|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$136.93 |
| Rate for Payer: Aetna Commercial |
$127.42
|
| Rate for Payer: Aetna Medicare |
$95.09
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$93.17
|
| Rate for Payer: BCN Commercial |
$90.82
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$136.93
|
| Rate for Payer: Cofinity Commercial |
$127.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$114.11
|
| Rate for Payer: Healthscope Whirlpool |
$114.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Nomi Health Commercial |
$114.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$93.83
|
| Rate for Payer: UHCCP DNSP |
$95.09
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Aetna Commercial |
$60.17
|
| Rate for Payer: Aetna Medicare |
$44.90
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$44.90
|
| Rate for Payer: BCN Commercial |
$68.72
|
| Rate for Payer: BCN Medicare Advantage |
$44.90
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$64.66
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.90
|
| Rate for Payer: Healthscope Commercial |
$53.88
|
| Rate for Payer: Healthscope Whirlpool |
$53.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.39
|
| Rate for Payer: Nomi Health Commercial |
$53.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.75
|
| Rate for Payer: PACE SWMI |
$44.90
|
| Rate for Payer: PHP Medicare Advantage |
$44.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.32
|
| Rate for Payer: Priority Health Medicare |
$44.90
|
| Rate for Payer: Priority Health Narrow Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$44.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.90
|
| Rate for Payer: UHC Exchange |
$71.68
|
| Rate for Payer: UHCCP DNSP |
$44.90
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$30.11 |
| Rate for Payer: Aetna Commercial |
$23.60
|
| Rate for Payer: Aetna Medicare |
$17.61
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$26.40
|
| Rate for Payer: BCN Medicare Advantage |
$17.61
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$23.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.61
|
| Rate for Payer: Healthscope Commercial |
$21.13
|
| Rate for Payer: Healthscope Whirlpool |
$21.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.37
|
| Rate for Payer: Nomi Health Commercial |
$21.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$17.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.08
|
| Rate for Payer: Priority Health Medicare |
$17.61
|
| Rate for Payer: Priority Health Narrow Network |
$25.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.61
|
| Rate for Payer: UHC Exchange |
$30.11
|
| Rate for Payer: UHCCP DNSP |
$17.61
|
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$451.50 |
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.50
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$561.63 |
| Rate for Payer: Aetna Commercial |
$522.63
|
| Rate for Payer: Aetna Medicare |
$390.02
|
| Rate for Payer: BCBS MAPPO |
$390.02
|
| Rate for Payer: BCBS Trust/PPO |
$397.18
|
| Rate for Payer: BCN Commercial |
$401.85
|
| Rate for Payer: BCN Medicare Advantage |
$390.02
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$561.63
|
| Rate for Payer: Cofinity Commercial |
$522.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.02
|
| Rate for Payer: Healthscope Commercial |
$468.02
|
| Rate for Payer: Healthscope Whirlpool |
$468.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$429.02
|
| Rate for Payer: Nomi Health Commercial |
$468.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: PACE SWMI |
$390.02
|
| Rate for Payer: PHP Medicare Advantage |
$390.02
|
| Rate for Payer: Priority Health Medicare |
$390.02
|
| Rate for Payer: Railroad Medicare Medicare |
$390.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$390.02
|
| Rate for Payer: UHC Exchange |
$389.83
|
| Rate for Payer: UHCCP DNSP |
$390.02
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$83.75
|
| Rate for Payer: Aetna Medicare |
$34.43
|
| Rate for Payer: ASR ASR |
$90.27
|
| Rate for Payer: BCBS Complete |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$76.73
|
| Rate for Payer: BCN Commercial |
$76.73
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$87.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$90.27
|
| Rate for Payer: Healthscope Whirlpool |
$93.06
|
| Rate for Payer: Mclaren Commercial |
$83.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Nomi Health Commercial |
