|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$416.63 |
| Max. Negotiated Rate |
$1,295.45 |
| Rate for Payer: Aetna Commercial |
$837.47
|
| Rate for Payer: Aetna Medicare |
$649.98
|
| Rate for Payer: BCBS Complete |
$437.46
|
| Rate for Payer: BCBS MAPPO |
$624.98
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: BCN Commercial |
$944.61
|
| 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: Mclaren Medicaid |
$416.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.23
|
| Rate for Payer: Meridian Medicaid |
$437.46
|
| 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 Choice Medicaid |
$416.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.45
|
| Rate for Payer: Priority Health HMO/PPO |
$990.76
|
| Rate for Payer: Priority Health Medicare |
$631.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$990.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.98
|
| Rate for Payer: UHC Exchange |
$624.98
|
| Rate for Payer: UHC Medicare Advantage |
$624.98
|
| Rate for Payer: UHCCP Medicaid |
$416.63
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,721.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Aetna Medicare |
$580.04
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS MAPPO |
$557.73
|
| Rate for Payer: BCBS Trust/PPO |
$405.73
|
| Rate for Payer: BCN Commercial |
$843.46
|
| 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: Mclaren Medicaid |
$372.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.62
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| 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 Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.65
|
| Rate for Payer: Priority Health HMO/PPO |
$884.91
|
| Rate for Payer: Priority Health Medicare |
$563.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$884.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.73
|
| Rate for Payer: UHC Exchange |
$557.73
|
| Rate for Payer: UHC Medicare Advantage |
$557.73
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$493.10 |
| Max. Negotiated Rate |
$2,869.73 |
| Rate for Payer: Aetna Commercial |
$961.32
|
| Rate for Payer: Aetna Medicare |
$746.10
|
| Rate for Payer: BCBS Complete |
$517.76
|
| Rate for Payer: BCBS MAPPO |
$717.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,869.73
|
| Rate for Payer: BCN Commercial |
$1,133.74
|
| 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: Mclaren Medicaid |
$493.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.27
|
| Rate for Payer: Meridian Medicaid |
$517.76
|
| 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 Choice Medicaid |
$493.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,178.02
|
| Rate for Payer: Priority Health Medicare |
$724.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,178.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.40
|
| Rate for Payer: UHC Exchange |
$717.40
|
| Rate for Payer: UHC Medicare Advantage |
$717.40
|
| Rate for Payer: UHCCP Medicaid |
$493.10
|
|
|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$326.53 |
| Max. Negotiated Rate |
$977.88 |
| Rate for Payer: Aetna Commercial |
$652.19
|
| Rate for Payer: Aetna Medicare |
$506.18
|
| Rate for Payer: BCBS Complete |
$342.86
|
| Rate for Payer: BCBS MAPPO |
$486.71
|
| Rate for Payer: BCBS Trust/PPO |
$977.88
|
| Rate for Payer: BCN Commercial |
$735.46
|
| 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: Mclaren Medicaid |
$326.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.05
|
| Rate for Payer: Meridian Medicaid |
$342.86
|
| 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 Choice Medicaid |
$326.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health HMO/PPO |
$774.49
|
| Rate for Payer: Priority Health Medicare |
$491.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$774.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.71
|
| Rate for Payer: UHC Exchange |
$486.71
|
| Rate for Payer: UHC Medicare Advantage |
$486.71
|
| Rate for Payer: UHCCP Medicaid |
$326.53
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$1,134.25 |
| Rate for Payer: Aetna Commercial |
$951.27
|
| Rate for Payer: Aetna Medicare |
$738.30
|
| Rate for Payer: BCBS Complete |
$503.21
|
| Rate for Payer: BCBS MAPPO |
$709.90
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$1,080.46
|
| 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: Mclaren Medicaid |
$479.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$745.40
|
| Rate for Payer: Meridian Medicaid |
$503.21
|
| 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 Choice Medicaid |
$479.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,134.25
|
| Rate for Payer: Priority Health Medicare |
$717.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,134.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.90
|
| Rate for Payer: UHC Exchange |
$709.90
|
| Rate for Payer: UHC Medicare Advantage |
$709.90
|
| Rate for Payer: UHCCP Medicaid |
$479.25
|
|
|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$2,374.00
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$194.41 |
| Max. Negotiated Rate |
$1,543.10 |
| Rate for Payer: Aetna Commercial |
$1,002.83
|
| Rate for Payer: Aetna Medicare |
