|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$233.02 |
| Max. Negotiated Rate |
$638.55 |
| Rate for Payer: Aetna Commercial |
$462.51
|
| Rate for Payer: Aetna Medicare |
$358.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.03
|
| Rate for Payer: BCBS Complete |
$244.67
|
| Rate for Payer: BCBS MAPPO |
$345.16
|
| Rate for Payer: BCN Commercial |
$559.23
|
| Rate for Payer: BCN Medicare Advantage |
$345.16
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$497.03
|
| Rate for Payer: Cofinity Commercial |
$462.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.16
|
| Rate for Payer: Healthscope Commercial |
$638.55
|
| Rate for Payer: Healthscope Commercial |
$552.26
|
| Rate for Payer: Mclaren Medicaid |
$233.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.42
|
| Rate for Payer: Meridian Medicaid |
$244.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$379.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.02
|
| Rate for Payer: Nomi Health Commercial |
$414.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: PACE SWMI |
$345.16
|
| Rate for Payer: PHP Medicare Advantage |
$345.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$597.80
|
| Rate for Payer: Priority Health Medicare |
$345.16
|
| Rate for Payer: Priority Health SBD |
$597.80
|
| Rate for Payer: Priority Health Tiered Network |
$597.80
|
| Rate for Payer: Railroad Medicare Medicare |
$345.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.99
|
| Rate for Payer: UHC Core |
$579.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$345.16
|
| Rate for Payer: UHC Exchange |
$579.99
|
| Rate for Payer: UHC Medicaid |
$233.02
|
| Rate for Payer: UHCCP Medicaid |
$233.02
|
|
|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna Commercial |
$231.86
|
| Rate for Payer: Aetna Medicare |
$179.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.16
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$173.03
|
| Rate for Payer: BCN Commercial |
$282.86
|
| Rate for Payer: BCN Medicare Advantage |
$173.03
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Cofinity Commercial |
$231.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.03
|
| Rate for Payer: Healthscope Commercial |
$320.11
|
| Rate for Payer: Healthscope Commercial |
$276.85
|
| Rate for Payer: Mclaren Medicaid |
$113.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.68
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$190.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.86
|
| Rate for Payer: Nomi Health Commercial |
$207.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$778.50
|
| Rate for Payer: PACE SWMI |
$173.03
|
| Rate for Payer: PHP Medicare Advantage |
$173.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.37
|
| Rate for Payer: Priority Health Medicare |
$173.03
|
| Rate for Payer: Priority Health SBD |
$302.37
|
| Rate for Payer: Priority Health Tiered Network |
$302.37
|
| Rate for Payer: Railroad Medicare Medicare |
$173.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.84
|
| Rate for Payer: UHC Core |
$316.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.03
|
| Rate for Payer: UHC Exchange |
$316.84
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Aetna Commercial |
$193.87
|
| Rate for Payer: Aetna Medicare |
$150.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.34
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS MAPPO |
$144.68
|
| Rate for Payer: BCN Commercial |
$237.54
|
| Rate for Payer: BCN Medicare Advantage |
$144.68
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Cofinity Commercial |
$193.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.68
|
| Rate for Payer: Healthscope Commercial |
$267.66
|
| Rate for Payer: Healthscope Commercial |
$231.49
|
| Rate for Payer: Mclaren Medicaid |
$95.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.91
|
| Rate for Payer: Meridian Medicaid |
$100.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.63
|
| Rate for Payer: Nomi Health Commercial |
$173.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.75
|
| Rate for Payer: PACE SWMI |
$144.68
|
| Rate for Payer: PHP Medicare Advantage |
$144.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$253.92
|
| Rate for Payer: Priority Health Medicare |
$144.68
|
| Rate for Payer: Priority Health SBD |
$253.92
|
| Rate for Payer: Priority Health Tiered Network |
$253.92
|
| Rate for Payer: Railroad Medicare Medicare |
$144.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.77
|
| Rate for Payer: UHC Core |
$260.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$144.68
|
| Rate for Payer: UHC Exchange |
$260.77
|
| Rate for Payer: UHC Medicaid |
$95.64
|
| Rate for Payer: UHCCP Medicaid |
$95.64
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$376.50 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: Aetna Medicare |
$157.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.71