$76.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$81.54
|
| Rate for Payer: Priority Health Narrow Network |
$65.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.89
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$83.75
|
| Rate for Payer: ASR ASR |
$90.27
|
| Rate for Payer: BCBS Trust/PPO |
$76.42
|
| Rate for Payer: BCN Commercial |
$76.42
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$87.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$90.27
|
| Rate for Payer: Healthscope Whirlpool |
$93.06
|
| Rate for Payer: Mclaren Commercial |
$83.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Nomi Health Commercial |
$76.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.89
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.54 |
| Max. Negotiated Rate |
$430.05 |
| Rate for Payer: Aetna Commercial |
$387.05
|
| Rate for Payer: ASR ASR |
$417.15
|
| Rate for Payer: BCBS Trust/PPO |
$353.16
|
| Rate for Payer: BCN Commercial |
$353.16
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$417.15
|
| Rate for Payer: Healthscope Whirlpool |
$430.05
|
| Rate for Payer: Mclaren Commercial |
$387.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.44
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna Commercial |
$100.89
|
| Rate for Payer: Aetna Medicare |
$41.48
|
| Rate for Payer: ASR ASR |
$108.73
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: BCBS Trust/PPO |
$92.42
|
| Rate for Payer: BCN Commercial |
$92.42
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$105.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$108.73
|
| Rate for Payer: Healthscope Whirlpool |
$112.09
|
| Rate for Payer: Mclaren Commercial |
$100.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98.22
|
| Rate for Payer: Priority Health Narrow Network |
$78.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.64
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.07 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna Commercial |
$100.89
|
| Rate for Payer: ASR ASR |
$108.73
|
| Rate for Payer: BCBS Trust/PPO |
$92.05
|
| Rate for Payer: BCN Commercial |
$92.05
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$105.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$108.73
|
| Rate for Payer: Healthscope Whirlpool |
$112.09
|
| Rate for Payer: Mclaren Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.64
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$430.05
|
|
|
Service Code
|
NDC 904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$430.05 |
| Rate for Payer: Aetna Commercial |
$387.05
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: ASR ASR |
$417.15
|
| Rate for Payer: BCBS Complete |
$172.02
|
| Rate for Payer: BCBS Trust/PPO |
$354.58
|
| Rate for Payer: BCN Commercial |
$354.58
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$417.15
|
| Rate for Payer: Healthscope Whirlpool |
$430.05
|
| Rate for Payer: Mclaren Commercial |
$387.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$376.81
|
| Rate for Payer: Priority Health Narrow Network |
$301.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.44
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna Commercial |
$97.99
|
| Rate for Payer: Aetna Medicare |
$73.13
|
| Rate for Payer: BCBS Complete |
$48.75
|
| Rate for Payer: BCBS MAPPO |
$73.13
|
| Rate for Payer: BCN Commercial |
$120.51
|
| Rate for Payer: BCN Medicare Advantage |
$73.13
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$97.99
|
| Rate for Payer: Cofinity Commercial |
$105.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.13
|
| Rate for Payer: Healthscope Commercial |
$87.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.79
|
| Rate for Payer: Meridian Medicaid |
$48.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.44
|
| Rate for Payer: Nomi Health Commercial |
$87.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PACE SWMI |
$73.13
|
| Rate for Payer: PHP Medicare Advantage |
$73.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.77
|
| Rate for Payer: Priority Health Medicare |
$73.13
|
| Rate for Payer: Priority Health Narrow Network |
$113.77
|
| Rate for Payer: Railroad Medicare Medicare |
$73.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.13
|
| Rate for Payer: UHC Exchange |
$142.66
|
| Rate for Payer: UHC Medicaid |
$46.43
|
| Rate for Payer: UHCCP DNSP |
$73.13
|
| Rate for Payer: UHCCP Medicaid |
$46.43
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$160.99
