|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,721.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Commercial |
$767.81
|
| Rate for Payer: Aetna Medicare |
$860.50
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS Trust/PPO |
$405.73
|
| Rate for Payer: BCN Commercial |
$843.46
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.91
|
| Rate for Payer: Priority Health Narrow Network |
$884.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$690.78
|
| Rate for Payer: UHC Exchange |
$690.78
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$493.10 |
| Max. Negotiated Rate |
$2,869.73 |
| Rate for Payer: Aetna Commercial |
$1,007.60
|
| Rate for Payer: Aetna Medicare |
$1,237.50
|
| Rate for Payer: BCBS Complete |
$517.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,869.73
|
| Rate for Payer: BCN Commercial |
$1,133.74
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Meridian Medicaid |
$517.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$493.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,178.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.96
|
| Rate for Payer: UHC Exchange |
$794.96
|
| Rate for Payer: UHCCP Medicaid |
$493.10
|
|
|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$326.53 |
| Max. Negotiated Rate |
$977.88 |
| Rate for Payer: Aetna Commercial |
$678.16
|
| Rate for Payer: Aetna Medicare |
$556.00
|
| Rate for Payer: BCBS Complete |
$342.86
|
| Rate for Payer: BCBS Trust/PPO |
$977.88
|
| Rate for Payer: BCN Commercial |
$735.46
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Meridian Medicaid |
$342.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$774.49
|
| Rate for Payer: Priority Health Narrow Network |
$774.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.68
|
| Rate for Payer: UHC Exchange |
$597.68
|
| Rate for Payer: UHCCP Medicaid |
$326.53
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$407.32 |
| Max. Negotiated Rate |
$1,134.25 |
| Rate for Payer: Aetna Commercial |
$978.81
|
| Rate for Payer: Aetna Medicare |
$631.50
|
| Rate for Payer: BCBS Complete |
$503.21
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$1,080.46
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Meridian Medicaid |
$503.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,134.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.84
|
| Rate for Payer: UHC Exchange |
$820.84
|
| Rate for Payer: UHCCP Medicaid |
$479.25
|
|
|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$2,374.00
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$194.41 |
| Max. Negotiated Rate |
$1,543.10 |
| Rate for Payer: Aetna Commercial |
$1,034.61
|
| Rate for Payer: Aetna Medicare |
$1,187.00
|
| Rate for Payer: BCBS Complete |
$530.05
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: BCN Commercial |
$1,138.13
|
| Rate for Payer: Cash Price |
$1,899.20
|
| Rate for Payer: Cash Price |
$1,899.20
|
| Rate for Payer: Meridian Medicaid |
$530.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,543.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,195.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$871.55
|
| Rate for Payer: UHC Exchange |
$871.55
|
| Rate for Payer: UHCCP Medicaid |
$504.81
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$70.79 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$983.83
|
| Rate for Payer: Aetna Medicare |
$1,156.50
|
| Rate for Payer: BCBS Complete |
$524.23
|
| Rate for Payer: BCBS Trust/PPO |
$70.79
|
| Rate for Payer: BCN Commercial |
$1,084.87
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Meridian Medicaid |
$524.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,143.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,143.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.83
|
| Rate for Payer: UHC Exchange |
$827.83
|
| Rate for Payer: UHCCP Medicaid |
$499.27
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$340.59 |
| Max. Negotiated Rate |
$1,061.45 |
| Rate for Payer: Aetna Commercial |
$707.25
|
| Rate for Payer: Aetna Medicare |
$816.50
|
| Rate for Payer: BCBS Complete |
$357.62
|
| Rate for Payer: BCBS Trust/PPO |
$945.13
|
| Rate for Payer: BCN Commercial |
$767.22
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Meridian Medicaid |
$357.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$808.08
|
| Rate for Payer: Priority Health Narrow Network |
$808.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$664.37
|
| Rate for Payer: UHC Exchange |
$664.37
|
| Rate for Payer: UHCCP Medicaid |
$340.59
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$453.26 |
| Max. Negotiated Rate |
$1,254.50 |
| Rate for Payer: Aetna Commercial |
$954.20
|
| Rate for Payer: Aetna Medicare |
$965.00
|
| Rate for Payer: BCBS Complete |
$475.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.47
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Meridian Medicaid |
$475.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$901.52
|
| Rate for Payer: UHC Exchange |
$901.52
|
| Rate for Payer: UHCCP Medicaid |
$453.26
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$954.79
|
| Rate for Payer: Aetna Medicare |
$1,190.50
|
| Rate for Payer: BCBS Complete |
$494.94
|
| Rate for Payer: BCBS Trust/PPO |
$87.17
|
| Rate for Payer: BCN Commercial |
$1,056.04
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Meridian Medicaid |
