|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$304.30 |
| Max. Negotiated Rate |
$1,057.55 |
| Rate for Payer: Aetna Commercial |
$908.43
|
| Rate for Payer: Aetna Medicare |
$677.93
|
| Rate for Payer: BCBS Complete |
$466.76
|
| Rate for Payer: BCBS MAPPO |
$677.93
|
| Rate for Payer: BCBS Trust/PPO |
$304.30
|
| Rate for Payer: BCN Commercial |
$1,012.05
|
| Rate for Payer: BCN Medicare Advantage |
$677.93
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Cofinity Commercial |
$908.43
|
| Rate for Payer: Cofinity Commercial |
$976.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.93
|
| Rate for Payer: Healthscope Commercial |
$813.52
|
| Rate for Payer: Healthscope Whirlpool |
$813.52
|
| Rate for Payer: Meridian Medicaid |
$466.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$711.83
|
| Rate for Payer: PACE SWMI |
$677.93
|
| Rate for Payer: PHP Medicare Advantage |
$677.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.55
|
| Rate for Payer: Priority Health Medicare |
$677.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,057.55
|
| Rate for Payer: UHC Medicare Advantage |
$698.27
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,157.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$1,509.90 |
| Rate for Payer: Aetna Commercial |
$897.28
|
| Rate for Payer: Aetna Medicare |
$669.61
|
| Rate for Payer: BCBS Complete |
$465.19
|
| Rate for Payer: BCBS MAPPO |
$669.61
|
| Rate for Payer: BCBS Trust/PPO |
$285.28
|
| Rate for Payer: BCN Commercial |
$1,018.41
|
| Rate for Payer: BCN Medicare Advantage |
$669.61
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cash Price |
$1,725.60
|
| Rate for Payer: Cofinity Commercial |
$897.28
|
| Rate for Payer: Cofinity Commercial |
$964.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.61
|
| Rate for Payer: Healthscope Commercial |
$803.53
|
| Rate for Payer: Healthscope Whirlpool |
$803.53
|
| Rate for Payer: Meridian Medicaid |
$465.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$703.09
|
| Rate for Payer: PACE SWMI |
$669.61
|
| Rate for Payer: PHP Medicare Advantage |
$669.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,064.20
|
| Rate for Payer: Priority Health Medicare |
$669.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,064.20
|
| Rate for Payer: UHC Medicare Advantage |
$689.70
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$455.82 |
| Max. Negotiated Rate |
$4,383.83 |
| Rate for Payer: Aetna Commercial |
$915.31
|
| Rate for Payer: Aetna Medicare |
$683.07
|
| Rate for Payer: BCBS Complete |
$478.61
|
| Rate for Payer: BCBS MAPPO |
$683.07
|
| Rate for Payer: BCBS Trust/PPO |
$4,383.83
|
| Rate for Payer: BCN Commercial |
$1,042.35
|
| Rate for Payer: BCN Medicare Advantage |
$683.07
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cofinity Commercial |
$983.62
|
| Rate for Payer: Cofinity Commercial |
$915.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.07
|
| Rate for Payer: Healthscope Commercial |
$819.68
|
| Rate for Payer: Healthscope Whirlpool |
$819.68
|
| Rate for Payer: Meridian Medicaid |
$478.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$717.22
|
| Rate for Payer: PACE SWMI |
$683.07
|
| Rate for Payer: PHP Medicare Advantage |
$683.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,089.21
|
| Rate for Payer: Priority Health Medicare |
$683.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,089.21
|
| Rate for Payer: UHC Medicare Advantage |
$703.56
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$1.05
|
| Rate for Payer: Aetna Medicare |
$0.78
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$1.05
|
| Rate for Payer: Cofinity Commercial |
$1.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Healthscope Whirlpool |
$0.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Medicare |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$0.81
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$1,954.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$414.71 |
| Max. Negotiated Rate |
$1,367.80 |
| Rate for Payer: Aetna Commercial |
$857.29
|
| Rate for Payer: Aetna Medicare |
$639.77
|
| Rate for Payer: BCBS Complete |
$435.45
|
| Rate for Payer: BCBS MAPPO |
$639.77
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: BCN Commercial |
$944.61
|
| Rate for Payer: BCN Medicare Advantage |
$639.77
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cofinity Commercial |
$857.29
|
| Rate for Payer: Cofinity Commercial |
$921.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$639.77
|
| Rate for Payer: Healthscope Commercial |
$767.72
|
| Rate for Payer: Healthscope Whirlpool |
$767.72
|
| Rate for Payer: Meridian Medicaid |
$435.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$671.76
|