|
| Rate for Payer: BCBS Complete |
$106.90
|
| Rate for Payer: BCBS MAPPO |
$160.99
|
| Rate for Payer: BCN Commercial |
$265.92
|
| Rate for Payer: BCN Medicare Advantage |
$160.99
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$231.83
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.99
|
| Rate for Payer: Healthscope Commercial |
$193.19
|
| Rate for Payer: Healthscope Whirlpool |
$193.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.04
|
| Rate for Payer: Meridian Medicaid |
$106.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$177.09
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PACE SWMI |
$160.99
|
| Rate for Payer: PHP Medicare Advantage |
$160.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.03
|
| Rate for Payer: Priority Health Medicare |
$160.99
|
| Rate for Payer: Priority Health Narrow Network |
$251.03
|
| Rate for Payer: Railroad Medicare Medicare |
$160.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.99
|
| Rate for Payer: UHC Exchange |
$317.97
|
| Rate for Payer: UHC Medicaid |
$101.81
|
| Rate for Payer: UHCCP DNSP |
$160.99
|
| Rate for Payer: UHCCP Medicaid |
$101.81
|
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$1,639.00
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,229.25 |
| Rate for Payer: Aetna Commercial |
$709.53
|
| Rate for Payer: Aetna Medicare |
$529.50
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS MAPPO |
$529.50
|
| Rate for Payer: BCN Commercial |
$875.95
|
| Rate for Payer: BCN Medicare Advantage |
$529.50
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cofinity Commercial |
$762.48
|
| Rate for Payer: Cofinity Commercial |
$709.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.50
|
| Rate for Payer: Healthscope Commercial |
$635.40
|
| Rate for Payer: Healthscope Whirlpool |
$635.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.98
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$582.45
|
| Rate for Payer: Nomi Health Commercial |
$635.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,229.25
|
| Rate for Payer: PACE SWMI |
$529.50
|
| Rate for Payer: PHP Medicare Advantage |
$529.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$936.36
|
| Rate for Payer: Priority Health Medicare |
$529.50
|
| Rate for Payer: Priority Health Narrow Network |
$936.36
|
| Rate for Payer: Railroad Medicare Medicare |
$529.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$986.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$529.50
|
| Rate for Payer: UHC Exchange |
$986.01
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP DNSP |
$529.50
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
|
|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$373.39 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$569.63
|
| Rate for Payer: BCBS Complete |
$392.06
|
| Rate for Payer: BCBS MAPPO |
$569.63
|
| Rate for Payer: BCN Commercial |
$943.68
|
| Rate for Payer: BCN Medicare Advantage |
$569.63
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cofinity Commercial |
$820.27
|
| Rate for Payer: Cofinity Commercial |
$763.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.63
|
| Rate for Payer: Healthscope Commercial |
$683.56
|
| Rate for Payer: Healthscope Whirlpool |
$683.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.11
|
| Rate for Payer: Meridian Medicaid |
$392.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$626.59
|
| Rate for Payer: Nomi Health Commercial |
$683.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,248.00
|
| Rate for Payer: PACE SWMI |
$569.63
|
| Rate for Payer: PHP Medicare Advantage |
$569.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,008.77
|
| Rate for Payer: Priority Health Medicare |
$569.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,008.77
|
| Rate for Payer: Railroad Medicare Medicare |
$569.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$569.63
|
| Rate for Payer: UHC Exchange |
$1,069.26
|
| Rate for Payer: UHC Medicaid |
$373.39
|
| Rate for Payer: UHCCP DNSP |
$569.63
|
| Rate for Payer: UHCCP Medicaid |
$373.39
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,483.50 |
| Rate for Payer: Aetna Commercial |
$863.11
|
| Rate for Payer: Aetna Medicare |
$644.11
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCBS MAPPO |
$644.11
|
| Rate for Payer: BCN Commercial |
$1,073.15
|
| Rate for Payer: BCN Medicare Advantage |
$644.11
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$927.52
