|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$206.57 |
| Max. Negotiated Rate |
$1,050.40 |
| Rate for Payer: Aetna Commercial |
$798.22
|
| Rate for Payer: Aetna Medicare |
$619.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.79
|
| Rate for Payer: BCBS Complete |
$423.82
|
| Rate for Payer: BCBS MAPPO |
$595.69
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$908.45
|
| Rate for Payer: BCN Medicare Advantage |
$595.69
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$798.22
|
| Rate for Payer: Cofinity Commercial |
$857.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.47
|
| Rate for Payer: Meridian Medicaid |
$423.82
|
| Rate for Payer: Nomi Health Commercial |
$714.83
|
| Rate for Payer: PACE SWMI |
$595.69
|
| Rate for Payer: PHP Commercial |
$833.97
|
| Rate for Payer: PHP Medicare Advantage |
$595.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$956.15
|
| Rate for Payer: Priority Health Medicare |
$595.69
|
| Rate for Payer: Priority Health Narrow Network |
$956.15
|
| Rate for Payer: Priority Health SBD |
$956.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.69
|
| Rate for Payer: UHC Medicare Advantage |
$595.69
|
| Rate for Payer: UHCCP Medicaid |
$403.64
|
| Rate for Payer: UMR Bronson Commercial |
$743.36
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$910.20
|
| Rate for Payer: Aetna Medicare |
$706.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.12
|
| Rate for Payer: BCBS Complete |
$481.97
|
| Rate for Payer: BCBS MAPPO |
$679.25
|
| Rate for Payer: BCBS Trust/PPO |
$173.28
|
| Rate for Payer: BCN Commercial |
$1,035.02
|
| Rate for Payer: BCN Medicare Advantage |
$679.25
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cofinity Commercial |
$910.20
|
| Rate for Payer: Cofinity Commercial |
$978.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.21
|
| Rate for Payer: Meridian Medicaid |
$481.97
|
| Rate for Payer: Nomi Health Commercial |
$815.10
|
| Rate for Payer: PACE SWMI |
$679.25
|
| Rate for Payer: PHP Commercial |
$950.95
|
| Rate for Payer: PHP Medicare Advantage |
$679.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,087.95
|
| Rate for Payer: Priority Health Medicare |
$679.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,087.95
|
| Rate for Payer: Priority Health SBD |
$1,087.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.25
|
| Rate for Payer: UHC Medicare Advantage |
$679.25
|
| Rate for Payer: UHCCP Medicaid |
$459.02
|
| Rate for Payer: UMR Bronson Commercial |
$883.20
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$304.30 |
| Max. Negotiated Rate |
$1,061.99 |
| Rate for Payer: Aetna Commercial |
$889.99
|
| Rate for Payer: Aetna Medicare |
$690.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.40
|
| Rate for Payer: BCBS Complete |
$471.45
|
| Rate for Payer: BCBS MAPPO |
$664.17
|
| Rate for Payer: BCBS Trust/PPO |
$304.30
|
| Rate for Payer: BCN Commercial |
$1,012.05
|
| Rate for Payer: BCN Medicare Advantage |
$664.17
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cofinity Commercial |
$889.99
|
| Rate for Payer: Cofinity Commercial |
$956.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.38
|
| Rate for Payer: Meridian Medicaid |
$471.45
|
| Rate for Payer: Nomi Health Commercial |
$797.00
|
| Rate for Payer: PACE SWMI |
$664.17
|
| Rate for Payer: PHP Commercial |
$929.84
|
| Rate for Payer: PHP Medicare Advantage |
$664.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,061.99
|
| Rate for Payer: Priority Health Medicare |
$664.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.99
|
| Rate for Payer: Priority Health SBD |
$1,061.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$664.17
|
| Rate for Payer: UHC Medicare Advantage |
$664.17
|
| Rate for Payer: UHCCP Medicaid |
$449.00
|
| Rate for Payer: UMR Bronson Commercial |
$569.02
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Medicare |
$667.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.64
|
| Rate for Payer: BCBS Complete |
$464.74
|
| Rate for Payer: BCBS MAPPO |
$641.42
|
| Rate for Payer: BCBS Trust/PPO |
$285.28
|
| Rate for Payer: BCN Commercial |
$1,018.41
|
| Rate for Payer: BCN Medicare Advantage |
$641.42
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cofinity Commercial |
$859.50
|
| Rate for Payer: Cofinity Commercial |
$923.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.49
|
| Rate for Payer: Meridian Medicaid |
$464.74
|
| Rate for Payer: Nomi Health Commercial |
$769.70
|
| Rate for Payer: PACE SWMI |
$641.42
|
| Rate for Payer: PHP Commercial |
$897.99
|
| Rate for Payer: PHP Medicare Advantage |
$641.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,058.43
|
| Rate for Payer: Priority Health Medicare |
$641.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,058.43
|
| Rate for Payer: Priority Health SBD |
$1,058.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.42
|
| Rate for Payer: UHC Medicare Advantage |
$641.42
|
| Rate for Payer: UHCCP Medicaid |
$442.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,012.00
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$455.61 |
| Max. Negotiated Rate |
$4,383.83 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Aetna Medicare |
$683.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.84
|
| Rate for Payer: BCBS Complete |
$478.39
|
| Rate for Payer: BCBS MAPPO |
$657.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,383.83
|
| Rate for Payer: BCN Commercial |
$1,042.35
|
| Rate for Payer: BCN Medicare Advantage |
$657.53
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$946.84
|
| Rate for Payer: Cofinity Commercial |
$881.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.41
|
| Rate for Payer: Meridian Medicaid |
$478.39
|
| Rate for Payer: Nomi Health Commercial |
$789.04
|
| Rate for Payer: PACE SWMI |
$657.53
|