$778.32
|
| Rate for Payer: BCBS Complete |
$530.05
|
| Rate for Payer: BCBS MAPPO |
$748.38
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: BCN Commercial |
$1,138.13
|
| 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: Mclaren Medicaid |
$504.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.80
|
| Rate for Payer: Meridian Medicaid |
$530.05
|
| 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 Choice Medicaid |
$504.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,543.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,195.31
|
| Rate for Payer: Priority Health Medicare |
$755.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,195.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$748.38
|
| Rate for Payer: UHC Exchange |
$748.38
|
| Rate for Payer: UHC Medicare Advantage |
$748.38
|
| Rate for Payer: UHCCP Medicaid |
$504.81
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$988.69
|
| Rate for Payer: Aetna Medicare |
$767.34
|
| Rate for Payer: BCBS Complete |
$524.23
|
| Rate for Payer: BCBS MAPPO |
$737.83
|
| Rate for Payer: BCBS Trust/PPO |
$70.79
|
| Rate for Payer: BCN Commercial |
$1,084.87
|
| 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: Mclaren Medicaid |
$499.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$774.72
|
| Rate for Payer: Meridian Medicaid |
$524.23
|
| 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 Choice Medicaid |
$499.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,143.41
|
| Rate for Payer: Priority Health Medicare |
$745.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,143.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$737.83
|
| Rate for Payer: UHC Exchange |
$737.83
|
| Rate for Payer: UHC Medicare Advantage |
$737.83
|
| Rate for Payer: UHCCP Medicaid |
$499.27
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$340.59 |
| Max. Negotiated Rate |
$1,061.45 |
| Rate for Payer: Aetna Commercial |
$676.43
|
| Rate for Payer: Aetna Medicare |
$524.99
|
| Rate for Payer: BCBS Complete |
$357.62
|
| Rate for Payer: BCBS MAPPO |
$504.80
|
| Rate for Payer: BCBS Trust/PPO |
$945.13
|
| Rate for Payer: BCN Commercial |
$767.22
|
| 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: Mclaren Medicaid |
$340.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$530.04
|
| Rate for Payer: Meridian Medicaid |
$357.62
|
| 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 Choice Medicaid |
$340.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.45
|
| Rate for Payer: Priority Health HMO/PPO |
$808.08
|
| Rate for Payer: Priority Health Medicare |
$509.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$808.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$504.80
|
| Rate for Payer: UHC Exchange |
$504.80
|
| Rate for Payer: UHC Medicare Advantage |
$504.80
|
| Rate for Payer: UHCCP Medicaid |
$340.59
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$453.26 |
| Max. Negotiated Rate |
$1,254.50 |
| Rate for Payer: Aetna Commercial |
$906.68
|
| Rate for Payer: Aetna Medicare |
$703.70
|
| Rate for Payer: BCBS Complete |
$475.92
|
| Rate for Payer: BCBS MAPPO |
$676.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.47
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| 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: Mclaren Medicaid |
$453.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.46
|
| Rate for Payer: Meridian Medicaid |
$475.92
|
| 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 Choice Medicaid |
$453.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,077.26
|
| Rate for Payer: Priority Health Medicare |
$683.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,077.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.63
|
| Rate for Payer: UHC Exchange |
$676.63
|
| Rate for Payer: UHC Medicare Advantage |
$676.63
|
| Rate for Payer: UHCCP Medicaid |
$453.26
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$932.37
|
| Rate for Payer: Aetna Medicare |
$723.63
|
| Rate for Payer: BCBS Complete |
$494.94
|
| Rate for Payer: BCBS MAPPO |
$695.80
|
| Rate for Payer: BCBS Trust/PPO |
$87.17
|
| Rate for Payer: BCN Commercial |
$1,056.04
|
| 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: Mclaren Medicaid |
$471.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.59
|
| Rate for Payer: Meridian Medicaid |
$494.94
|
| 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 Choice Medicaid |
$471.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,110.85
|
| Rate for Payer: Priority Health Medicare |
$702.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.80
|
| Rate for Payer: UHC Exchange |
$695.80
|
| Rate for Payer: UHC Medicare Advantage |
$695.80
|
| Rate for Payer: UHCCP Medicaid |
$471.37
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$2,710.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$572.97 |
| Max. Negotiated Rate |
$1,761.50 |
| Rate for Payer: Aetna Commercial |
$1,162.60
|
| Rate for Payer: Aetna Medicare |
$902.31
|
| Rate for Payer: BCBS Complete |
$601.62
|
| Rate for Payer: BCBS MAPPO |
$867.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.71
|
| Rate for Payer: BCN Commercial |
$1,307.21
|
