|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,988.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$414.07 |
| Max. Negotiated Rate |
$1,491.00 |
| Rate for Payer: Aetna Commercial |
$954.20
|
| Rate for Payer: Aetna Medicare |
$994.00
|
| Rate for Payer: BCBS Complete |
$434.77
|
| Rate for Payer: BCN Commercial |
$1,059.70
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Mclaren Medicaid |
$414.07
|
| Rate for Payer: Meridian Medicaid |
$434.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,132.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,132.79
|
| Rate for Payer: UHC Medicaid |
$414.07
|
| Rate for Payer: UHCCP Medicaid |
$414.07
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$2,452.00
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$1,839.00 |
| Rate for Payer: Aetna Commercial |
$954.79
|
| Rate for Payer: Aetna Medicare |
$1,226.00
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCN Commercial |
$1,102.03
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Mclaren Medicaid |
$427.28
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,839.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,178.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,178.04
|
| Rate for Payer: UHC Medicaid |
$427.28
|
| Rate for Payer: UHCCP Medicaid |
$427.28
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$2,791.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$524.62 |
| Max. Negotiated Rate |
$2,093.25 |
| Rate for Payer: Aetna Commercial |
$1,215.09
|
| Rate for Payer: Aetna Medicare |
$1,395.50
|
| Rate for Payer: BCBS Complete |
$550.85
|
| Rate for Payer: BCN Commercial |
$1,339.57
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Mclaren Medicaid |
$524.62
|
| Rate for Payer: Meridian Medicaid |
$550.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,093.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$524.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,431.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,431.96
|
| Rate for Payer: UHC Medicaid |
$524.62
|
| Rate for Payer: UHCCP Medicaid |
$524.62
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,204.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Aetna Commercial |
$795.07
|
| Rate for Payer: Aetna Medicare |
$1,102.00
|
| Rate for Payer: BCBS Complete |
$369.92
|
| Rate for Payer: BCN Commercial |
$883.92
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Mclaren Medicaid |
$352.30
|
| Rate for Payer: Meridian Medicaid |
$369.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,653.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$944.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.88
|
| Rate for Payer: UHC Medicaid |
$352.30
|
| Rate for Payer: UHCCP Medicaid |
$352.30
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$1,109.25 |
| Rate for Payer: Aetna Commercial |
$565.84
|
| Rate for Payer: Aetna Medicare |
$739.50
|
| Rate for Payer: BCBS Complete |
$265.69
|
| Rate for Payer: BCN Commercial |
$636.42
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Mclaren Medicaid |
$253.04
|
| Rate for Payer: Meridian Medicaid |
$265.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,109.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$680.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$680.32
|
| Rate for Payer: UHC Medicaid |
$253.04
|
| Rate for Payer: UHCCP Medicaid |
$253.04
|
|
|
PR AMPUTATION PENIS COMPLETE
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$476.48 |
| Max. Negotiated Rate |
$1,350.74 |
| Rate for Payer: Aetna Commercial |
$1,048.07
|
| Rate for Payer: Aetna Medicare |
$799.50
|
| Rate for Payer: BCBS Complete |
$500.30
|
| Rate for Payer: BCN Commercial |
$1,239.97
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Mclaren Medicaid |
$476.48
|
| Rate for Payer: Meridian Medicaid |
$500.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,199.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,350.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,350.74
|
| Rate for Payer: UHC Medicaid |
$476.48
|
| Rate for Payer: UHCCP Medicaid |
$476.48
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$367.64 |
| Max. Negotiated Rate |
$1,035.55 |
| Rate for Payer: Aetna Commercial |
$809.58
|
| Rate for Payer: Aetna Medicare |
$619.00
|
| Rate for Payer: BCBS Complete |
$386.02
|
| Rate for Payer: BCN Commercial |
$950.64
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Mclaren Medicaid |
$367.64
|
| Rate for Payer: Meridian Medicaid |
$386.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,035.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,035.55
|
| 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 |
$1,938.76 |
| Rate for Payer: Aetna Commercial |
$1,532.39
|
| Rate for Payer: Aetna Medicare |
$1,278.00
|
| Rate for Payer: BCBS Complete |
$715.46
|
| Rate for Payer: BCN Commercial |
$1,779.78
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Mclaren Medicaid |
$681.39
|
| Rate for Payer: Meridian Medicaid |
$715.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,938.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,938.76
|
| 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 |
$1,060.77
|
| Rate for Payer: Aetna Medicare |
$1,329.50
|
| Rate for Payer: BCBS Complete |
$482.86
|
| Rate for Payer: BCN Commercial |
$1,167.26
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Mclaren Medicaid |
$459.87
|
| Rate for Payer: Meridian Medicaid |
$482.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,994.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,247.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,247.77
|
| 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 |
$958.03
|
| Rate for Payer: Aetna Medicare |
$1,250.50
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCN Commercial |
$1,066.18
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Mclaren Medicaid |
$420.89
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,139.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,139.72
|
| 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 |
$901.24
|
| Rate for Payer: Aetna Medicare |
$1,595.00
|
| Rate for Payer: BCBS Complete |
$420.68
|
| Rate for Payer: BCN Commercial |
$1,011.40
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Mclaren Medicaid |
$400.65
|
| Rate for Payer: Meridian Medicaid |
$420.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,392.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,081.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,081.16
|
| 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: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna Medicare |
$693.00
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCN Commercial |
$258.95
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Mclaren Medicaid |
$99.68
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,039.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.81
|
| 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 |
$243.14
|
| Rate for Payer: Aetna Medicare |
$802.00
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCN Commercial |
$265.43