| Rate for Payer: PACE SWMI |
$639.77
|
| Rate for Payer: PHP Medicare Advantage |
$639.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,367.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$987.09
|
| Rate for Payer: Priority Health Medicare |
$639.77
|
| Rate for Payer: Priority Health Narrow Network |
$987.09
|
| Rate for Payer: UHC Medicare Advantage |
$658.96
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$370.41 |
| Max. Negotiated Rate |
$1,180.90 |
| Rate for Payer: Aetna Commercial |
$764.47
|
| Rate for Payer: Aetna Medicare |
$570.50
|
| Rate for Payer: BCBS Complete |
$388.93
|
| Rate for Payer: BCBS MAPPO |
$570.50
|
| Rate for Payer: BCBS Trust/PPO |
$405.73
|
| Rate for Payer: BCN Commercial |
$843.46
|
| Rate for Payer: BCN Medicare Advantage |
$570.50
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$821.52
|
| Rate for Payer: Cofinity Commercial |
$764.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.50
|
| Rate for Payer: Healthscope Commercial |
$684.60
|
| Rate for Payer: Healthscope Whirlpool |
$684.60
|
| Rate for Payer: Meridian Medicaid |
$388.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$599.02
|
| Rate for Payer: PACE SWMI |
$570.50
|
| Rate for Payer: PHP Medicare Advantage |
$570.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.38
|
| Rate for Payer: Priority Health Medicare |
$570.50
|
| Rate for Payer: Priority Health Narrow Network |
$881.38
|
| Rate for Payer: UHC Medicare Advantage |
$587.62
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,426.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$493.10 |
| Max. Negotiated Rate |
$2,869.73 |
| Rate for Payer: Aetna Commercial |
$1,002.37
|
| Rate for Payer: Aetna Medicare |
$748.04
|
| Rate for Payer: BCBS Complete |
$517.76
|
| Rate for Payer: BCBS MAPPO |
$748.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,869.73
|
| Rate for Payer: BCN Commercial |
$1,133.74
|
| Rate for Payer: BCN Medicare Advantage |
$748.04
|
| Rate for Payer: Cash Price |
$1,940.80
|
| Rate for Payer: Cash Price |
$1,940.80
|
| Rate for Payer: Cofinity Commercial |
$1,077.18
|
| Rate for Payer: Cofinity Commercial |
$1,002.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.04
|
| Rate for Payer: Healthscope Commercial |
$897.65
|
| Rate for Payer: Healthscope Whirlpool |
$897.65
|
| Rate for Payer: Meridian Medicaid |
$517.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$785.44
|
| Rate for Payer: PACE SWMI |
$748.04
|
| Rate for Payer: PHP Medicare Advantage |
$748.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$493.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,698.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,184.70
|
| Rate for Payer: Priority Health Medicare |
$748.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,184.70
|
| Rate for Payer: UHC Medicare Advantage |
$770.48
|
|
|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$324.19 |
| Max. Negotiated Rate |
$977.88 |
| Rate for Payer: Aetna Commercial |
$664.56
|
| Rate for Payer: Aetna Medicare |
$495.94
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$495.94
|
| Rate for Payer: BCBS Trust/PPO |
$977.88
|
| Rate for Payer: BCN Commercial |
$735.46
|
| Rate for Payer: BCN Medicare Advantage |
$495.94
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cofinity Commercial |
$714.15
|
| Rate for Payer: Cofinity Commercial |
$664.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.94
|
| Rate for Payer: Healthscope Commercial |
$595.13
|
| Rate for Payer: Healthscope Whirlpool |
$595.13
|
| Rate for Payer: Meridian Medicaid |
$340.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$520.74
|
| Rate for Payer: PACE SWMI |
$495.94
|
| Rate for Payer: PHP Medicare Advantage |
$495.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$768.52
|
| Rate for Payer: Priority Health Medicare |
$495.94
|
| Rate for Payer: Priority Health Narrow Network |
$768.52
|
| Rate for Payer: UHC Medicare Advantage |
$510.82
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$1,129.05 |
| Rate for Payer: Aetna Commercial |
$970.86
|
| Rate for Payer: Aetna Medicare |
$724.52
|
| Rate for Payer: BCBS Complete |
$498.52
|
| Rate for Payer: BCBS MAPPO |
$724.52
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$1,080.46
|
| Rate for Payer: BCN Medicare Advantage |
$724.52
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$970.86
|
| Rate for Payer: Cofinity Commercial |
$1,043.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.52
|
| Rate for Payer: Healthscope Commercial |
$869.42
|
| Rate for Payer: Healthscope Whirlpool |
$869.42
|
| Rate for Payer: Meridian Medicaid |
$498.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$760.75
|
| Rate for Payer: PACE SWMI |