| 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: Mclaren Medicaid |
$572.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.99
|
| Rate for Payer: Meridian Medicaid |
$601.62
|
| 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 Choice Medicaid |
$572.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,761.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,365.79
|
| Rate for Payer: Priority Health Medicare |
$876.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,365.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.61
|
| Rate for Payer: UHC Exchange |
$867.61
|
| Rate for Payer: UHC Medicare Advantage |
$867.61
|
| Rate for Payer: UHCCP Medicaid |
$572.97
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$378.08 |
| Max. Negotiated Rate |
$1,391.00 |
| Rate for Payer: Aetna Commercial |
$765.23
|
| Rate for Payer: Aetna Medicare |
$593.91
|
| Rate for Payer: BCBS Complete |
$396.98
|
| Rate for Payer: BCBS MAPPO |
$571.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.86
|
| Rate for Payer: BCN Commercial |
$859.58
|
| 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: Mclaren Medicaid |
$378.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.62
|
| Rate for Payer: Meridian Medicaid |
$396.98
|
| 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 Choice Medicaid |
$378.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,391.00
|
| Rate for Payer: Priority Health HMO/PPO |
$900.18
|
| Rate for Payer: Priority Health Medicare |
$576.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.07
|
| Rate for Payer: UHC Exchange |
$571.07
|
| Rate for Payer: UHC Medicare Advantage |
$571.07
|
| Rate for Payer: UHCCP Medicaid |
$378.08
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna Commercial |
$1,220.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.21
|
| Rate for Payer: BCN Commercial |
$1,109.74
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,234.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Healthscope Commercial |
$1,292.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.60
|
| Rate for Payer: Nomi Health Commercial |
$1,177.52
|
| Rate for Payer: PHP Commercial |
$1,220.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,249.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$962.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,263.68
|
| Rate for Payer: UHC Core |
$1,199.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.00
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$272.21 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$540.93
|
| Rate for Payer: Aetna Medicare |
$419.83
|
| Rate for Payer: BCBS Complete |
$285.82
|
| Rate for Payer: BCBS MAPPO |
$403.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.24
|
| Rate for Payer: BCN Commercial |
$615.25
|
| 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: Mclaren Medicaid |
$272.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.86
|
| Rate for Payer: Meridian Medicaid |
$285.82
|
| 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 Choice Medicaid |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO |
$648.28
|
| Rate for Payer: Priority Health Medicare |
$407.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.68
|
| Rate for Payer: UHC Exchange |
$403.68
|
| Rate for Payer: UHC Medicare Advantage |
$403.68
|
| Rate for Payer: UHCCP Medicaid |
$272.21
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$272.21 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$540.93
|
| Rate for Payer: Aetna Medicare |
$419.83
|
| Rate for Payer: BCBS Complete |
$285.82
|
| Rate for Payer: BCBS MAPPO |
$403.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.24
|
| Rate for Payer: BCN Commercial |
$615.25
|
| 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: Mclaren Medicaid |
$272.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.86
|
| Rate for Payer: Meridian Medicaid |
$285.82
|
| 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 Choice Medicaid |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO |
$648.28
|
| Rate for Payer: Priority Health Medicare |
$407.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.68
|
| Rate for Payer: UHC Exchange |
$403.68
|
| Rate for Payer: UHC Medicare Advantage |
$403.68
|
| Rate for Payer: UHCCP Medicaid |
$272.21
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$341.05 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: Aetna Commercial |
$1,220.60
|
| Rate for Payer: Aetna Medicare |
$373.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$448.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$448.75
|
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: BCBS MAPPO |
$359.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.54
|
| Rate for Payer: BCN Commercial |
$1,116.49
|
| Rate for Payer: BCN Medicare Advantage |
$359.00
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,234.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.00
|
| Rate for Payer: Healthscope Commercial |
$1,292.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.00
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$376.95
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$412.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.60