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS MAPPO |
$151.19
|
| Rate for Payer: BCN Commercial |
$250.56
|
| Rate for Payer: BCN Medicare Advantage |
$151.19
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$217.71
|
| Rate for Payer: Cofinity Commercial |
$202.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.19
|
| Rate for Payer: Healthscope Commercial |
$279.70
|
| Rate for Payer: Healthscope Commercial |
$241.90
|
| Rate for Payer: Mclaren Medicaid |
$97.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.75
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.04
|
| Rate for Payer: Nomi Health Commercial |
$181.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.50
|
| Rate for Payer: PACE SWMI |
$151.19
|
| Rate for Payer: PHP Medicare Advantage |
$151.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$243.81
|
| Rate for Payer: Priority Health Medicare |
$151.19
|
| Rate for Payer: Priority Health SBD |
$243.81
|
| Rate for Payer: Priority Health Tiered Network |
$243.81
|
| Rate for Payer: Railroad Medicare Medicare |
$151.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.97
|
| Rate for Payer: UHC Core |
$227.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.19
|
| Rate for Payer: UHC Exchange |
$227.97
|
| Rate for Payer: UHC Medicaid |
$97.98
|
| Rate for Payer: UHCCP Medicaid |
$97.98
|
|
|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$278.82 |
| Max. Negotiated Rate |
$770.21 |
| Rate for Payer: PHP Medicare Advantage |
$416.33
|
| Rate for Payer: Aetna Commercial |
$557.88
|
| Rate for Payer: Aetna Medicare |
$432.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.52
|
| Rate for Payer: BCBS Complete |
$292.76
|
| Rate for Payer: BCBS MAPPO |
$416.33
|
| Rate for Payer: BCN Commercial |
$651.36
|
| Rate for Payer: BCN Medicare Advantage |
$416.33
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$599.52
|
| Rate for Payer: Cofinity Commercial |
$557.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.33
|
| Rate for Payer: Healthscope Commercial |
$770.21
|
| Rate for Payer: Healthscope Commercial |
$666.13
|
| Rate for Payer: Mclaren Medicaid |
$278.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.15
|
| Rate for Payer: Meridian Medicaid |
$292.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: Nomi Health Commercial |
$499.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.25
|
| Rate for Payer: PACE SWMI |
$416.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$696.28
|
| Rate for Payer: Priority Health Medicare |
$416.33
|
| Rate for Payer: Priority Health SBD |
$696.28
|
| Rate for Payer: Priority Health Tiered Network |
$696.28
|
| Rate for Payer: Railroad Medicare Medicare |
$416.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$723.74
|
| Rate for Payer: UHC Core |
$723.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.33
|
| Rate for Payer: UHC Exchange |
$723.74
|
| Rate for Payer: UHC Medicaid |
$278.82
|
| Rate for Payer: UHCCP Medicaid |
$278.82
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$150.34 |
| Rate for Payer: Aetna Commercial |
$94.83
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.83
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCN Commercial |
$124.99
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$94.83
|
| Rate for Payer: Cofinity Commercial |
$101.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Healthscope Commercial |
$130.92
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Mclaren Medicaid |
$45.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: Nomi Health Commercial |
$84.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$133.61
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health SBD |
$133.61
|
| Rate for Payer: Priority Health Tiered Network |
$133.61
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.62
|
| Rate for Payer: UHC Core |
$149.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Exchange |
$149.62
|
| Rate for Payer: UHC Medicaid |
$45.16
|
| Rate for Payer: UHCCP Medicaid |
$45.16
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$253.57 |
| Rate for Payer: Aetna Commercial |
$164.62
|
| Rate for Payer: Aetna Medicare |
$127.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.90
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS MAPPO |
$122.85
|
| Rate for Payer: BCN Commercial |
$213.13
|
| Rate for Payer: BCN Medicare Advantage |
$122.85
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$176.90
|
| Rate for Payer: Cofinity Commercial |
$164.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.85
|
| Rate for Payer: Healthscope Commercial |
$227.27
|
| Rate for Payer: Healthscope Commercial |
$196.56
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.99
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.57
|
| Rate for Payer: Nomi Health Commercial |
$147.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: PACE SWMI |
$122.85
|
| Rate for Payer: PHP Medicare Advantage |
