBS Complete |
$1,870.39
|
| Rate for Payer: BCBS MAPPO |
$2,796.59
|
| Rate for Payer: BCN Commercial |
$4,525.65
|
| Rate for Payer: BCN Medicare Advantage |
$2,796.59
|
| Rate for Payer: Cash Price |
$5,076.80
|
| Rate for Payer: Cash Price |
$5,076.80
|
| Rate for Payer: Cofinity Commercial |
$4,027.09
|
| Rate for Payer: Cofinity Commercial |
$3,747.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,796.59
|
| Rate for Payer: Healthscope Commercial |
$5,173.69
|
| Rate for Payer: Healthscope Commercial |
$4,474.54
|
| Rate for Payer: Mclaren Medicaid |
$1,781.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,936.42
|
| Rate for Payer: Meridian Medicaid |
$1,870.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,076.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,283.36
|
| Rate for Payer: Nomi Health Commercial |
$3,355.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,759.50
|
| Rate for Payer: PACE SWMI |
$2,796.59
|
| Rate for Payer: PHP Medicare Advantage |
$2,796.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,781.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,514.21
|
| Rate for Payer: Priority Health Medicare |
$2,796.59
|
| Rate for Payer: Priority Health SBD |
$5,514.21
|
| Rate for Payer: Priority Health Tiered Network |
$5,514.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2,796.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,447.07
|
| Rate for Payer: UHC Core |
$5,447.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,796.59
|
| Rate for Payer: UHC Exchange |
$5,447.07
|
| Rate for Payer: UHC Medicaid |
$1,781.32
|
| Rate for Payer: UHCCP Medicaid |
$1,781.32
|
|
|
PR ANASTOMOSIS FACIAL HYPOGLOSSAL
|
Professional
|
Both
|
$1,914.00
|
|
|
Service Code
|
HCPCS 64868
|
| Min. Negotiated Rate |
$553.59 |
| Max. Negotiated Rate |
$1,761.84 |
| Rate for Payer: Aetna Commercial |
$1,139.11
|
| Rate for Payer: Aetna Medicare |
$884.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,139.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,224.12
|
| Rate for Payer: BCBS Complete |
$581.27
|
| Rate for Payer: BCBS MAPPO |
$850.08
|
| Rate for Payer: BCN Commercial |
$1,484.98
|
| Rate for Payer: BCN Medicare Advantage |
$850.08
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Cofinity Commercial |
$1,224.12
|
| Rate for Payer: Cofinity Commercial |
$1,139.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$850.08
|
| Rate for Payer: Healthscope Commercial |
$1,572.65
|
| Rate for Payer: Healthscope Commercial |
$1,360.13
|
| Rate for Payer: Mclaren Medicaid |
$553.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$892.58
|
| Rate for Payer: Meridian Medicaid |
$581.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$935.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.84
|
| Rate for Payer: Nomi Health Commercial |
$1,020.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,435.50
|
| Rate for Payer: PACE SWMI |
$850.08
|
| Rate for Payer: PHP Medicare Advantage |
$850.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,724.77
|
| Rate for Payer: Priority Health Medicare |
$850.08
|
| Rate for Payer: Priority Health SBD |
$1,724.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,724.77
|
| Rate for Payer: Railroad Medicare Medicare |
$850.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,736.94
|
| Rate for Payer: UHC Core |
$1,736.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$850.08
|
| Rate for Payer: UHC Exchange |
$1,736.94
|
| Rate for Payer: UHC Medicaid |
$553.59
|
| Rate for Payer: UHCCP Medicaid |
$553.59
|
|
|
PR ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI
|
Professional
|
Both
|
$4,851.00
|
|
|
Service Code
|
HCPCS 47780
|
| Min. Negotiated Rate |
$1,456.28 |
| Max. Negotiated Rate |
$4,508.20 |
| Rate for Payer: Aetna Commercial |
$3,056.49
|
| Rate for Payer: Aetna Medicare |
$2,372.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,056.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,284.58
|
| Rate for Payer: BCBS Complete |
$1,529.09
|
| Rate for Payer: BCBS MAPPO |
$2,280.96
|
| Rate for Payer: BCN Commercial |
$3,700.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,280.96
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cofinity Commercial |
$3,284.58
|
| Rate for Payer: Cofinity Commercial |
$3,056.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,280.96
|
| Rate for Payer: Healthscope Commercial |