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Mclaren Medicaid |
$103.09
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.74
|
| Rate for Payer: UHC Medicaid |
$103.09
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
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 |
$282.79 |
| Max. Negotiated Rate |
$1,443.60 |
| Rate for Payer: Aetna Commercial |
$1,363.40
|
| Rate for Payer: Aetna Medicare |
$417.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$501.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$501.25
|
| Rate for Payer: BCBS Complete |
$296.90
|
| Rate for Payer: BCBS MAPPO |
$401.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.65
|
| Rate for Payer: BCN Commercial |
$1,318.65
|
| Rate for Payer: BCN Medicare Advantage |
$401.00
|
| Rate for Payer: Cash Price |
$1,283.20
|
| 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 |
$401.00
|
| Rate for Payer: Healthscope Commercial |
$1,443.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,203.00
|
| Rate for Payer: Mclaren Medicaid |
$282.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$421.05
|
| Rate for Payer: Meridian Medicaid |
$296.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$461.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$441.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,363.40
|
| Rate for Payer: Nomi Health Commercial |
$1,315.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE Senior Care Partners |
$380.95
|
| Rate for Payer: PACE SWMI |
$401.00
|
| Rate for Payer: PHP Commercial |
$1,363.40
|
| Rate for Payer: PHP Medicare Advantage |
$401.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,395.48
|
| Rate for Payer: Priority Health Medicare |
$405.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.38
|
| Rate for Payer: Railroad Medicare Medicare |
$401.00
|
| Rate for Payer: UHC Core |
$1,339.34
|
| Rate for Payer: UHC Exchange |
$401.00
|
| Rate for Payer: UHC Medicaid |
$282.79
|
| Rate for Payer: UHC Medicare Advantage |
$401.00
|
| Rate for Payer: UHCCP Medicaid |
$282.79
|
| Rate for Payer: VA VA |
$401.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,203.00
|
|
|
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 |
$1,116.38 |
| Max. Negotiated Rate |
$1,443.60 |
| Rate for Payer: Aetna Commercial |
$1,363.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.74
|
| Rate for Payer: BCN Commercial |
$1,324.74
|
| Rate for Payer: Cash Price |
$1,283.20
|
| 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: Lakeland Regional Health Systems Commercial |
$1,203.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,363.40
|
| Rate for Payer: Nomi Health Commercial |
$1,315.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PHP Commercial |
$1,363.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,395.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.38
|
| Rate for Payer: UHC Core |
$1,339.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,203.00
|
|
|
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 |
$243.14
|
| Rate for Payer: Aetna Medicare |
$802.00
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCN Commercial |
$265.43
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Mclaren Medicaid |
$103.09
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.74
|
| Rate for Payer: UHC Medicaid |
$103.09
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
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 |
$133.74
|
| Rate for Payer: Aetna Medicare |
$162.50
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCN Commercial |
$176.28
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Mclaren Medicaid |
$61.13
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.58
|
| 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 |
$74.26
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCN Commercial |
$98.10
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Mclaren Medicaid |
$34.08
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.47
|
| 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: 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: 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 |
$3,326.27
|
| Rate for Payer: Aetna Medicare |
$4,051.00
|
| Rate for Payer: BCBS Complete |
$1,670.44
|
| Rate for Payer: BCN Commercial |
$5,472.13
|
| Rate for Payer: Cash Price |
$6,481.60
|
| Rate for Payer: Cash Price |
$6,481.60
|
| Rate for Payer: Mclaren Medicaid |
$1,590.90
|
| Rate for Payer: Meridian Medicaid |
$1,670.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,590.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,600.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,600.56
|
| 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 |
$4,113.75
|
| Rate for Payer: Aetna Medicare |
$3,173.00
|
| Rate for Payer: BCBS Complete |
$1,870.39
|
| Rate for Payer: BCN Commercial |
$4,525.65
|
| Rate for Payer: Cash Price |
$5,076.80
|
| Rate for Payer: Cash Price |
$5,076.80
|
| Rate for Payer: Mclaren Medicaid |
$1,781.32
|
| Rate for Payer: Meridian Medicaid |
$1,870.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,759.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,781.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,514.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,514.21
|
| 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 |
$1,724.77 |
| Rate for Payer: Aetna Commercial |
$1,278.09
|
| Rate for Payer: Aetna Medicare |
$957.00
|
| Rate for Payer: BCBS Complete |
$581.27
|
| Rate for Payer: BCN Commercial |
$1,484.98
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Cash Price |
$1,531.20
|
| Rate for Payer: Mclaren Medicaid |
$553.59
|
| Rate for Payer: Meridian Medicaid |
$581.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,435.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,724.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,724.77
|
| 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 |
$3,347.72
|
| Rate for Payer: Aetna Medicare |
$2,425.50
|
| Rate for Payer: BCBS Complete |
$1,529.09
|
| Rate for Payer: BCN Commercial |
$3,700.00
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Mclaren Medicaid |
$1,456.28
|
| Rate for Payer: Meridian Medicaid |
$1,529.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,638.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,456.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,508.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,508.20
|
| 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 |
$3,045.85
|
| Rate for Payer: Aetna Medicare |
$2,198.00
|
| Rate for Payer: BCBS Complete |
$1,391.32
|
| Rate for Payer: BCN Commercial |
$3,364.36
|
| Rate for Payer: Cash Price |
$3,516.80
|
| Rate for Payer: Cash Price |
$3,516.80
|
| Rate for Payer: Mclaren Medicaid |
$1,325.07
|
| Rate for Payer: Meridian Medicaid |
$1,391.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,297.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,325.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,099.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,099.25
|
| Rate for Payer: UHC Medicaid |
$1,325.07
|
| Rate for Payer: UHCCP Medicaid |
$1,325.07
|
|