$122.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$227.83
|
| Rate for Payer: Priority Health Medicare |
$122.85
|
| Rate for Payer: Priority Health SBD |
$227.83
|
| Rate for Payer: Priority Health Tiered Network |
$227.83
|
| Rate for Payer: Railroad Medicare Medicare |
$122.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.05
|
| Rate for Payer: UHC Core |
$249.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$122.85
|
| Rate for Payer: UHC Exchange |
$249.05
|
| Rate for Payer: UHC Medicaid |
$78.38
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.68
|
| Rate for Payer: BCBS MAPPO |
$26.63
|
| Rate for Payer: BCN Commercial |
$28.04
|
| Rate for Payer: BCN Medicare Advantage |
$26.63
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$35.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$42.61
|
| Rate for Payer: Healthscope Commercial |
$49.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.54
|
| Rate for Payer: Nomi Health Commercial |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PACE SWMI |
$26.63
|
| Rate for Payer: PHP Medicare Advantage |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$26.63
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$26.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.02
|
| Rate for Payer: UHC Core |
$25.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.63
|
| Rate for Payer: UHC Exchange |
$25.02
|
|
|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$215.85
|
| Rate for Payer: Aetna Medicare |
$167.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.96
|
| Rate for Payer: BCBS Complete |
$109.59
|
| Rate for Payer: BCBS MAPPO |
$161.08
|
| Rate for Payer: BCN Commercial |
$273.89
|
| Rate for Payer: BCN Medicare Advantage |
$161.08
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$231.96
|
| Rate for Payer: Cofinity Commercial |
$215.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.08
|
| Rate for Payer: Healthscope Commercial |
$298.00
|
| Rate for Payer: Healthscope Commercial |
$257.73
|
| Rate for Payer: Mclaren Medicaid |
$104.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.13
|
| Rate for Payer: Meridian Medicaid |
$109.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$177.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.15
|
| Rate for Payer: Nomi Health Commercial |
$193.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.75
|
| Rate for Payer: PACE SWMI |
$161.08
|
| Rate for Payer: PHP Medicare Advantage |
$161.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$277.40
|
| Rate for Payer: Priority Health Medicare |
$161.08
|
| Rate for Payer: Priority Health SBD |
$277.40
|
| Rate for Payer: Priority Health Tiered Network |
$277.40
|
| Rate for Payer: Railroad Medicare Medicare |
$161.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.57
|
| Rate for Payer: UHC Core |
$319.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.08
|
| Rate for Payer: UHC Exchange |
$319.57
|
| Rate for Payer: UHC Medicaid |
$104.37
|
| Rate for Payer: UHCCP Medicaid |
$104.37
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$2,412.00
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$684.16 |
| Max. Negotiated Rate |
$2,077.53 |
| Rate for Payer: Aetna Commercial |
$1,425.01
|
| Rate for Payer: Aetna Medicare |
$1,105.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.35
|
| Rate for Payer: BCBS Complete |
$718.37
|
| Rate for Payer: BCBS MAPPO |
$1,063.44
|
| Rate for Payer: BCN Commercial |
$1,705.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.44
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Cofinity Commercial |
$1,425.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.44
|
| Rate for Payer: Healthscope Commercial |
$1,967.36
|
| Rate for Payer: Healthscope Commercial |
$1,701.50
|
| Rate for Payer: Mclaren Medicaid |
$684.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,116.61
|
| Rate for Payer: Meridian Medicaid |
$718.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,169.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,031.62
|
| Rate for Payer: Nomi Health Commercial |
$1,276.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.00
|
| Rate for Payer: PACE SWMI |
$1,063.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$684.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,077.53
|
| Rate for Payer: Priority Health Medicare |
$1,063.44
|
| Rate for Payer: Priority Health SBD |
$2,077.53
|
| Rate for Payer: Priority Health Tiered Network |
$2,077.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,063.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,010.87
|
| Rate for Payer: UHC Core |
$2,010.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,063.44
|
| Rate for Payer: UHC Exchange |
$2,010.87
|
| Rate for Payer: UHC Medicaid |
$684.16
|
| Rate for Payer: UHCCP Medicaid |
$684.16
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$537.75 |