|
| Rate for Payer: Nomi Health Commercial |
$1,177.52
|
| Rate for Payer: PACE Senior Care Partners |
$341.05
|
| Rate for Payer: PACE SWMI |
$359.00
|
| Rate for Payer: PHP Commercial |
$1,220.60
|
| Rate for Payer: PHP Medicare Advantage |
$359.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,249.32
|
| Rate for Payer: Priority Health Medicare |
$362.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$962.12
|
| Rate for Payer: Railroad Medicare Medicare |
$359.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,263.68
|
| Rate for Payer: UHC Core |
$1,199.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.00
|
| Rate for Payer: UHC Exchange |
$359.00
|
| Rate for Payer: UHC Medicare Advantage |
$359.00
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
| Rate for Payer: VA VA |
$359.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.00
|
|
|
PR AMPUTATION PENIS COMPLETE
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$530.37 |
| Max. Negotiated Rate |
$2,350.94 |
| Rate for Payer: Aetna Commercial |
$1,060.96
|
| Rate for Payer: Aetna Medicare |
$823.43
|
| Rate for Payer: BCBS Complete |
$556.89
|
| Rate for Payer: BCBS MAPPO |
$791.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.94
|
| Rate for Payer: BCN Commercial |
$1,190.42
|
| 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: Mclaren Medicaid |
$530.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$831.35
|
| Rate for Payer: Meridian Medicaid |
$556.89
|
| 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 Choice Medicaid |
$530.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,309.14
|
| Rate for Payer: Priority Health Medicare |
$799.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,309.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$791.76
|
| Rate for Payer: UHC Exchange |
$791.76
|
| Rate for Payer: UHC Medicare Advantage |
$791.76
|
| Rate for Payer: UHCCP Medicaid |
$530.37
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$406.62 |
| Max. Negotiated Rate |
$3,526.40 |
| Rate for Payer: Aetna Commercial |
$811.60
|
| Rate for Payer: Aetna Medicare |
$629.90
|
| Rate for Payer: BCBS Complete |
$426.95
|
| Rate for Payer: BCBS MAPPO |
$605.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,526.40
|
| Rate for Payer: BCN Commercial |
$912.85
|
| 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: Mclaren Medicaid |
$406.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$635.95
|
| Rate for Payer: Meridian Medicaid |
$426.95
|
| 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 Choice Medicaid |
$406.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,009.81
|
| Rate for Payer: Priority Health Medicare |
$611.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,009.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.67
|
| Rate for Payer: UHC Exchange |
$605.67
|
| Rate for Payer: UHC Medicare Advantage |
$605.67
|
| Rate for Payer: UHCCP Medicaid |
$406.62
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,482.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$761.26 |
| Max. Negotiated Rate |
$3,502.63 |
| Rate for Payer: Aetna Commercial |
$1,525.48
|
| Rate for Payer: Aetna Medicare |
$1,183.96
|
| Rate for Payer: BCBS Complete |
$799.32
|
| Rate for Payer: BCBS MAPPO |
$1,138.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,502.63
|
| Rate for Payer: BCN Commercial |
$1,715.75
|
| 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: Mclaren Medicaid |
$761.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,195.34
|
| Rate for Payer: Meridian Medicaid |
$799.32
|
| 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 Choice Medicaid |
$761.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,613.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,891.79
|
| Rate for Payer: Priority Health Medicare |
$1,149.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,891.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,138.42
|
| Rate for Payer: UHC Exchange |
$1,138.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,138.42
|
| Rate for Payer: UHCCP Medicaid |
$761.26
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$2,644.67 |
| Rate for Payer: Aetna Commercial |
$1,014.21
|
| Rate for Payer: Aetna Medicare |
$787.14
|
| Rate for Payer: BCBS Complete |
$524.23
|
| Rate for Payer: BCBS MAPPO |
$756.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,644.67
|
| Rate for Payer: BCN Commercial |
$1,139.60
|
| 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: Mclaren Medicaid |
$499.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.71
|
| Rate for Payer: Meridian Medicaid |
$524.23
|
| 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 Choice Medicaid |
$499.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,192.77
|
| Rate for Payer: Priority Health Medicare |
$764.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,192.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.87
|
| Rate for Payer: UHC Exchange |
$756.87
|
| Rate for Payer: UHC Medicare Advantage |
$756.87
|
| Rate for Payer: UHCCP Medicaid |
$499.27
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: Aetna Commercial |
$918.82
|
