|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$2,445.00
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$460.51 |
| Max. Negotiated Rate |
$1,833.75 |
| Rate for Payer: Aetna Commercial |
$946.33
|
| Rate for Payer: Aetna Medicare |
$706.22
|
| Rate for Payer: BCBS Complete |
$483.54
|
| Rate for Payer: BCBS MAPPO |
$706.22
|
| Rate for Payer: BCN Commercial |
$1,180.21
|
| Rate for Payer: BCN Medicare Advantage |
$706.22
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cofinity Commercial |
$946.33
|
| Rate for Payer: Cofinity Commercial |
$1,016.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.22
|
| Rate for Payer: Healthscope Commercial |
$847.46
|
| Rate for Payer: Healthscope Whirlpool |
$847.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.53
|
| Rate for Payer: Meridian Medicaid |
$483.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.84
|
| Rate for Payer: Nomi Health Commercial |
$847.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.75
|
| Rate for Payer: PACE SWMI |
$706.22
|
| Rate for Payer: PHP Medicare Advantage |
$706.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,261.61
|
| Rate for Payer: Priority Health Medicare |
$706.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,261.61
|
| Rate for Payer: Railroad Medicare Medicare |
$706.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,353.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$706.22
|
| Rate for Payer: UHC Exchange |
$1,353.91
|
| Rate for Payer: UHC Medicaid |
$460.51
|
| Rate for Payer: UHCCP DNSP |
$706.22
|
| Rate for Payer: UHCCP Medicaid |
$460.51
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,382.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$459.23 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna Commercial |
$940.08
|
| Rate for Payer: Aetna Medicare |
$701.55
|
| Rate for Payer: BCBS Complete |
$482.19
|
| Rate for Payer: BCBS MAPPO |
$701.55
|
| Rate for Payer: BCN Commercial |
$1,167.26
|
| Rate for Payer: BCN Medicare Advantage |
$701.55
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cofinity Commercial |
$940.08
|
| Rate for Payer: Cofinity Commercial |
$1,010.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.55
|
| Rate for Payer: Healthscope Commercial |
$841.86
|
| Rate for Payer: Healthscope Whirlpool |
$841.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$736.63
|
| Rate for Payer: Meridian Medicaid |
$482.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$771.71
|
| Rate for Payer: Nomi Health Commercial |
$841.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: PACE SWMI |
$701.55
|
| Rate for Payer: PHP Medicare Advantage |
$701.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,247.77
|
| Rate for Payer: Priority Health Medicare |
$701.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,247.77
|
| Rate for Payer: Railroad Medicare Medicare |
$701.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,288.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$701.55
|
| Rate for Payer: UHC Exchange |
$1,288.64
|
| Rate for Payer: UHC Medicaid |
$459.23
|
| Rate for Payer: UHCCP DNSP |
$701.55
|
| Rate for Payer: UHCCP Medicaid |
$459.23
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$1,682.00
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$1,261.50 |
| Rate for Payer: Aetna Commercial |
$644.33
|
| Rate for Payer: Aetna Medicare |
$480.84
|
| Rate for Payer: BCBS Complete |
$328.99
|
| Rate for Payer: BCBS MAPPO |
$480.84
|
| Rate for Payer: BCN Commercial |
$796.27
|
| Rate for Payer: BCN Medicare Advantage |
$480.84
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Cofinity Commercial |
$692.41
|
| Rate for Payer: Cofinity Commercial |
$644.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.84
|
| Rate for Payer: Healthscope Commercial |
$577.01
|
| Rate for Payer: Healthscope Whirlpool |
$577.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.88
|
| Rate for Payer: Meridian Medicaid |
$328.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$528.92
|
| Rate for Payer: Nomi Health Commercial |
$577.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,261.50
|
| Rate for Payer: PACE SWMI |
$480.84
|
| Rate for Payer: PHP Medicare Advantage |
$480.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$851.19
|
| Rate for Payer: Priority Health Medicare |
$480.84
|
| Rate for Payer: Priority Health Narrow Network |
$851.19
|
| Rate for Payer: Railroad Medicare Medicare |
$480.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$938.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.84
|
| Rate for Payer: UHC Exchange |
$938.83
|
| Rate for Payer: UHC Medicaid |
$313.32
|
| Rate for Payer: UHCCP DNSP |
$480.84
|
| Rate for Payer: UHCCP Medicaid |