|
| Rate for Payer: Cofinity Commercial |
$863.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$772.93
|
| Rate for Payer: Healthscope Whirlpool |
$772.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.32
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$708.52
|
| Rate for Payer: Nomi Health Commercial |
$772.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,483.50
|
| Rate for Payer: PACE SWMI |
$644.11
|
| Rate for Payer: PHP Medicare Advantage |
$644.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,147.17
|
| Rate for Payer: Priority Health Medicare |
$644.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,147.17
|
| Rate for Payer: Railroad Medicare Medicare |
$644.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,224.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$644.11
|
| Rate for Payer: UHC Exchange |
$1,224.73
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP DNSP |
$644.11
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$411.94 |
| Max. Negotiated Rate |
$1,195.97 |
| Rate for Payer: Aetna Commercial |
$844.31
|
| Rate for Payer: Aetna Medicare |
$630.08
|
| Rate for Payer: BCBS Complete |
$432.54
|
| Rate for Payer: BCBS MAPPO |
$630.08
|
| Rate for Payer: BCN Commercial |
$1,049.74
|
| Rate for Payer: BCN Medicare Advantage |
$630.08
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$907.32
|
| Rate for Payer: Cofinity Commercial |
$844.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.08
|
| Rate for Payer: Healthscope Commercial |
$756.10
|
| Rate for Payer: Healthscope Whirlpool |
$756.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$661.58
|
| Rate for Payer: Meridian Medicaid |
$432.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$693.09
|
| Rate for Payer: Nomi Health Commercial |
$756.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$955.50
|
| Rate for Payer: PACE SWMI |
$630.08
|
| Rate for Payer: PHP Medicare Advantage |
$630.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,122.14
|
| Rate for Payer: Priority Health Medicare |
$630.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,122.14
|
| Rate for Payer: Railroad Medicare Medicare |
$630.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,195.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$630.08
|
| Rate for Payer: UHC Exchange |
$1,195.97
|
| Rate for Payer: UHC Medicaid |
$411.94
|
| Rate for Payer: UHCCP DNSP |
$630.08
|
| Rate for Payer: UHCCP Medicaid |
$411.94
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$425.79 |
| Max. Negotiated Rate |
$1,699.50 |
| Rate for Payer: Aetna Commercial |
$853.35
|
| Rate for Payer: Aetna Medicare |
$636.83
|
| Rate for Payer: BCBS Complete |
$447.08
|
| Rate for Payer: BCBS MAPPO |
$636.83
|
| Rate for Payer: BCN Commercial |
$1,034.80
|
| Rate for Payer: BCN Medicare Advantage |
$636.83
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cofinity Commercial |
$917.04
|
| Rate for Payer: Cofinity Commercial |
$853.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.83
|
| Rate for Payer: Healthscope Commercial |
$764.20
|
| Rate for Payer: Healthscope Whirlpool |
$764.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.67
|
| Rate for Payer: Meridian Medicaid |
$447.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$700.51
|
| Rate for Payer: Nomi Health Commercial |
$764.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.50
|
| Rate for Payer: PACE SWMI |
$636.83
|
| Rate for Payer: PHP Medicare Advantage |
$636.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,106.18
|
| Rate for Payer: Priority Health Medicare |
$636.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,106.18
|
| Rate for Payer: Railroad Medicare Medicare |
$636.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,127.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$636.83
|
| Rate for Payer: UHC Exchange |
$1,127.29
|
| Rate for Payer: UHC Medicaid |
$425.79
|
| Rate for Payer: UHCCP DNSP |
$636.83
|
| Rate for Payer: UHCCP Medicaid |
$425.79
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$446.02 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$889.92
|
| Rate for Payer: Aetna Medicare |
$664.12
|
| Rate for Payer: BCBS Complete |
$468.32
|
| Rate for Payer: BCBS MAPPO |
$664.12
|
| Rate for Payer: BCN Commercial |
$1,065.18
|
| Rate for Payer: BCN Medicare Advantage |
$664.12
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cofinity Commercial |
$956.33
|
| Rate for Payer: Cofinity Commercial |