$494.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,110.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$844.43
|
| Rate for Payer: UHC Exchange |
$844.43
|
| Rate for Payer: UHCCP Medicaid |
$471.37
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$2,710.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$572.97 |
| Max. Negotiated Rate |
$1,761.50 |
| Rate for Payer: Aetna Commercial |
$1,215.09
|
| Rate for Payer: Aetna Medicare |
$1,355.00
|
| Rate for Payer: BCBS Complete |
$601.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.71
|
| Rate for Payer: BCN Commercial |
$1,307.21
|
| Rate for Payer: Cash Price |
$2,168.00
|
| Rate for Payer: Cash Price |
$2,168.00
|
| Rate for Payer: Meridian Medicaid |
$601.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$572.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,761.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,365.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,365.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.99
|
| Rate for Payer: UHC Exchange |
$1,111.99
|
| Rate for Payer: UHCCP Medicaid |
$572.97
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$378.08 |
| Max. Negotiated Rate |
$1,391.00 |
| Rate for Payer: Aetna Commercial |
$795.07
|
| Rate for Payer: Aetna Medicare |
$1,070.00
|
| Rate for Payer: BCBS Complete |
$396.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.86
|
| Rate for Payer: BCN Commercial |
$859.58
|
| Rate for Payer: Cash Price |
$1,712.00
|
| Rate for Payer: Cash Price |
$1,712.00
|
| Rate for Payer: Meridian Medicaid |
$396.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$378.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,391.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.18
|
| Rate for Payer: Priority Health Narrow Network |
$900.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$745.99
|
| Rate for Payer: UHC Exchange |
$745.99
|
| Rate for Payer: UHCCP Medicaid |
$378.08
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$272.21 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$565.84
|
| Rate for Payer: Aetna Medicare |
$718.00
|
| Rate for Payer: BCBS Complete |
$285.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.24
|
| Rate for Payer: BCN Commercial |
$615.25
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Meridian Medicaid |
$285.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.28
|
| Rate for Payer: Priority Health Narrow Network |
$648.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.08
|
| Rate for Payer: UHC Exchange |
$521.08
|
| Rate for Payer: UHCCP Medicaid |
$272.21
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,292.40
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$1,392.92
|
| Rate for Payer: ASR Commercial |
$1,392.92
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.94
|
| Rate for Payer: BCN Commercial |
$1,113.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,349.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,436.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,392.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,292.40
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.60
|
| Rate for Payer: Nomi Health Commercial |
$1,177.52
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,258.22
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,006.64
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,263.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$272.21 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$565.84
|
| Rate for Payer: Aetna Medicare |
$718.00
|
| Rate for Payer: BCBS Complete |
$285.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.24
|
| Rate for Payer: BCN Commercial |
$615.25
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Meridian Medicaid |
$285.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.28
|
| Rate for Payer: Priority Health Narrow Network |
$648.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.08
|
| Rate for Payer: UHC Exchange |
$521.08
|
| Rate for Payer: UHCCP Medicaid |
$272.21
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: Aetna Commercial |
$1,292.40
|
| Rate for Payer: ASR ASR |
$1,392.92
|
| Rate for Payer: ASR Commercial |
$1,392.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.20
|
| Rate for Payer: BCN Commercial |
$1,113.33
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,349.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.80
|
| Rate for Payer: Healthscope Commercial |
$1,436.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,392.92
|
| Rate for Payer: Mclaren Commercial |
$1,292.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.60
|
| Rate for Payer: Nomi Health Commercial |
$1,177.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,263.68
|
|
|
PR AMPUTATION PENIS COMPLETE
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$530.37 |
| Max. Negotiated Rate |
$2,350.94 |
| Rate for Payer: Aetna Commercial |
$1,048.07
|
| Rate for Payer: Aetna Medicare |
$776.00
|
| Rate for Payer: BCBS Complete |
$556.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.94
|
| Rate for Payer: BCN Commercial |
$1,190.42
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Cash Price |
$1,241.60
|
| Rate for Payer: Meridian Medicaid |
$556.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,309.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$981.15
|
| Rate for Payer: UHC Exchange |