| Rate for Payer: PHP Commercial |
$920.54
|
| Rate for Payer: PHP Medicare Advantage |
$657.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.96
|
| Rate for Payer: Priority Health Medicare |
$657.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.96
|
| Rate for Payer: Priority Health SBD |
$1,088.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.53
|
| Rate for Payer: UHC Medicare Advantage |
$657.53
|
| Rate for Payer: UHCCP Medicaid |
$455.61
|
| Rate for Payer: UMR Bronson Commercial |
$759.00
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.70
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Medicare Advantage |
$0.49
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.66
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.51
|
| Rate for Payer: Nomi Health Commercial |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.49
|
| Rate for Payer: PHP Commercial |
$0.68
|
| Rate for Payer: PHP Medicare Advantage |
$0.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.49
|
| Rate for Payer: UHC Medicare Advantage |
$0.49
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
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: Aetna New Business (MI Preferred) |
$837.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.97
|
| 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 |
$837.47
|
| Rate for Payer: Cofinity Commercial |
$899.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.98
|
| 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 Commercial |
$874.97
|
| 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/Tiered Network |
$990.76
|
| Rate for Payer: Priority Health Medicare |
$624.98
|
| Rate for Payer: Priority Health Narrow Network |
$990.76
|
| Rate for Payer: Priority Health SBD |
$990.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.98
|
| Rate for Payer: UHC Medicare Advantage |
$624.98
|
| Rate for Payer: UHCCP Medicaid |
$416.63
|
| Rate for Payer: UMR Bronson Commercial |
$916.78
|
|
|
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: Aetna New Business (MI Preferred) |
$747.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.13
|
| 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 |
$747.36
|
| Rate for Payer: Cofinity Commercial |
$803.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.73
|
| 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 Commercial |
$780.82
|
| 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/Tiered Network |
$884.91
|
| Rate for Payer: Priority Health Medicare |
$557.73
|
| Rate for Payer: Priority Health Narrow Network |
$884.91
|
| Rate for Payer: Priority Health SBD |
$884.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.73
|
| Rate for Payer: UHC Medicare Advantage |
$557.73
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
| Rate for Payer: UMR Bronson Commercial |
$791.66
|
|
|
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: Aetna New Business (MI Preferred) |
$1,033.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.32
|
| 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 |
$1,033.06
|
| Rate for Payer: Cofinity Commercial |
$961.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.40
|
| 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 Commercial |
$1,004.36
|
| 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/Tiered Network |
$1,178.02
|
| Rate for Payer: Priority Health Medicare |
$717.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.02
|
| Rate for Payer: Priority Health SBD |
$1,178.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.40
|
| Rate for Payer: UHC Medicare Advantage |
$717.40
|
| Rate for Payer: UHCCP Medicaid |
$493.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.50
|
|
|
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: Aetna New Business (MI Preferred) |
$652.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.86
|
| 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 |
$652.19
|
| Rate for Payer: Cofinity Commercial |
$700.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.71
|
| 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 Commercial |
$681.39
|
| 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/Tiered Network |
$774.49
|
| Rate for Payer: Priority Health Medicare |
$486.71
|
| Rate for Payer: Priority Health Narrow Network |
$774.49
|
| Rate for Payer: Priority Health SBD |
$774.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.71
|
| Rate for Payer: UHC Medicare Advantage |
$486.71
|
| Rate for Payer: UHCCP Medicaid |
$326.53
|
| Rate for Payer: UMR Bronson Commercial |
$511.52
|
|
|
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: Aetna New Business (MI Preferred) |
$1,022.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.27
|
| 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 |
$1,022.26
|
| Rate for Payer: Cofinity Commercial |
$951.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.90
|
| 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 Commercial |
$993.86
|
| 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/Tiered Network |
$1,134.25
|
| Rate for Payer: Priority Health Medicare |
$709.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.25
|
| Rate for Payer: Priority Health SBD |
$1,134.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.90
|
| Rate for Payer: UHC Medicare Advantage |
$709.90
|
| Rate for Payer: UHCCP Medicaid |
$479.25
|
| Rate for Payer: UMR Bronson Commercial |
$580.98
|
|
|
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: Aetna New Business (MI Preferred) |
$1,002.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.67
|
| 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 |
$1,002.83
|
| Rate for Payer: Cofinity Commercial |
$1,077.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.38
|
| 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 Commercial |
$1,047.73
|