$313.32
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,988.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$414.07 |
| Max. Negotiated Rate |
$1,491.00 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$640.08
|
| Rate for Payer: BCBS Complete |
$434.77
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCN Commercial |
$1,059.70
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Commercial |
$921.72
|
| Rate for Payer: Cofinity Commercial |
$857.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.08
|
| Rate for Payer: Healthscope Commercial |
$768.10
|
| Rate for Payer: Healthscope Whirlpool |
$768.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Meridian Medicaid |
$434.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$704.09
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,132.79
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,132.79
|
| Rate for Payer: Railroad Medicare Medicare |
$640.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$640.08
|
| Rate for Payer: UHC Exchange |
$1,275.54
|
| Rate for Payer: UHC Medicaid |
$414.07
|
| Rate for Payer: UHCCP DNSP |
$640.08
|
| Rate for Payer: UHCCP Medicaid |
$414.07
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$2,452.00
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$1,839.00 |
| Rate for Payer: Aetna Commercial |
$874.38
|
| Rate for Payer: Aetna Medicare |
$652.52
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS MAPPO |
$652.52
|
| Rate for Payer: BCN Commercial |
$1,102.03
|
| Rate for Payer: BCN Medicare Advantage |
$652.52
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cofinity Commercial |
$939.63
|
| Rate for Payer: Cofinity Commercial |
$874.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.52
|
| Rate for Payer: Healthscope Commercial |
$783.02
|
| Rate for Payer: Healthscope Whirlpool |
$783.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.15
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$717.77
|
| Rate for Payer: Nomi Health Commercial |
$783.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,839.00
|
| Rate for Payer: PACE SWMI |
$652.52
|
| Rate for Payer: PHP Medicare Advantage |
$652.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,178.04
|
| Rate for Payer: Priority Health Medicare |
$652.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.04
|
| Rate for Payer: Railroad Medicare Medicare |
$652.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,240.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$652.52
|
| Rate for Payer: UHC Exchange |
$1,240.15
|
| Rate for Payer: UHC Medicaid |
$427.28
|
| Rate for Payer: UHCCP DNSP |
$652.52
|
| Rate for Payer: UHCCP Medicaid |
$427.28
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$2,791.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$524.62 |
| Max. Negotiated Rate |
$2,093.25 |
| Rate for Payer: Aetna Commercial |
$1,100.31
|
| Rate for Payer: Aetna Medicare |
$821.13
|
| Rate for Payer: BCBS Complete |
$550.85
|
| Rate for Payer: BCBS MAPPO |
$821.13
|
| Rate for Payer: BCN Commercial |
$1,339.57
|
| Rate for Payer: BCN Medicare Advantage |
$821.13
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cofinity Commercial |
$1,182.43
|
| Rate for Payer: Cofinity Commercial |
$1,100.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.13
|
| Rate for Payer: Healthscope Commercial |
$985.36
|
| Rate for Payer: Healthscope Whirlpool |
$985.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.19
|
| Rate for Payer: Meridian Medicaid |
$550.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$903.24
|
| Rate for Payer: Nomi Health Commercial |
$985.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,093.25
|
| Rate for Payer: PACE SWMI |
$821.13
|
| Rate for Payer: PHP Medicare Advantage |
$821.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$524.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,431.96
|
| Rate for Payer: Priority Health Medicare |
$821.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.96
|
| Rate for Payer: Railroad Medicare Medicare |
$821.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,614.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$821.13
|
| Rate for Payer: UHC Exchange |
$1,614.48
|
| Rate for Payer: UHC Medicaid |
$524.62
|
| Rate for Payer: UHCCP DNSP |
$821.13
|
| Rate for Payer: UHCCP Medicaid |
$524.62
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,204.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Aetna Commercial |
$736.08
|
| Rate for Payer: Aetna Medicare |
$549.31
|
| Rate for Payer: BCBS Complete |
$369.92
|
| Rate for Payer: BCBS MAPPO |
$549.31
|
| Rate for Payer: BCN Commercial |
$883.92
|
| Rate for Payer: BCN Medicare Advantage |
$549.31