$724.52
|
| Rate for Payer: PHP Medicare Advantage |
$724.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.05
|
| Rate for Payer: Priority Health Medicare |
$724.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,129.05
|
| Rate for Payer: UHC Medicare Advantage |
$746.26
|
|
|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$2,327.00
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$194.41 |
| Max. Negotiated Rate |
$1,628.90 |
| Rate for Payer: Aetna Commercial |
$1,023.40
|
| Rate for Payer: Aetna Medicare |
$763.73
|
| Rate for Payer: BCBS Complete |
$525.36
|
| Rate for Payer: BCBS MAPPO |
$763.73
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: BCN Commercial |
$1,138.13
|
| Rate for Payer: BCN Medicare Advantage |
$763.73
|
| Rate for Payer: Cash Price |
$1,861.60
|
| Rate for Payer: Cash Price |
$1,861.60
|
| Rate for Payer: Cofinity Commercial |
$1,099.77
|
| Rate for Payer: Cofinity Commercial |
$1,023.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.73
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Healthscope Whirlpool |
$916.48
|
| Rate for Payer: Meridian Medicaid |
$525.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$801.92
|
| Rate for Payer: PACE SWMI |
$763.73
|
| Rate for Payer: PHP Medicare Advantage |
$763.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,628.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.30
|
| Rate for Payer: Priority Health Medicare |
$763.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.30
|
| Rate for Payer: UHC Medicare Advantage |
$786.64
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,268.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$1,587.60 |
| Rate for Payer: Aetna Commercial |
$974.86
|
| Rate for Payer: Aetna Medicare |
$727.51
|
| Rate for Payer: BCBS Complete |
$502.54
|
| Rate for Payer: BCBS MAPPO |
$727.51
|
| Rate for Payer: BCBS Trust/PPO |
$70.79
|
| Rate for Payer: BCN Commercial |
$1,084.87
|
| Rate for Payer: BCN Medicare Advantage |
$727.51
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cofinity Commercial |
$1,047.61
|
| Rate for Payer: Cofinity Commercial |
$974.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$727.51
|
| Rate for Payer: Healthscope Commercial |
$873.01
|
| Rate for Payer: Healthscope Whirlpool |
$873.01
|
| Rate for Payer: Meridian Medicaid |
$502.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$763.89
|
| Rate for Payer: PACE SWMI |
$727.51
|
| Rate for Payer: PHP Medicare Advantage |
$727.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,133.65
|
| Rate for Payer: Priority Health Medicare |
$727.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,133.65
|
| Rate for Payer: UHC Medicare Advantage |
$749.34
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$1,601.00
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,120.70 |
| Rate for Payer: Aetna Commercial |
$692.34
|
| Rate for Payer: Aetna Medicare |
$516.67
|
| Rate for Payer: BCBS Complete |
$355.15
|
| Rate for Payer: BCBS MAPPO |
$516.67
|
| Rate for Payer: BCBS Trust/PPO |
$945.13
|
| Rate for Payer: BCN Commercial |
$767.22
|
| Rate for Payer: BCN Medicare Advantage |
$516.67
|
| Rate for Payer: Cash Price |
$1,280.80
|
| Rate for Payer: Cash Price |
$1,280.80
|
| Rate for Payer: Cofinity Commercial |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$692.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.67
|
| Rate for Payer: Healthscope Commercial |
$620.00
|
| Rate for Payer: Healthscope Whirlpool |
$620.00
|
| Rate for Payer: Meridian Medicaid |
$355.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$542.50
|
| Rate for Payer: PACE SWMI |
$516.67
|
| Rate for Payer: PHP Medicare Advantage |
$516.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$801.72
|
| Rate for Payer: Priority Health Medicare |
$516.67
|
| Rate for Payer: Priority Health Narrow Network |
$801.72
|
| Rate for Payer: UHC Medicare Advantage |
$532.17
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,892.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$450.92 |
| Max. Negotiated Rate |
$1,324.40 |
| Rate for Payer: Aetna Commercial |
$932.89
|
| Rate for Payer: Aetna Medicare |
$696.19
|
| Rate for Payer: BCBS Complete |
$473.47
|
| Rate for Payer: BCBS MAPPO |
$696.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.47
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| Rate for Payer: BCN Medicare Advantage |
$696.19
|
| Rate for Payer: Cash Price |
$1,513.60
|
| Rate for Payer: Cash Price |
$1,513.60
|
| Rate for Payer: Cofinity Commercial |
$932.89
|
| Rate for Payer: Cofinity Commercial |
$1,002.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.19
|
| Rate for Payer: Healthscope Commercial |
$835.43
|