| 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/Tiered Network |
$1,195.31
|
| Rate for Payer: Priority Health Medicare |
$748.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,195.31
|
| Rate for Payer: Priority Health SBD |
$1,195.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$748.38
|
| Rate for Payer: UHC Medicare Advantage |
$748.38
|
| Rate for Payer: UHCCP Medicaid |
$504.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,092.04
|
|
|
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: Aetna New Business (MI Preferred) |
$1,062.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.69
|
| 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 |
$1,062.48
|
| Rate for Payer: Cofinity Commercial |
$988.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$737.83
|
| 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 Commercial |
$1,032.96
|
| 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/Tiered Network |
$1,143.41
|
| Rate for Payer: Priority Health Medicare |
$737.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,143.41
|
| Rate for Payer: Priority Health SBD |
$1,143.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$737.83
|
| Rate for Payer: UHC Medicare Advantage |
$737.83
|
| Rate for Payer: UHCCP Medicaid |
$499.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,063.98
|
|
|
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: Aetna New Business (MI Preferred) |
$676.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.91
|
| 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 |
$676.43
|
| Rate for Payer: Cofinity Commercial |
$726.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$504.80
|
| 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 Commercial |
$706.72
|
| 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/Tiered Network |
$808.08
|
| Rate for Payer: Priority Health Medicare |
$504.80
|
| Rate for Payer: Priority Health Narrow Network |
$808.08
|
| Rate for Payer: Priority Health SBD |
$808.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$504.80
|
| Rate for Payer: UHC Medicare Advantage |
$504.80
|
| Rate for Payer: UHCCP Medicaid |
$340.59
|
| Rate for Payer: UMR Bronson Commercial |
$751.18
|
|
|
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: Aetna New Business (MI Preferred) |
$906.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.35
|
| 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 |
$906.68
|
| Rate for Payer: Cofinity Commercial |
$974.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.63
|
| 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 Commercial |
$947.28
|
| 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/Tiered Network |
$1,077.26
|
| Rate for Payer: Priority Health Medicare |
$676.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.26
|
| Rate for Payer: Priority Health SBD |
$1,077.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.63
|
| Rate for Payer: UHC Medicare Advantage |
$676.63
|
| Rate for Payer: UHCCP Medicaid |
$453.26
|
| Rate for Payer: UMR Bronson Commercial |
$887.80
|
|
|
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: Aetna New Business (MI Preferred) |
$1,001.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.37
|
| 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 |
$1,001.95
|
| Rate for Payer: Cofinity Commercial |
$932.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.80
|
| 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 Commercial |
$974.12
|
| 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/Tiered Network |
$1,110.85
|
| Rate for Payer: Priority Health Medicare |
$695.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,110.85
|
| Rate for Payer: Priority Health SBD |
$1,110.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.80
|
| Rate for Payer: UHC Medicare Advantage |
$695.80
|
| Rate for Payer: UHCCP Medicaid |
$471.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,095.26
|
|
|
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: Aetna New Business (MI Preferred) |
$1,162.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.36
|
| 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 |
$1,162.60
|
| Rate for Payer: Cofinity Commercial |
$1,249.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$867.61
|
| 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 Commercial |
$1,214.65
|
| 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/Tiered Network |
$1,365.79
|
| Rate for Payer: Priority Health Medicare |
$867.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,365.79
|
| Rate for Payer: Priority Health SBD |
$1,365.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.61
|
| Rate for Payer: UHC Medicare Advantage |
$867.61
|
| Rate for Payer: UHCCP Medicaid |
$572.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,246.60
|
|
|
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: Aetna New Business (MI Preferred) |
$765.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.34
|
| 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 |
$765.23
|
| Rate for Payer: Cofinity Commercial |
$822.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.07
|
| 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 Commercial |
$799.50
|
| 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/Tiered Network |
$900.18
|
| Rate for Payer: Priority Health Medicare |
$571.07
|
| Rate for Payer: Priority Health Narrow Network |
$900.18
|
| Rate for Payer: Priority Health SBD |
$900.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.07
|
| Rate for Payer: UHC Medicare Advantage |
$571.07
|
| Rate for Payer: UHCCP Medicaid |
$378.08
|
| Rate for Payer: UMR Bronson Commercial |
$984.40
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$631.84 |
| Max. Negotiated Rate |
$1,292.40 |
| Rate for Payer: Aetna American Axle |
$933.40
|
| Rate for Payer: Aetna Commercial |