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cofinity Commercial |
$791.01
|
| Rate for Payer: Cofinity Commercial |
$736.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.31
|
| Rate for Payer: Healthscope Commercial |
$659.17
|
| Rate for Payer: Healthscope Whirlpool |
$659.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$576.78
|
| Rate for Payer: Meridian Medicaid |
$369.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$604.24
|
| Rate for Payer: Nomi Health Commercial |
$659.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,653.00
|
| Rate for Payer: PACE SWMI |
$549.31
|
| Rate for Payer: PHP Medicare Advantage |
$549.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$944.88
|
| Rate for Payer: Priority Health Medicare |
$549.31
|
| Rate for Payer: Priority Health Narrow Network |
$944.88
|
| Rate for Payer: Railroad Medicare Medicare |
$549.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,058.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$549.31
|
| Rate for Payer: UHC Exchange |
$1,058.88
|
| Rate for Payer: UHC Medicaid |
$352.30
|
| Rate for Payer: UHCCP DNSP |
$549.31
|
| Rate for Payer: UHCCP Medicaid |
$352.30
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$1,109.25 |
| Rate for Payer: Aetna Commercial |
$519.93
|
| Rate for Payer: Aetna Medicare |
$388.01
|
| Rate for Payer: BCBS Complete |
$265.69
|
| Rate for Payer: BCBS MAPPO |
$388.01
|
| Rate for Payer: BCN Commercial |
$636.42
|
| Rate for Payer: BCN Medicare Advantage |
$388.01
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$558.73
|
| Rate for Payer: Cofinity Commercial |
$519.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.01
|
| Rate for Payer: Healthscope Commercial |
$465.61
|
| Rate for Payer: Healthscope Whirlpool |
$465.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.41
|
| Rate for Payer: Meridian Medicaid |
$265.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$426.81
|
| Rate for Payer: Nomi Health Commercial |
$465.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,109.25
|
| Rate for Payer: PACE SWMI |
$388.01
|
| Rate for Payer: PHP Medicare Advantage |
$388.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$680.32
|
| Rate for Payer: Priority Health Medicare |
$388.01
|
| Rate for Payer: Priority Health Narrow Network |
$680.32
|
| Rate for Payer: Railroad Medicare Medicare |
$388.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$388.01
|
| Rate for Payer: UHC Exchange |
$751.89
|
| Rate for Payer: UHC Medicaid |
$253.04
|
| Rate for Payer: UHCCP DNSP |
$388.01
|
| Rate for Payer: UHCCP Medicaid |
$253.04
|
|
|
PR AMPUTATION PENIS COMPLETE
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$476.48 |
| Max. Negotiated Rate |
$1,438.84 |
| Rate for Payer: Aetna Commercial |
$988.36
|
| Rate for Payer: Aetna Medicare |
$737.58
|
| Rate for Payer: BCBS Complete |
$500.30
|
| Rate for Payer: BCBS MAPPO |
$737.58
|
| Rate for Payer: BCN Commercial |
$1,239.97
|
| Rate for Payer: BCN Medicare Advantage |
$737.58
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cofinity Commercial |
$988.36
|
| Rate for Payer: Cofinity Commercial |
$1,062.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$737.58
|
| Rate for Payer: Healthscope Commercial |
$885.10
|
| Rate for Payer: Healthscope Whirlpool |
$885.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$774.46
|
| Rate for Payer: Meridian Medicaid |
$500.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$811.34
|
| Rate for Payer: Nomi Health Commercial |
$885.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,199.25
|
| Rate for Payer: PACE SWMI |
$737.58
|
| Rate for Payer: PHP Medicare Advantage |
$737.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,350.74
|
| Rate for Payer: Priority Health Medicare |
$737.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.74
|
| Rate for Payer: Railroad Medicare Medicare |
$737.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,438.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$737.58
|
| Rate for Payer: UHC Exchange |
$1,438.84
|
| Rate for Payer: UHC Medicaid |
$476.48
|
| Rate for Payer: UHCCP DNSP |
$737.58
|
| Rate for Payer: UHCCP Medicaid |
$476.48
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$367.64 |
| Max. Negotiated Rate |
$1,112.94 |
| Rate for Payer: Aetna Commercial |
$760.52
|
| Rate for Payer: Aetna Medicare |
$567.55
|
| Rate for Payer: BCBS Complete |
$386.02
|
| Rate for Payer: BCBS MAPPO |
$567.55
|
| Rate for Payer: BCN Commercial |
$950.64
|
| Rate for Payer: BCN Medicare Advantage |
$567.55
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$817.27
|
| Rate for Payer: Cofinity Commercial |
$760.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.55
|
| Rate for Payer: Healthscope Commercial |