| Rate for Payer: Healthscope Whirlpool |
$835.43
|
| Rate for Payer: Meridian Medicaid |
$473.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$731.00
|
| Rate for Payer: PACE SWMI |
$696.19
|
| Rate for Payer: PHP Medicare Advantage |
$696.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$450.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,324.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,073.39
|
| Rate for Payer: Priority Health Medicare |
$696.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,073.39
|
| Rate for Payer: UHC Medicare Advantage |
$717.08
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$2,334.00
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$1,633.80 |
| Rate for Payer: Aetna Commercial |
$946.80
|
| Rate for Payer: Aetna Medicare |
$706.57
|
| Rate for Payer: BCBS Complete |
$488.23
|
| Rate for Payer: BCBS MAPPO |
$706.57
|
| Rate for Payer: BCBS Trust/PPO |
$87.17
|
| Rate for Payer: BCN Commercial |
$1,056.04
|
| Rate for Payer: BCN Medicare Advantage |
$706.57
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cofinity Commercial |
$946.80
|
| Rate for Payer: Cofinity Commercial |
$1,017.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.57
|
| Rate for Payer: Healthscope Commercial |
$847.88
|
| Rate for Payer: Healthscope Whirlpool |
$847.88
|
| Rate for Payer: Meridian Medicaid |
$488.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$741.90
|
| Rate for Payer: PACE SWMI |
$706.57
|
| Rate for Payer: PHP Medicare Advantage |
$706.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,103.51
|
| Rate for Payer: Priority Health Medicare |
$706.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,103.51
|
| Rate for Payer: UHC Medicare Advantage |
$727.77
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$2,657.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$571.69 |
| Max. Negotiated Rate |
$1,859.90 |
| Rate for Payer: Aetna Commercial |
$1,195.44
|
| Rate for Payer: Aetna Medicare |
$892.12
|
| Rate for Payer: BCBS Complete |
$600.27
|
| Rate for Payer: BCBS MAPPO |
$892.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.71
|
| Rate for Payer: BCN Commercial |
$1,307.21
|
| Rate for Payer: BCN Medicare Advantage |
$892.12
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,195.44
|
| Rate for Payer: Cofinity Commercial |
$1,284.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$892.12
|
| Rate for Payer: Healthscope Commercial |
$1,070.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.54
|
| Rate for Payer: Meridian Medicaid |
$600.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$936.73
|
| Rate for Payer: PACE SWMI |
$892.12
|
| Rate for Payer: PHP Medicare Advantage |
$892.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,859.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,365.98
|
| Rate for Payer: Priority Health Medicare |
$892.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,365.98
|
| Rate for Payer: UHC Medicare Advantage |
$918.88
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$376.80 |
| Max. Negotiated Rate |
$1,468.60 |
| Rate for Payer: Aetna Commercial |
$784.60
|
| Rate for Payer: Aetna Medicare |
$585.52
|
| Rate for Payer: BCBS Complete |
$395.64
|
| Rate for Payer: BCBS MAPPO |
$585.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.86
|
| Rate for Payer: BCN Commercial |
$859.58
|
| Rate for Payer: BCN Medicare Advantage |
$585.52
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cofinity Commercial |
$784.60
|
| Rate for Payer: Cofinity Commercial |
$843.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.52
|
| Rate for Payer: Healthscope Commercial |
$702.62
|
| Rate for Payer: Healthscope Whirlpool |
$702.62
|
| Rate for Payer: Meridian Medicaid |
$395.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$614.80
|
| Rate for Payer: PACE SWMI |
$585.52
|
| Rate for Payer: PHP Medicare Advantage |
$585.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$376.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,468.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$898.24
|
| Rate for Payer: Priority Health Medicare |
$585.52
|
| Rate for Payer: Priority Health Narrow Network |
$898.24
|
| Rate for Payer: UHC Medicare Advantage |
$603.09
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,408.00
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$554.99
|
| Rate for Payer: Aetna Medicare |
$414.17
|
| Rate for Payer: BCBS Complete |
$284.93
|
| Rate for Payer: BCBS MAPPO |
$414.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.24
|
| Rate for Payer: BCN Commercial |
$615.25
|
| Rate for Payer: BCN Medicare Advantage |
$414.17
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cofinity Commercial |
$554.99
|