| Rate for Payer: Aetna Commercial |
$272.56
|
| Rate for Payer: Aetna Medicare |
$211.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.90
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS MAPPO |
$203.40
|
| Rate for Payer: BCN Commercial |
$354.56
|
| Rate for Payer: BCN Medicare Advantage |
$203.40
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cofinity Commercial |
$292.90
|
| Rate for Payer: Cofinity Commercial |
$272.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.40
|
| Rate for Payer: Healthscope Commercial |
$376.29
|
| Rate for Payer: Healthscope Commercial |
$325.44
|
| Rate for Payer: Mclaren Medicaid |
$134.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.57
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$223.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.90
|
| Rate for Payer: Nomi Health Commercial |
$244.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$537.75
|
| Rate for Payer: PACE SWMI |
$203.40
|
| Rate for Payer: PHP Medicare Advantage |
$203.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$432.02
|
| Rate for Payer: Priority Health Medicare |
$203.40
|
| Rate for Payer: Priority Health SBD |
$432.02
|
| Rate for Payer: Priority Health Tiered Network |
$432.02
|
| Rate for Payer: Railroad Medicare Medicare |
$203.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.52
|
| Rate for Payer: UHC Core |
$386.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$203.40
|
| Rate for Payer: UHC Exchange |
$386.52
|
| Rate for Payer: UHC Medicaid |
$134.19
|
| Rate for Payer: UHCCP Medicaid |
$134.19
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,681.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
19300
|
| Min. Negotiated Rate |
$271.58 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Aetna Commercial |
$552.87
|
| Rate for Payer: Aetna Medicare |
$429.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.13
|
| Rate for Payer: BCBS Complete |
$285.16
|
| Rate for Payer: BCBS MAPPO |
$412.59
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Medicare Advantage |
$412.59
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Commercial |
$552.87
|
| Rate for Payer: Cofinity Commercial |
$594.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.59
|
| Rate for Payer: Healthscope Commercial |
$763.29
|
| Rate for Payer: Healthscope Commercial |
$660.14
|
| Rate for Payer: Mclaren Medicaid |
$271.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.22
|
| Rate for Payer: Meridian Medicaid |
$285.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$453.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.92
|
| Rate for Payer: Nomi Health Commercial |
$495.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PACE SWMI |
$412.59
|
| Rate for Payer: PHP Medicare Advantage |
$412.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$602.54
|
| Rate for Payer: Priority Health Medicare |
$412.59
|
| Rate for Payer: Priority Health SBD |
$602.54
|
| Rate for Payer: Priority Health Tiered Network |
$602.54
|
| Rate for Payer: Railroad Medicare Medicare |
$412.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.68
|
| Rate for Payer: UHC Core |
$732.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$412.59
|
| Rate for Payer: UHC Exchange |
$732.68
|
| Rate for Payer: UHC Medicaid |
$271.58
|
| Rate for Payer: UHCCP Medicaid |
$271.58
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,681.00
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$271.58 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Aetna Commercial |
$552.87
|
| Rate for Payer: Aetna Medicare |
$429.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.13
|
| Rate for Payer: BCBS Complete |
$285.16
|
| Rate for Payer: BCBS MAPPO |
$412.59
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Medicare Advantage |
$412.59
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Commercial |
$594.13
|
| Rate for Payer: Cofinity Commercial |
$552.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.59
|
| Rate for Payer: Healthscope Commercial |
$763.29
|
| Rate for Payer: Healthscope Commercial |
$660.14
|
| Rate for Payer: Mclaren Medicaid |
$271.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.22
|
| Rate for Payer: Meridian Medicaid |
$285.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$453.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.92
|
| Rate for Payer: Nomi Health Commercial |
$495.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PACE SWMI |
$412.59
|
| Rate for Payer: PHP Medicare Advantage |
$412.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$602.54
|
| Rate for Payer: Priority Health Medicare |
$412.59
|
| Rate for Payer: Priority Health SBD |
$602.54
|
| Rate for Payer: Priority Health Tiered Network |
$602.54
|
| Rate for Payer: Railroad Medicare Medicare |
$412.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.68
|
| Rate for Payer: UHC Core |