| Rate for Payer: Aetna Medicare |
$713.12
|
| Rate for Payer: BCBS Complete |
$478.83
|
| Rate for Payer: BCBS MAPPO |
$685.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.83
|
| Rate for Payer: BCN Commercial |
$1,040.39
|
| 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: Mclaren Medicaid |
$456.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.97
|
| Rate for Payer: Meridian Medicaid |
$478.83
|
| 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 Choice Medicaid |
$456.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,085.40
|
| Rate for Payer: Priority Health Medicare |
$692.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,085.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.69
|
| Rate for Payer: UHC Exchange |
$685.69
|
| Rate for Payer: UHC Medicare Advantage |
$685.69
|
| Rate for Payer: UHCCP Medicaid |
$456.03
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$873.75
|
| Rate for Payer: Aetna Medicare |
$678.13
|
| Rate for Payer: BCBS Complete |
$454.23
|
| Rate for Payer: BCBS MAPPO |
$652.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.62
|
| Rate for Payer: BCN Commercial |
$975.89
|
| 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: Mclaren Medicaid |
$432.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.65
|
| Rate for Payer: Meridian Medicaid |
$454.23
|
| 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 Choice Medicaid |
$432.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,021.28
|
| Rate for Payer: Priority Health Medicare |
$658.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,021.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.05
|
| Rate for Payer: UHC Exchange |
$652.05
|
| Rate for Payer: UHC Medicare Advantage |
$652.05
|
| Rate for Payer: UHCCP Medicaid |
$432.60
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$995.32 |
| Rate for Payer: Aetna Commercial |
$222.91
|
| Rate for Payer: Aetna Medicare |
$173.00
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS MAPPO |
$166.35
|
| Rate for Payer: BCBS Trust/PPO |
$995.32
|
| Rate for Payer: BCN Commercial |
$425.15
|
| 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: Mclaren Medicaid |
$110.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.67
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| 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 Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health HMO/PPO |
$263.09
|
| Rate for Payer: Priority Health Medicare |
$168.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.35
|
| Rate for Payer: UHC Exchange |
$166.35
|
| Rate for Payer: UHC Medicare Advantage |
$166.35
|
| Rate for Payer: UHCCP Medicaid |
$110.76
|
|
|
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 |
$369.79 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: Aetna Commercial |
$1,323.45
|
| Rate for Payer: Aetna Medicare |
$404.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.56
|
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: BCBS MAPPO |
$389.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.01
|
| Rate for Payer: BCN Commercial |
$1,210.57
|
| Rate for Payer: BCN Medicare Advantage |
$389.25
|
| 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: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.25
|
| Rate for Payer: Healthscope Commercial |
$1,401.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,167.75
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.71
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: Nomi Health Commercial |
$1,276.74
|
| Rate for Payer: PACE Senior Care Partners |
$369.79
|
| Rate for Payer: PACE SWMI |
$389.25
|
| Rate for Payer: PHP Commercial |
$1,323.45
|
| Rate for Payer: PHP Medicare Advantage |
$389.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,354.59
|
| Rate for Payer: Priority Health Medicare |
$393.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.19
|
| Rate for Payer: Railroad Medicare Medicare |
$389.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,370.16
|
| Rate for Payer: UHC Core |
$1,300.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.25
|
| Rate for Payer: UHC Exchange |
$389.25
|
| Rate for Payer: UHC Medicare Advantage |
$389.25
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
| Rate for Payer: VA VA |
$389.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,167.75
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$228.55
|
| Rate for Payer: Aetna Medicare |
$177.38
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS MAPPO |
$170.56
|
| Rate for Payer: BCBS Trust/PPO |
$852.68
|
| Rate for Payer: BCN Commercial |
$434.44
|
| 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: Mclaren Medicaid |
$113.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.09
|
| Rate for Payer: Meridian Medicaid |
$119.21
|
| 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 Choice Medicaid |
$113.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO |
$269.69
|
| Rate for Payer: Priority Health Medicare |
$172.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.56
|
| Rate for Payer: UHC Exchange |
$170.56
|
| Rate for Payer: UHC Medicare Advantage |
$170.56
|
| Rate for Payer: UHCCP Medicaid |
$113.53
|
|