$4,219.78
|
| Rate for Payer: Healthscope Commercial |
$3,649.54
|
| Rate for Payer: Mclaren Medicaid |
$1,456.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,395.01
|
| Rate for Payer: Meridian Medicaid |
$1,529.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,509.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,428.23
|
| Rate for Payer: Nomi Health Commercial |
$2,737.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,638.25
|
| Rate for Payer: PACE SWMI |
$2,280.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,280.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,456.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,508.20
|
| Rate for Payer: Priority Health Medicare |
$2,280.96
|
| Rate for Payer: Priority Health SBD |
$4,508.20
|
| Rate for Payer: Priority Health Tiered Network |
$4,508.20
|
| Rate for Payer: Railroad Medicare Medicare |
$2,280.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,424.14
|
| Rate for Payer: UHC Core |
$4,424.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,280.96
|
| Rate for Payer: UHC Exchange |
$4,424.14
|
| Rate for Payer: UHC Medicaid |
$1,456.28
|
| Rate for Payer: UHCCP Medicaid |
$1,456.28
|
|
|
PR ANAST XTRHEPATC BILIARY DUCTS & GI TRACT
|
Professional
|
Both
|
$4,396.00
|
|
|
Service Code
|
HCPCS 47760
|
| Min. Negotiated Rate |
$1,325.07 |
| Max. Negotiated Rate |
$4,099.25 |
| Rate for Payer: Aetna Commercial |
$2,778.65
|
| Rate for Payer: Aetna Medicare |
$2,156.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,778.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,986.01
|
| Rate for Payer: BCBS Complete |
$1,391.32
|
| Rate for Payer: BCBS MAPPO |
$2,073.62
|
| Rate for Payer: BCN Commercial |
$3,364.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,073.62
|
| Rate for Payer: Cash Price |
$3,516.80
|
| Rate for Payer: Cash Price |
$3,516.80
|
| Rate for Payer: Cofinity Commercial |
$2,986.01
|
| Rate for Payer: Cofinity Commercial |
$2,778.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,073.62
|
| Rate for Payer: Healthscope Commercial |
$3,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,317.79
|
| Rate for Payer: Mclaren Medicaid |
$1,325.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,177.30
|
| Rate for Payer: Meridian Medicaid |
$1,391.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,280.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,029.19
|
| Rate for Payer: Nomi Health Commercial |
$2,488.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,297.00
|
| Rate for Payer: PACE SWMI |
$2,073.62
|
| Rate for Payer: PHP Medicare Advantage |
$2,073.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,325.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,099.25
|
| Rate for Payer: Priority Health Medicare |
$2,073.62
|
| Rate for Payer: Priority Health SBD |
$4,099.25
|
| Rate for Payer: Priority Health Tiered Network |
$4,099.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2,073.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,026.60
|
| Rate for Payer: UHC Core |
$4,026.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,073.62
|
| Rate for Payer: UHC Exchange |
$4,026.60
|
| Rate for Payer: UHC Medicaid |
$1,325.07
|
| Rate for Payer: UHCCP Medicaid |
$1,325.07
|
|
|
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 |
$50.00 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
|
|
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 |
$50.00 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
|
|
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 |
$50.00 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44.50
|
| Rate for Payer: Priority Health SBD |
$44.50
|
| Rate for Payer: Priority Health Tiered Network |
$44.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.00
|
| Rate for Payer: UHC Core |
$40.00
|
| Rate for Payer: UHC Exchange |
$40.00
|
|
|
PR ANES ALL CAST APPLICATION RMVL/REPAIR KNEE JOINT
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01420
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
|
|
PR ANES ALL CLOSED PX UPR END TIBIA FIBULA&/PATELLA
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01390
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
|
|
PR ANES ALL CLSD PX RADIUS ULNA WRIST/HAND BONES
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01820
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
|