$732.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$412.59
|
| Rate for Payer: UHC Exchange |
$732.68
|
| Rate for Payer: UHC Medicaid |
$271.58
|
| Rate for Payer: UHCCP Medicaid |
$271.58
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,059.03 |
| Max. Negotiated Rate |
$1,512.90 |
| Rate for Payer: Aetna Commercial |
$1,428.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,092.65
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Advantage |
$1,176.70
|
| Rate for Payer: Cofinity Commercial |
$1,445.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,344.80
|
| Rate for Payer: Healthscope Commercial |
$1,512.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,428.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PHP Commercial |
$1,428.85
|
| Rate for Payer: Priority Health SBD |
$1,059.03
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,059.03 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Commercial |
$1,428.85
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,092.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,955.39
|
| Rate for Payer: BCN Commercial |
$3,955.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Advantage |
$1,176.70
|
| Rate for Payer: Cofinity Commercial |
$1,445.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,344.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$1,512.90
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,428.85
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$1,428.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$1,059.03
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$719.46 |
| Max. Negotiated Rate |
$1,027.80 |
| Rate for Payer: Aetna Commercial |
$970.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.30
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Advantage |
$799.40
|
| Rate for Payer: Cofinity Commercial |
$982.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$913.60
|
| Rate for Payer: Healthscope Commercial |
$1,027.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PHP Commercial |
$970.70
|
| Rate for Payer: Priority Health SBD |
$719.46
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$403.42 |
| Max. Negotiated Rate |
$1,179.65 |
| Rate for Payer: Aetna Commercial |
$836.98
|
| Rate for Payer: Aetna Medicare |
$649.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.44
|
| Rate for Payer: BCBS Complete |
$423.59
|
| Rate for Payer: BCBS MAPPO |
$624.61
|
| Rate for Payer: BCN Commercial |
$996.46
|
| Rate for Payer: BCN Medicare Advantage |
$624.61
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$899.44
|
| Rate for Payer: Cofinity Commercial |
$836.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.61
|
| Rate for Payer: Healthscope Commercial |
$999.38
|
| Rate for Payer: Healthscope Commercial |
$1,155.53
|
| Rate for Payer: Mclaren Medicaid |
$403.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.84
|
| Rate for Payer: Meridian Medicaid |
$423.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.65
|
| Rate for Payer: Nomi Health Commercial |
$749.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PACE SWMI |
$624.61
|
| Rate for Payer: PHP Medicare Advantage |
$624.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$912.01
|
| Rate for Payer: Priority Health Medicare |
$624.61
|
| Rate for Payer: Priority Health SBD |
$912.01
|
| Rate for Payer: Priority Health Tiered Network |
$912.01
|
| Rate for Payer: Railroad Medicare Medicare |
$624.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,161.99
|
| Rate for Payer: UHC Core |
$1,161.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$624.61
|
| Rate for Payer: UHC Exchange |
$1,161.99
|
| Rate for Payer: UHC Medicaid |
$403.42
|
| Rate for Payer: UHCCP Medicaid |
$403.42
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$719.46 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Commercial |
$970.70
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.02
|
| Rate for Payer: BCN Commercial |
$2,915.02
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Advantage |
$799.40
|
| Rate for Payer: Cofinity Commercial |
$982.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$913.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$1,027.80
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.70
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$970.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$719.46
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$403.42 |
| Max. Negotiated Rate |
$1,179.65 |
| Rate for Payer: Aetna Commercial |
$836.98
|
| Rate for Payer: Aetna Medicare |
$649.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.44
|
| Rate for Payer: BCBS Complete |
$423.59
|
| Rate for Payer: BCBS MAPPO |
$624.61
|
| Rate for Payer: BCN Commercial |
$996.46
|
| Rate for Payer: BCN Medicare Advantage |
$624.61
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$899.44
|
| Rate for Payer: Cofinity Commercial |