$681.06
|
| Rate for Payer: Healthscope Whirlpool |
$681.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.93
|
| Rate for Payer: Meridian Medicaid |
$386.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$624.30
|
| Rate for Payer: Nomi Health Commercial |
$681.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.50
|
| Rate for Payer: PACE SWMI |
$567.55
|
| Rate for Payer: PHP Medicare Advantage |
$567.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,035.55
|
| Rate for Payer: Priority Health Medicare |
$567.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,035.55
|
| Rate for Payer: Railroad Medicare Medicare |
$567.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$567.55
|
| Rate for Payer: UHC Exchange |
$1,112.94
|
| Rate for Payer: UHC Medicaid |
$367.64
|
| Rate for Payer: UHCCP DNSP |
$567.55
|
| Rate for Payer: UHCCP Medicaid |
$367.64
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,556.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$681.39 |
| Max. Negotiated Rate |
$2,109.77 |
| Rate for Payer: Aetna Commercial |
$1,416.61
|
| Rate for Payer: Aetna Medicare |
$1,057.17
|
| Rate for Payer: BCBS Complete |
$715.46
|
| Rate for Payer: BCBS MAPPO |
$1,057.17
|
| Rate for Payer: BCN Commercial |
$1,779.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.17
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cofinity Commercial |
$1,522.32
|
| Rate for Payer: Cofinity Commercial |
$1,416.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.17
|
| Rate for Payer: Healthscope Commercial |
$1,268.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,268.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,110.03
|
| Rate for Payer: Meridian Medicaid |
$715.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,162.89
|
| Rate for Payer: Nomi Health Commercial |
$1,268.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.00
|
| Rate for Payer: PACE SWMI |
$1,057.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,938.76
|
| Rate for Payer: Priority Health Medicare |
$1,057.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,938.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,109.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,057.17
|
| Rate for Payer: UHC Exchange |
$2,109.77
|
| Rate for Payer: UHC Medicaid |
$681.39
|
| Rate for Payer: UHCCP DNSP |
$1,057.17
|
| Rate for Payer: UHCCP Medicaid |
$681.39
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,659.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$459.87 |
| Max. Negotiated Rate |
$1,994.25 |
| Rate for Payer: Aetna Commercial |
$964.97
|
| Rate for Payer: Aetna Medicare |
$720.13
|
| Rate for Payer: BCBS Complete |
$482.86
|
| Rate for Payer: BCBS MAPPO |
$720.13
|
| Rate for Payer: BCN Commercial |
$1,167.26
|
| Rate for Payer: BCN Medicare Advantage |
$720.13
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cofinity Commercial |
$964.97
|
| Rate for Payer: Cofinity Commercial |
$1,036.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.13
|
| Rate for Payer: Healthscope Commercial |
$864.16
|
| Rate for Payer: Healthscope Whirlpool |
$864.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$756.14
|
| Rate for Payer: Meridian Medicaid |
$482.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$792.14
|
| Rate for Payer: Nomi Health Commercial |
$864.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,994.25
|
| Rate for Payer: PACE SWMI |
$720.13
|
| Rate for Payer: PHP Medicare Advantage |
$720.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,247.77
|
| Rate for Payer: Priority Health Medicare |
$720.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,247.77
|
| Rate for Payer: Railroad Medicare Medicare |
$720.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,410.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$720.13
|
| Rate for Payer: UHC Exchange |
$1,410.93
|
| Rate for Payer: UHC Medicaid |
$459.87
|
| Rate for Payer: UHCCP DNSP |
$720.13
|
| Rate for Payer: UHCCP Medicaid |
$459.87
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,501.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,875.75 |
| Rate for Payer: Aetna Commercial |
$875.85
|
| Rate for Payer: Aetna Medicare |
$653.62
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCBS MAPPO |
$653.62
|
| Rate for Payer: BCN Commercial |
$1,066.18
|
| Rate for Payer: BCN Medicare Advantage |
$653.62
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cofinity Commercial |
$941.21
|
| Rate for Payer: Cofinity Commercial |
$875.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.62
|
| Rate for Payer: Healthscope Commercial |
$784.34
|
| Rate for Payer: Healthscope Whirlpool |
$784.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.30