$981.15
|
| Rate for Payer: UHCCP Medicaid |
$530.37
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$406.62 |
| Max. Negotiated Rate |
$3,526.40 |
| Rate for Payer: Aetna Commercial |
$809.58
|
| Rate for Payer: Aetna Medicare |
$601.00
|
| Rate for Payer: BCBS Complete |
$426.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,526.40
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Meridian Medicaid |
$426.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$760.60
|
| Rate for Payer: UHC Exchange |
$760.60
|
| Rate for Payer: UHCCP Medicaid |
$406.62
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,482.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$761.26 |
| Max. Negotiated Rate |
$3,502.63 |
| Rate for Payer: Aetna Commercial |
$1,532.39
|
| Rate for Payer: Aetna Medicare |
$1,241.00
|
| Rate for Payer: BCBS Complete |
$799.32
|
| Rate for Payer: BCBS Trust/PPO |
$3,502.63
|
| Rate for Payer: BCN Commercial |
$1,715.75
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Meridian Medicaid |
$799.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,613.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,891.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,891.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,444.83
|
| Rate for Payer: UHC Exchange |
$1,444.83
|
| Rate for Payer: UHCCP Medicaid |
$761.26
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$2,644.67 |
| Rate for Payer: Aetna Commercial |
$1,060.77
|
| Rate for Payer: Aetna Medicare |
$1,291.00
|
| Rate for Payer: BCBS Complete |
$524.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,644.67
|
| Rate for Payer: BCN Commercial |
$1,139.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Meridian Medicaid |
$524.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$983.92
|
| Rate for Payer: UHC Exchange |
$983.92
|
| Rate for Payer: UHCCP Medicaid |
$499.27
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: Aetna Commercial |
$958.03
|
| Rate for Payer: Aetna Medicare |
$1,214.00
|
| Rate for Payer: BCBS Complete |
$478.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.83
|
| Rate for Payer: BCN Commercial |
$1,040.39
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Meridian Medicaid |
$478.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,085.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,085.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$866.53
|
| Rate for Payer: UHC Exchange |
$866.53
|
| Rate for Payer: UHCCP Medicaid |
$456.03
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$901.24
|
| Rate for Payer: Aetna Medicare |
$1,548.50
|
| Rate for Payer: BCBS Complete |
$454.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.62
|
| Rate for Payer: BCN Commercial |
$975.89
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Meridian Medicaid |
$454.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,021.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$828.77
|
| Rate for Payer: UHC Exchange |
$828.77
|
| Rate for Payer: UHCCP Medicaid |
$432.60
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$995.32 |
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna Medicare |
$673.00
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS Trust/PPO |
$995.32
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.09
|
| Rate for Payer: Priority Health Narrow Network |
$263.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.72
|
| Rate for Payer: UHC Exchange |
$472.72
|
| Rate for Payer: UHCCP Medicaid |
$110.76
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$243.14
|
| Rate for Payer: Aetna Medicare |
$778.50
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS Trust/PPO |
$852.68
|
| Rate for Payer: BCN Commercial |
$434.44
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Meridian Medicaid |
$119.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.69
|
| Rate for Payer: Priority Health Narrow Network |
$269.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.89
|
| Rate for Payer: UHC Exchange |
$405.89
|
| Rate for Payer: UHCCP Medicaid |
$113.53
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,012.05 |
| Max. Negotiated Rate |
$1,557.00 |
| Rate for Payer: Aetna Commercial |
$1,401.30
|
| Rate for Payer: ASR ASR |
$1,510.29
|
| Rate for Payer: ASR Commercial |
$1,510.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,268.80
|
| Rate for Payer: BCN Commercial |
$1,207.14
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,463.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Healthscope Commercial |
$1,557.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,510.29
|
| Rate for Payer: Mclaren Commercial |
$1,401.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: Nomi Health Commercial |
$1,276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,370.16
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$243.14
|
| Rate for Payer: Aetna Medicare |
$778.50
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS Trust/PPO |
$852.68
|
| Rate for Payer: BCN Commercial |
$434.44
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Meridian Medicaid |
$119.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.69
|
| Rate for Payer: Priority Health Narrow Network |
$269.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.89
|
| Rate for Payer: UHC Exchange |
$405.89
|
| Rate for Payer: UHCCP Medicaid |
$113.53
|
|