$889.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.12
|
| Rate for Payer: Healthscope Commercial |
$796.94
|
| Rate for Payer: Healthscope Whirlpool |
$796.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.33
|
| Rate for Payer: Meridian Medicaid |
$468.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.53
|
| Rate for Payer: Nomi Health Commercial |
$796.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,275.00
|
| Rate for Payer: PACE SWMI |
$664.12
|
| Rate for Payer: PHP Medicare Advantage |
$664.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,138.65
|
| Rate for Payer: Priority Health Medicare |
$664.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,138.65
|
| Rate for Payer: Railroad Medicare Medicare |
$664.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,138.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$664.12
|
| Rate for Payer: UHC Exchange |
$1,138.59
|
| Rate for Payer: UHC Medicaid |
$446.02
|
| Rate for Payer: UHCCP DNSP |
$664.12
|
| Rate for Payer: UHCCP Medicaid |
$446.02
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$0.92
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$0.77
|
| Rate for Payer: Healthscope Whirlpool |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.70
|
| Rate for Payer: Nomi Health Commercial |
$0.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHCCP DNSP |
$0.64
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$383.83 |
| Max. Negotiated Rate |
$1,539.75 |
| Rate for Payer: Aetna Commercial |
$797.22
|
| Rate for Payer: Aetna Medicare |
$594.94
|
| Rate for Payer: BCBS Complete |
$403.02
|
| Rate for Payer: BCBS MAPPO |
$594.94
|
| Rate for Payer: BCN Commercial |
$974.05
|
| Rate for Payer: BCN Medicare Advantage |
$594.94
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$856.71
|
| Rate for Payer: Cofinity Commercial |
$797.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.94
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Healthscope Whirlpool |
$713.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$624.69
|
| Rate for Payer: Meridian Medicaid |
$403.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$654.43
|
| Rate for Payer: Nomi Health Commercial |
$713.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.75
|
| Rate for Payer: PACE SWMI |
$594.94
|
| Rate for Payer: PHP Medicare Advantage |
$594.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,041.24
|
| Rate for Payer: Priority Health Medicare |
$594.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,041.24
|
| Rate for Payer: Railroad Medicare Medicare |
$594.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,154.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$594.94
|
| Rate for Payer: UHC Exchange |
$1,154.59
|
| Rate for Payer: UHC Medicaid |
$383.83
|
| Rate for Payer: UHCCP DNSP |
$594.94
|
| Rate for Payer: UHCCP Medicaid |
$383.83
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$349.32 |
| Max. Negotiated Rate |
$1,329.75 |
| Rate for Payer: Aetna Commercial |
$723.22
|
| Rate for Payer: Aetna Medicare |
$539.72
|
| Rate for Payer: BCBS Complete |
$366.79
|
| Rate for Payer: BCBS MAPPO |
$539.72
|
| Rate for Payer: BCN Commercial |
$870.97
|
| Rate for Payer: BCN Medicare Advantage |
$539.72
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Cofinity Commercial |
$777.20
|
| Rate for Payer: Cofinity Commercial |
$723.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.72
|
| Rate for Payer: Healthscope Commercial |
$647.66
|
| Rate for Payer: Healthscope Whirlpool |
$647.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$566.71
|
| Rate for Payer: Meridian Medicaid |
$366.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$593.69
|
| Rate for Payer: Nomi Health Commercial |
$647.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,329.75
|
| Rate for Payer: PACE SWMI |
$539.72
|
| Rate for Payer: PHP Medicare Advantage |
$539.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$931.04
|
| Rate for Payer: Priority Health Medicare |
$539.72
|
| Rate for Payer: Priority Health Narrow Network |
$931.04
|
| Rate for Payer: Railroad Medicare Medicare |
$539.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,009.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$539.72
|
| Rate for Payer: UHC Exchange |
$1,009.13
|
| Rate for Payer: UHC Medicaid |
$349.32
|
| Rate for Payer: UHCCP DNSP |
$539.72
|
| Rate for Payer: UHCCP Medicaid |
$349.32