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$718.98
|
| Rate for Payer: Nomi Health Commercial |
$784.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.75
|
| Rate for Payer: PACE SWMI |
$653.62
|
| Rate for Payer: PHP Medicare Advantage |
$653.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,139.72
|
| Rate for Payer: Priority Health Medicare |
$653.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,139.72
|
| Rate for Payer: Railroad Medicare Medicare |
$653.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,262.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$653.62
|
| Rate for Payer: UHC Exchange |
$1,262.53
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP DNSP |
$653.62
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$400.65 |
| Max. Negotiated Rate |
$2,392.50 |
| Rate for Payer: Aetna Commercial |
$835.57
|
| Rate for Payer: Aetna Medicare |
$623.56
|
| Rate for Payer: BCBS Complete |
$420.68
|
| Rate for Payer: BCBS MAPPO |
$623.56
|
| Rate for Payer: BCN Commercial |
$1,011.40
|
| Rate for Payer: BCN Medicare Advantage |
$623.56
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cofinity Commercial |
$897.93
|
| Rate for Payer: Cofinity Commercial |
$835.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.56
|
| Rate for Payer: Healthscope Commercial |
$748.27
|
| Rate for Payer: Healthscope Whirlpool |
$748.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.74
|
| Rate for Payer: Meridian Medicaid |
$420.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$685.92
|
| Rate for Payer: Nomi Health Commercial |
$748.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,392.50
|
| Rate for Payer: PACE SWMI |
$623.56
|
| Rate for Payer: PHP Medicare Advantage |
$623.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,081.16
|
| Rate for Payer: Priority Health Medicare |
$623.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,081.16
|
| Rate for Payer: Railroad Medicare Medicare |
$623.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,196.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$623.56
|
| Rate for Payer: UHC Exchange |
$1,196.77
|
| Rate for Payer: UHC Medicaid |
$400.65
|
| Rate for Payer: UHCCP DNSP |
$623.56
|
| Rate for Payer: UHCCP Medicaid |
$400.65
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Aetna Commercial |
$207.94
|
| Rate for Payer: Aetna Medicare |
$155.18
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$155.18
|
| Rate for Payer: BCN Commercial |
$258.95
|
| Rate for Payer: BCN Medicare Advantage |
$155.18
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cofinity Commercial |
$223.46
|
| Rate for Payer: Cofinity Commercial |
$207.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.18
|
| Rate for Payer: Healthscope Commercial |
$186.22
|
| Rate for Payer: Healthscope Whirlpool |
$186.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.94
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.70
|
| Rate for Payer: Nomi Health Commercial |
$186.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,039.50
|
| Rate for Payer: PACE SWMI |
$155.18
|
| Rate for Payer: PHP Medicare Advantage |
$155.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$276.81
|
| Rate for Payer: Priority Health Medicare |
$155.18
|
| Rate for Payer: Priority Health Narrow Network |
$276.81
|
| Rate for Payer: Railroad Medicare Medicare |
$155.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$641.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.18
|
| Rate for Payer: UHC Exchange |
$641.10
|
| Rate for Payer: UHC Medicaid |
$99.68
|
| Rate for Payer: UHCCP DNSP |
$155.18
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna Commercial |
$215.15
|
| Rate for Payer: Aetna Medicare |
$160.56
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS MAPPO |
$160.56
|
| Rate for Payer: BCN Commercial |
$265.43
|
| Rate for Payer: BCN Medicare Advantage |
$160.56
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$215.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.56
|
| Rate for Payer: Healthscope Commercial |
$192.67
|
| Rate for Payer: Healthscope Whirlpool |
$192.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.59
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.62
|
| Rate for Payer: Nomi Health Commercial |
$192.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE SWMI |
$160.56
|
| Rate for Payer: PHP Medicare Advantage |
$160.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$283.74
|
| Rate for Payer: Priority Health Medicare |
$160.56
|
| Rate for Payer: Priority Health Narrow Network |
$283.74
|
| Rate for Payer: Railroad Medicare Medicare |
$160.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.56
|
| Rate for Payer: UHC Exchange |