| Rate for Payer: Cofinity Commercial |
$596.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.17
|
| Rate for Payer: Healthscope Commercial |
$497.00
|
| Rate for Payer: Healthscope Whirlpool |
$497.00
|
| Rate for Payer: Meridian Medicaid |
$284.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$434.88
|
| Rate for Payer: PACE SWMI |
$414.17
|
| Rate for Payer: PHP Medicare Advantage |
$414.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$642.91
|
| Rate for Payer: Priority Health Medicare |
$414.17
|
| Rate for Payer: Priority Health Narrow Network |
$642.91
|
| Rate for Payer: UHC Medicare Advantage |
$426.60
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,408.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$554.99
|
| Rate for Payer: Aetna Medicare |
$414.17
|
| Rate for Payer: BCBS Complete |
$284.93
|
| Rate for Payer: BCBS MAPPO |
$414.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.24
|
| Rate for Payer: BCN Commercial |
$615.25
|
| Rate for Payer: BCN Medicare Advantage |
$414.17
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cofinity Commercial |
$596.40
|
| Rate for Payer: Cofinity Commercial |
$554.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.17
|
| Rate for Payer: Healthscope Commercial |
$497.00
|
| Rate for Payer: Healthscope Whirlpool |
$497.00
|
| Rate for Payer: Meridian Medicaid |
$284.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$434.88
|
| Rate for Payer: PACE SWMI |
$414.17
|
| Rate for Payer: PHP Medicare Advantage |
$414.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$642.91
|
| Rate for Payer: Priority Health Medicare |
$414.17
|
| Rate for Payer: Priority Health Narrow Network |
$642.91
|
| Rate for Payer: UHC Medicare Advantage |
$426.60
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$985.60 |
| Max. Negotiated Rate |
$1,408.00 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: ASR ASR |
$1,365.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.62
|
| Rate for Payer: BCN Commercial |
$1,091.62
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cofinity Commercial |
$1,323.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.40
|
| Rate for Payer: Healthscope Commercial |
$1,408.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,365.76
|
| Rate for Payer: Mclaren Commercial |
$1,267.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,196.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.04
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$985.60 |
| Max. Negotiated Rate |
$3,596.44 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Medicare |
$2,877.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: ASR ASR |
$1,365.76
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.62
|
| Rate for Payer: BCN Commercial |
$1,091.62
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cofinity Commercial |
$1,323.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$1,408.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,365.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,877.15
|
| Rate for Payer: Mclaren Commercial |
$1,267.20
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,196.80
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$3,164.86
|
| Rate for Payer: PHP Medicaid |
$1,573.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,281.28
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$999.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PR AMPUTATION PENIS COMPLETE
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$523.55 |
| Max. Negotiated Rate |
$2,350.94 |
| Rate for Payer: Aetna Commercial |
$1,080.33
|
| Rate for Payer: Aetna Medicare |
$806.22
|
| Rate for Payer: BCBS Complete |
$549.73
|
| Rate for Payer: BCBS MAPPO |
$806.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.94
|
| Rate for Payer: BCN Commercial |
$1,190.42
|
| Rate for Payer: BCN Medicare Advantage |
$806.22
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cofinity Commercial |
$1,080.33
|
| Rate for Payer: Cofinity Commercial |
$1,160.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.22
|
| Rate for Payer: Healthscope Commercial |
$967.46
|
| Rate for Payer: Healthscope Whirlpool |
$967.46
|
| Rate for Payer: Meridian Medicaid |
$549.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.53
|
| Rate for Payer: PACE SWMI |
$806.22
|
| Rate for Payer: PHP Medicare Advantage |
$806.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,316.31
|
| Rate for Payer: Priority Health Medicare |
$806.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,316.31
|
| Rate for Payer: UHC Medicare Advantage |
$830.41
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,178.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$403.85 |
| Max. Negotiated Rate |