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,549.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$472.22 |
| Max. Negotiated Rate |
$1,911.75 |
| Rate for Payer: Aetna Commercial |
$949.94
|
| Rate for Payer: Aetna Medicare |
$708.91
|
| Rate for Payer: BCBS Complete |
$495.83
|
| Rate for Payer: BCBS MAPPO |
$708.91
|
| Rate for Payer: BCN Commercial |
$1,152.83
|
| Rate for Payer: BCN Medicare Advantage |
$708.91
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cofinity Commercial |
$949.94
|
| Rate for Payer: Cofinity Commercial |
$1,020.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.91
|
| Rate for Payer: Healthscope Commercial |
$850.69
|
| Rate for Payer: Healthscope Whirlpool |
$850.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.36
|
| Rate for Payer: Meridian Medicaid |
$495.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$779.80
|
| Rate for Payer: Nomi Health Commercial |
$850.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,911.75
|
| Rate for Payer: PACE SWMI |
$708.91
|
| Rate for Payer: PHP Medicare Advantage |
$708.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,232.34
|
| Rate for Payer: Priority Health Medicare |
$708.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,232.34
|
| Rate for Payer: Railroad Medicare Medicare |
$708.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,263.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$708.91
|
| Rate for Payer: UHC Exchange |
$1,263.90
|
| Rate for Payer: UHC Medicaid |
$472.22
|
| Rate for Payer: UHCCP DNSP |
$708.91
|
| Rate for Payer: UHCCP Medicaid |
$472.22
|
|
|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$897.21 |
| Rate for Payer: Aetna Commercial |
$628.58
|
| Rate for Payer: Aetna Medicare |
$469.09
|
| Rate for Payer: BCBS Complete |
$320.04
|
| Rate for Payer: BCBS MAPPO |
$469.09
|
| Rate for Payer: BCN Commercial |
$763.41
|
| Rate for Payer: BCN Medicare Advantage |
$469.09
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| Rate for Payer: Cofinity Commercial |
$628.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.09
|
| Rate for Payer: Healthscope Commercial |
$562.91
|
| Rate for Payer: Healthscope Whirlpool |
$562.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$492.54
|
| Rate for Payer: Meridian Medicaid |
$320.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$516.00
|
| Rate for Payer: Nomi Health Commercial |
$562.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.75
|
| Rate for Payer: PACE SWMI |
$469.09
|
| Rate for Payer: PHP Medicare Advantage |
$469.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$816.06
|
| Rate for Payer: Priority Health Medicare |
$469.09
|
| Rate for Payer: Priority Health Narrow Network |
$816.06
|
| Rate for Payer: Railroad Medicare Medicare |
$469.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$469.09
|
| Rate for Payer: UHC Exchange |
$897.21
|
| Rate for Payer: UHC Medicaid |
$304.80
|
| Rate for Payer: UHCCP DNSP |
$469.09
|
| Rate for Payer: UHCCP Medicaid |
$304.80
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$1,279.80 |
| Rate for Payer: Aetna Commercial |
$899.33
|
| Rate for Payer: Aetna Medicare |
$671.14
|
| Rate for Payer: BCBS Complete |
$460.05
|
| Rate for Payer: BCBS MAPPO |
$671.14
|
| Rate for Payer: BCN Commercial |
$1,120.46
|
| Rate for Payer: BCN Medicare Advantage |
$671.14
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$966.44
|
| Rate for Payer: Cofinity Commercial |
$899.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.14
|
| Rate for Payer: Healthscope Commercial |
$805.37
|
| Rate for Payer: Healthscope Whirlpool |
$805.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.70
|
| Rate for Payer: Meridian Medicaid |
$460.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$738.25
|
| Rate for Payer: Nomi Health Commercial |
$805.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PACE SWMI |
$671.14
|
| Rate for Payer: PHP Medicare Advantage |
$671.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,197.74
|
| Rate for Payer: Priority Health Medicare |
$671.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,197.74
|
| Rate for Payer: Railroad Medicare Medicare |
$671.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,279.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$671.14
|
| Rate for Payer: UHC Exchange |
$1,279.80
|
| Rate for Payer: UHC Medicaid |
$438.14
|
| Rate for Payer: UHCCP DNSP |
$671.14
|
| Rate for Payer: UHCCP Medicaid |
$438.14
|
|