$1,220.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.40
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,005.20
|
| Rate for Payer: Cofinity Commercial |
$1,234.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Healthscope Commercial |
$1,292.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,005.20
|
| 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: PHP Commercial |
$1,220.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health SBD |
$904.68
|
| Rate for Payer: UMR Bronson Commercial |
$631.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,077.00
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$407.88 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna American Axle |
$933.40
|
| Rate for Payer: Aetna Commercial |
$1,220.60
|
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,148.80
|
| 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: Cofinity Commercial |
$1,005.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,005.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,292.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,005.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,077.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.60
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$1,220.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Priority Health SBD |
$904.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.67
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$407.88
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: UMR Bronson Commercial |
$531.32
|
| Rate for Payer: VA VA |
$3,179.00
|
| 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: Aetna New Business (MI Preferred) |
$540.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.30
|
| 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 |
$540.93
|
| Rate for Payer: Cofinity Commercial |
$581.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.68
|
| 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 Commercial |
$565.15
|
| 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/Tiered Network |
$648.28
|
| Rate for Payer: Priority Health Medicare |
$403.68
|
| Rate for Payer: Priority Health Narrow Network |
$648.28
|
| Rate for Payer: Priority Health SBD |
$648.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.68
|
| Rate for Payer: UHC Medicare Advantage |
$403.68
|
| Rate for Payer: UHCCP Medicaid |
$272.21
|
| Rate for Payer: UMR Bronson Commercial |
$660.56
|
|
|
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: Aetna New Business (MI Preferred) |
$540.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.30
|
| 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: 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 Commercial |
$565.15
|
| 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/Tiered Network |
$648.28
|
| Rate for Payer: Priority Health Medicare |
$403.68
|
| Rate for Payer: Priority Health Narrow Network |
$648.28
|
| Rate for Payer: Priority Health SBD |
$648.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.68
|
| Rate for Payer: UHC Medicare Advantage |
$403.68
|
| Rate for Payer: UHCCP Medicaid |
$272.21
|
| Rate for Payer: UMR Bronson Commercial |
$660.56
|
|
|
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: Aetna New Business (MI Preferred) |
$1,060.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,140.13
|
| 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 |
$1,060.96
|
| Rate for Payer: Cofinity Commercial |
$1,140.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$791.76
|
| 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 Commercial |
$1,108.46
|
| 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/Tiered Network |
$1,309.14
|
| Rate for Payer: Priority Health Medicare |
$791.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.14
|
| Rate for Payer: Priority Health SBD |
$1,309.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$791.76
|
| Rate for Payer: UHC Medicare Advantage |
$791.76
|
| Rate for Payer: UHCCP Medicaid |
$530.37
|
| Rate for Payer: UMR Bronson Commercial |
$713.92
|
|
|
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: Aetna New Business (MI Preferred) |
$811.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.16
|
| 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 |
$811.60
|
| Rate for Payer: Cofinity Commercial |
$872.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.67
|
| 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 Commercial |
$847.94
|
| 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/Tiered Network |
$1,009.81
|
| Rate for Payer: Priority Health Medicare |
$605.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.81
|
| Rate for Payer: Priority Health SBD |
$1,009.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.67
|
| Rate for Payer: UHC Medicare Advantage |
$605.67
|
| Rate for Payer: UHCCP Medicaid |
$406.62
|
| Rate for Payer: UMR Bronson Commercial |
$552.92
|
|
|
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: Aetna New Business (MI Preferred) |
$1,525.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.32
|
| 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 |
$1,525.48
|
| Rate for Payer: Cofinity Commercial |
$1,639.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,138.42
|
| 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 Commercial |
$1,593.79
|
| 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/Tiered Network |
$1,891.79
|
| Rate for Payer: Priority Health Medicare |
$1,138.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,891.79
|
| Rate for Payer: Priority Health SBD |
$1,891.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,138.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,138.42
|
| Rate for Payer: UHCCP Medicaid |
$761.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,141.72
|
|