$3,526.40 |
| Rate for Payer: Aetna Commercial |
$827.06
|
| Rate for Payer: Aetna Medicare |
$617.21
|
| Rate for Payer: BCBS Complete |
$424.04
|
| Rate for Payer: BCBS MAPPO |
$617.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,526.40
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: BCN Medicare Advantage |
$617.21
|
| Rate for Payer: Cash Price |
$942.40
|
| Rate for Payer: Cash Price |
$942.40
|
| Rate for Payer: Cofinity Commercial |
$827.06
|
| Rate for Payer: Cofinity Commercial |
$888.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$617.21
|
| Rate for Payer: Healthscope Commercial |
$740.65
|
| Rate for Payer: Healthscope Whirlpool |
$740.65
|
| Rate for Payer: Meridian Medicaid |
$424.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$648.07
|
| Rate for Payer: PACE SWMI |
$617.21
|
| Rate for Payer: PHP Medicare Advantage |
$617.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.38
|
| Rate for Payer: Priority Health Medicare |
$617.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.38
|
| Rate for Payer: UHC Medicare Advantage |
$635.73
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,433.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$756.58 |
| Max. Negotiated Rate |
$3,502.63 |
| Rate for Payer: Aetna Commercial |
$1,560.23
|
| Rate for Payer: Aetna Medicare |
$1,164.35
|
| Rate for Payer: BCBS Complete |
$794.41
|
| Rate for Payer: BCBS MAPPO |
$1,164.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,502.63
|
| Rate for Payer: BCN Commercial |
$1,715.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,164.35
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Cofinity Commercial |
$1,676.66
|
| Rate for Payer: Cofinity Commercial |
$1,560.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,164.35
|
| Rate for Payer: Healthscope Commercial |
$1,397.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,397.22
|
| Rate for Payer: Meridian Medicaid |
$794.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,222.57
|
| Rate for Payer: PACE SWMI |
$1,164.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,164.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$756.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,897.20
|
| Rate for Payer: Priority Health Medicare |
$1,164.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,897.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,199.28
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,531.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$2,644.67 |
| Rate for Payer: Aetna Commercial |
$1,042.95
|
| Rate for Payer: Aetna Medicare |
$778.32
|
| Rate for Payer: BCBS Complete |
$524.23
|
| Rate for Payer: BCBS MAPPO |
$778.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,644.67
|
| Rate for Payer: BCN Commercial |
$1,139.60
|
| Rate for Payer: BCN Medicare Advantage |
$778.32
|
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Cash Price |
$2,024.80
|
| Rate for Payer: Cofinity Commercial |
$1,120.78
|
| Rate for Payer: Cofinity Commercial |
$1,042.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.32
|
| Rate for Payer: Healthscope Commercial |
$933.98
|
| Rate for Payer: Healthscope Whirlpool |
$933.98
|
| Rate for Payer: Meridian Medicaid |
$524.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$817.24
|
| Rate for Payer: PACE SWMI |
$778.32
|
| Rate for Payer: PHP Medicare Advantage |
$778.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,190.84
|
| Rate for Payer: Priority Health Medicare |
$778.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,190.84
|
| Rate for Payer: UHC Medicare Advantage |
$801.67
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$454.33 |
| Max. Negotiated Rate |
$1,666.00 |
| Rate for Payer: Aetna Commercial |
$945.60
|
| Rate for Payer: Aetna Medicare |
$705.67
|
| Rate for Payer: BCBS Complete |
$477.05
|
| Rate for Payer: BCBS MAPPO |
$705.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.83
|
| Rate for Payer: BCN Commercial |
$1,040.39
|
| Rate for Payer: BCN Medicare Advantage |
$705.67
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$1,016.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.67
|
| Rate for Payer: Healthscope Commercial |
$846.80
|
| Rate for Payer: Healthscope Whirlpool |
$846.80
|
| Rate for Payer: Meridian Medicaid |
$477.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$740.95
|
| Rate for Payer: PACE SWMI |
$705.67
|
| Rate for Payer: PHP Medicare Advantage |
$705.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,666.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,087.18
|
| Rate for Payer: Priority Health Medicare |
$705.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,087.18
|
| Rate for Payer: UHC Medicare Advantage |
$726.84
|
|