$836.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.61
|
| Rate for Payer: Healthscope Commercial |
$999.38
|
| Rate for Payer: Healthscope Commercial |
$1,155.53
|
| Rate for Payer: Mclaren Medicaid |
$403.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.84
|
| Rate for Payer: Meridian Medicaid |
$423.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.65
|
| Rate for Payer: Nomi Health Commercial |
$749.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PACE SWMI |
$624.61
|
| Rate for Payer: PHP Medicare Advantage |
$624.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$912.01
|
| Rate for Payer: Priority Health Medicare |
$624.61
|
| Rate for Payer: Priority Health SBD |
$912.01
|
| Rate for Payer: Priority Health Tiered Network |
$912.01
|
| Rate for Payer: Railroad Medicare Medicare |
$624.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,161.99
|
| Rate for Payer: UHC Core |
$1,161.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$624.61
|
| Rate for Payer: UHC Exchange |
$1,161.99
|
| Rate for Payer: UHC Medicaid |
$403.42
|
| Rate for Payer: UHCCP Medicaid |
$403.42
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$553.16 |
| Max. Negotiated Rate |
$1,620.36 |
| Rate for Payer: Aetna Commercial |
$1,148.27
|
| Rate for Payer: Aetna Medicare |
$891.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,233.96
|
| Rate for Payer: BCBS Complete |
$580.82
|
| Rate for Payer: BCBS MAPPO |
$856.92
|
| Rate for Payer: BCN Commercial |
$1,368.95
|
| Rate for Payer: BCN Medicare Advantage |
$856.92
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cofinity Commercial |
$1,233.96
|
| Rate for Payer: Cofinity Commercial |
$1,148.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.92
|
| Rate for Payer: Healthscope Commercial |
$1,585.30
|
| Rate for Payer: Healthscope Commercial |
$1,371.07
|
| Rate for Payer: Mclaren Medicaid |
$553.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$899.77
|
| Rate for Payer: Meridian Medicaid |
$580.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$942.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,620.36
|
| Rate for Payer: Nomi Health Commercial |
$1,028.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.00
|
| Rate for Payer: PACE SWMI |
$856.92
|
| Rate for Payer: PHP Medicare Advantage |
$856.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,252.95
|
| Rate for Payer: Priority Health Medicare |
$856.92
|
| Rate for Payer: Priority Health SBD |
$1,252.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,252.95
|
| Rate for Payer: Railroad Medicare Medicare |
$856.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,597.81
|
| Rate for Payer: UHC Core |
$1,597.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$856.92
|
| Rate for Payer: UHC Exchange |
$1,597.81
|
| Rate for Payer: UHC Medicaid |
$553.16
|
| Rate for Payer: UHCCP Medicaid |
$553.16
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,948.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,227.24 |
| Max. Negotiated Rate |
$21,396.49 |
| Rate for Payer: Aetna Commercial |
$1,655.80
|
| Rate for Payer: Aetna Medicare |
$6,880.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,270.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,270.36
|
| Rate for Payer: BCBS Complete |
$3,633.67
|
| Rate for Payer: BCBS MAPPO |
$6,616.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,653.23
|
| Rate for Payer: BCN Commercial |
$5,653.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,616.29
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cofinity Advantage |
$1,363.60
|
| Rate for Payer: Cofinity Commercial |
$1,675.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,616.29
|
| Rate for Payer: Healthscope Commercial |
$1,753.20
|
| Rate for Payer: Mclaren Medicaid |
$3,460.32
|
| Rate for Payer: Mclaren Medicare |
$6,616.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,947.10
|
| Rate for Payer: Meridian Medicaid |
$6,947.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,608.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,277.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.80
|
| Rate for Payer: Nomi Health Commercial |
$19,848.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: PACE Medicare |
$6,285.48
|
| Rate for Payer: PACE SWMI |
$6,616.29
|
| Rate for Payer: PHP Commercial |
$1,655.80
|
| Rate for Payer: PHP Medicare Advantage |
$6,616.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,460.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,396.49
|
| Rate for Payer: Priority Health Medicare |
$6,616.29
|
| Rate for Payer: Priority Health SBD |
$1,227.24
|
| Rate for Payer: Priority Health Tiered Network |
$17,117.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,616.29
|
| Rate for Payer: UHC Medicaid |
$3,460.32
|
| Rate for Payer: UHCCP Medicaid |
$3,460.32
|
| Rate for Payer: VA VA |
$6,616.29