$684.83
|
| Rate for Payer: UHC Medicaid |
$103.09
|
| Rate for Payer: UHCCP DNSP |
$160.56
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,203.00 |
| Max. Negotiated Rate |
$1,604.00 |
| Rate for Payer: Aetna Commercial |
$1,443.60
|
| Rate for Payer: ASR ASR |
$1,555.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.20
|
| Rate for Payer: BCN Commercial |
$1,317.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,507.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,283.20
|
| Rate for Payer: Healthscope Commercial |
$1,555.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,604.00
|
| Rate for Payer: Mclaren Commercial |
$1,443.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,363.40
|
| Rate for Payer: Nomi Health Commercial |
$1,315.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna Commercial |
$215.15
|
| Rate for Payer: Aetna Medicare |
$160.56
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS MAPPO |
$160.56
|
| Rate for Payer: BCN Commercial |
$265.43
|
| Rate for Payer: BCN Medicare Advantage |
$160.56
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Commercial |
$215.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.56
|
| Rate for Payer: Healthscope Commercial |
$192.67
|
| Rate for Payer: Healthscope Whirlpool |
$192.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.59
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.62
|
| Rate for Payer: Nomi Health Commercial |
$192.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE SWMI |
$160.56
|
| Rate for Payer: PHP Medicare Advantage |
$160.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$283.74
|
| Rate for Payer: Priority Health Medicare |
$160.56
|
| Rate for Payer: Priority Health Narrow Network |
$283.74
|
| Rate for Payer: Railroad Medicare Medicare |
$160.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.56
|
| Rate for Payer: UHC Exchange |
$684.83
|
| Rate for Payer: UHC Medicaid |
$103.09
|
| Rate for Payer: UHCCP DNSP |
$160.56
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,124.40 |
| Max. Negotiated Rate |
$4,075.29 |
| Rate for Payer: Aetna Commercial |
$1,443.60
|
| Rate for Payer: Aetna Medicare |
$3,260.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: ASR ASR |
$1,555.88
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.50
|
| Rate for Payer: BCN Commercial |
$1,322.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,507.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,283.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$1,555.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,604.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,260.23
|
| Rate for Payer: Mclaren Commercial |
$1,443.60
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$1,790.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,363.40
|
| Rate for Payer: Nomi Health Commercial |
$1,315.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$3,586.25
|
| Rate for Payer: PHP Medicaid |
$1,747.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,405.42
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,124.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP DNSP |
$3,260.23
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 92603
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna Commercial |
$126.13
|
| Rate for Payer: Aetna Medicare |
$94.13
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS MAPPO |
$94.13
|
| Rate for Payer: BCN Commercial |
$176.28
|
| Rate for Payer: BCN Medicare Advantage |
$94.13
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$135.55
|
| Rate for Payer: Cofinity Commercial |
$126.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.13
|
| Rate for Payer: Healthscope Commercial |
$112.96
|
| Rate for Payer: Healthscope Whirlpool |
$112.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.84
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.54
|
| Rate for Payer: Nomi Health Commercial |
$112.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PACE SWMI |
$94.13
|
| Rate for Payer: PHP Medicare Advantage |
$94.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.58
|
| Rate for Payer: Priority Health Medicare |
$94.13
|
| Rate for Payer: Priority Health Narrow Network |
$162.58
|
| Rate for Payer: Railroad Medicare Medicare |
$94.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.13
|
| Rate for Payer: UHC Exchange |
$196.56
|
| Rate for Payer: UHC Medicaid |
$61.13
|
| Rate for Payer: UHCCP DNSP |
$94.13
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 92604
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$98.10
|
| Rate for Payer: BCN Medicare Advantage |
$52.50
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$70.35
|
| Rate for Payer: Cofinity Commercial |