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,948.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$584.05 |
| Max. Negotiated Rate |
$1,712.07 |
| Rate for Payer: Aetna Commercial |
$1,213.69
|
| Rate for Payer: Aetna Medicare |
$941.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,213.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,304.27
|
| Rate for Payer: BCBS Complete |
$613.25
|
| Rate for Payer: BCBS MAPPO |
$905.74
|
| Rate for Payer: BCN Commercial |
$1,447.63
|
| Rate for Payer: BCN Medicare Advantage |
$905.74
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cofinity Commercial |
$1,304.27
|
| Rate for Payer: Cofinity Commercial |
$1,213.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.74
|
| Rate for Payer: Healthscope Commercial |
$1,675.62
|
| Rate for Payer: Healthscope Commercial |
$1,449.18
|
| Rate for Payer: Mclaren Medicaid |
$584.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$951.03
|
| Rate for Payer: Meridian Medicaid |
$613.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$996.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.07
|
| Rate for Payer: Nomi Health Commercial |
$1,086.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: PACE SWMI |
$905.74
|
| Rate for Payer: PHP Medicare Advantage |
$905.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,324.95
|
| Rate for Payer: Priority Health Medicare |
$905.74
|
| Rate for Payer: Priority Health SBD |
$1,324.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,324.95
|
| Rate for Payer: Railroad Medicare Medicare |
$905.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,698.59
|
| Rate for Payer: UHC Core |
$1,698.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$905.74
|
| Rate for Payer: UHC Exchange |
$1,698.59
|
| Rate for Payer: UHC Medicaid |
$584.05
|
| Rate for Payer: UHCCP Medicaid |
$584.05
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,948.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$584.05 |
| Max. Negotiated Rate |
$1,712.07 |
| Rate for Payer: Aetna Commercial |
$1,213.69
|
| Rate for Payer: Aetna Medicare |
$941.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,213.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,304.27
|
| Rate for Payer: BCBS Complete |
$613.25
|
| Rate for Payer: BCBS MAPPO |
$905.74
|
| Rate for Payer: BCN Commercial |
$1,447.63
|
| Rate for Payer: BCN Medicare Advantage |
$905.74
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cofinity Commercial |
$1,304.27
|
| Rate for Payer: Cofinity Commercial |
$1,213.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.74
|
| Rate for Payer: Healthscope Commercial |
$1,675.62
|
| Rate for Payer: Healthscope Commercial |
$1,449.18
|
| Rate for Payer: Mclaren Medicaid |
$584.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$951.03
|
| Rate for Payer: Meridian Medicaid |
$613.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$996.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.07
|
| Rate for Payer: Nomi Health Commercial |
$1,086.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: PACE SWMI |
$905.74
|
| Rate for Payer: PHP Medicare Advantage |
$905.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,324.95
|
| Rate for Payer: Priority Health Medicare |
$905.74
|
| Rate for Payer: Priority Health SBD |
$1,324.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,324.95
|
| Rate for Payer: Railroad Medicare Medicare |
$905.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,698.59
|
| Rate for Payer: UHC Core |
$1,698.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$905.74
|
| Rate for Payer: UHC Exchange |
$1,698.59
|
| Rate for Payer: UHC Medicaid |
$584.05
|
| Rate for Payer: UHCCP Medicaid |
$584.05
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,948.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,227.24 |
| Max. Negotiated Rate |
$1,753.20 |
| Rate for Payer: Aetna Commercial |
$1,655.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.20
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cofinity Advantage |
$1,363.60
|
| Rate for Payer: Cofinity Commercial |
$1,675.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.40
|
| Rate for Payer: Healthscope Commercial |
$1,753.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: PHP Commercial |
$1,655.80
|
| Rate for Payer: Priority Health SBD |
$1,227.24
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$715.05 |
| Max. Negotiated Rate |
$1,021.50 |
| Rate for Payer: Aetna Commercial |
$964.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.75
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Cofinity Advantage |
$794.50
|
| Rate for Payer: Cofinity Commercial |
$976.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.00
|
| Rate for Payer: Healthscope Commercial |
$1,021.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.25
|
| Rate for Payer: PHP Commercial |
$964.75
|
| Rate for Payer: Priority Health SBD |
$715.05
|
|