$75.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.12
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.75
|
| Rate for Payer: Nomi Health Commercial |
$63.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.00
|
| Rate for Payer: PACE SWMI |
$52.50
|
| Rate for Payer: PHP Medicare Advantage |
$52.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$90.47
|
| Rate for Payer: Priority Health Medicare |
$52.50
|
| Rate for Payer: Priority Health Narrow Network |
$90.47
|
| Rate for Payer: Railroad Medicare Medicare |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.50
|
| Rate for Payer: UHC Exchange |
$109.56
|
| Rate for Payer: UHC Medicaid |
$34.08
|
| Rate for Payer: UHCCP DNSP |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR ANALYZE NEUROSTIM BRAIN, FIRST 1H
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 95978
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: BCBS Complete |
$208.80
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.50
|
|
|
PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 95979
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.75
|
|
|
PR ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES
|
Professional
|
Both
|
$8,102.00
|
|
|
Service Code
|
HCPCS 61711
|
| Min. Negotiated Rate |
$1,590.90 |
| Max. Negotiated Rate |
$6,076.50 |
| Rate for Payer: Aetna Commercial |
$3,346.86
|
| Rate for Payer: Aetna Medicare |
$2,497.66
|
| Rate for Payer: BCBS Complete |
$1,670.44
|
| Rate for Payer: BCBS MAPPO |
$2,497.66
|
| Rate for Payer: BCN Commercial |
$5,472.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,497.66
|
| Rate for Payer: Cash Price |
$6,481.60
|
| Rate for Payer: Cash Price |
$6,481.60
|
| Rate for Payer: Cofinity Commercial |
$3,346.86
|
| Rate for Payer: Cofinity Commercial |
$3,596.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,497.66
|
| Rate for Payer: Healthscope Commercial |
$2,997.19
|
| Rate for Payer: Healthscope Whirlpool |
$2,997.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,622.54
|
| Rate for Payer: Meridian Medicaid |
$1,670.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,747.43
|
| Rate for Payer: Nomi Health Commercial |
$2,997.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.50
|
| Rate for Payer: PACE SWMI |
$2,497.66
|
| Rate for Payer: PHP Medicare Advantage |
$2,497.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,590.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,600.56
|
| Rate for Payer: Priority Health Medicare |
$2,497.66
|
| Rate for Payer: Priority Health Narrow Network |
$4,600.56
|
| Rate for Payer: Railroad Medicare Medicare |
$2,497.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,582.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,497.66
|
| Rate for Payer: UHC Exchange |
$4,582.73
|
| Rate for Payer: UHC Medicaid |
$1,590.90
|
| Rate for Payer: UHCCP DNSP |
$2,497.66
|
| Rate for Payer: UHCCP Medicaid |
$1,590.90
|
|
|
PR ANAST INTRAHEPATC DUCTS & GI TRACT
|
Professional
|
Both
|
$6,346.00
|
|
|
Service Code
|
HCPCS 47765
|
| Min. Negotiated Rate |
$1,781.32 |
| Max. Negotiated Rate |
$5,514.21 |
| Rate for Payer: Aetna Commercial |
$3,747.43
|
| Rate for Payer: Aetna Medicare |
$2,796.59
|
| Rate for Payer: BCBS Complete |
$1,870.39
|
| Rate for Payer: BCBS MAPPO |
$2,796.59
|
| Rate for Payer: BCN Commercial |
$4,525.65
|
| Rate for Payer: BCN Medicare Advantage |
$2,796.59
|
| Rate for Payer: Cash Price |
$5,076.80
|
| Rate for Payer: Cash Price |
$5,076.80
|
| Rate for Payer: Cofinity Commercial |
$4,027.09
|
| Rate for Payer: Cofinity Commercial |
$3,747.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,796.59
|
| Rate for Payer: Healthscope Commercial |
$3,355.91
|
| Rate for Payer: Healthscope Whirlpool |
$3,355.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,936.42
|
| Rate for Payer: Meridian Medicaid |
$1,870.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,076.25
|
| Rate for Payer: Nomi Health Commercial |
$3,355.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,759.50
|
| Rate for Payer: PACE SWMI |
$2,796.59
|
| Rate for Payer: PHP Medicare Advantage |
$2,796.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,781.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,514.21
|
| Rate for Payer: Priority Health Medicare |
$2,796.59
|
| Rate for Payer: Priority Health Narrow Network |
$5,514.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2,796.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,447.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,796.59
|
| Rate for Payer: UHC Exchange |
$5,447.07
|
| Rate for Payer: UHC Medicaid |
$1,781.32
|
| Rate for Payer: UHCCP DNSP |
$2,796.59
|
| Rate for Payer: UHCCP Medicaid |
$1,781.32
|
|
