|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$457.59 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Commercial |
$1,387.20
|
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,060.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,088.03
|
| Rate for Payer: BCN Commercial |
$3,088.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,403.52
|
| Rate for Payer: Cofinity Commercial |
$1,142.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,142.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,468.80
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$1,387.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Priority Health SBD |
$1,028.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.59
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,112.29
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
19300
|
| Min. Negotiated Rate |
$281.59 |
| Max. Negotiated Rate |
$76,592.00 |
| Rate for Payer: Aetna Commercial |
$556.46
|
| Rate for Payer: Aetna Medicare |
$431.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.99
|
| Rate for Payer: BCBS Complete |
$295.67
|
| Rate for Payer: BCBS MAPPO |
$415.27
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: BCN Medicare Advantage |
$415.27
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$597.99
|
| Rate for Payer: Cofinity Commercial |
$556.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.27
|
| Rate for Payer: Healthscope Commercial |
$768.25
|
| Rate for Payer: Healthscope Commercial |
$664.43
|
| Rate for Payer: Mclaren Medicaid |
$281.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.03
|
| Rate for Payer: Meridian Medicaid |
$295.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76,592.00
|
| Rate for Payer: Nomi Health Commercial |
$498.32
|
| Rate for Payer: PACE SWMI |
$415.27
|
| Rate for Payer: PHP Medicare Advantage |
$415.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.14
|
| Rate for Payer: Priority Health Medicare |
$415.27
|
| Rate for Payer: Priority Health Narrow Network |
$590.14
|
| Rate for Payer: Priority Health SBD |
$590.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.27
|
| Rate for Payer: UHC Exchange |
$553.29
|
| Rate for Payer: UHC Medicare Advantage |
$415.27
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$698.67 |
| Max. Negotiated Rate |
$998.10 |
| Rate for Payer: Aetna Commercial |
$942.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.85
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$776.30
|
| Rate for Payer: Cofinity Commercial |
$953.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$776.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Healthscope Commercial |
$998.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: PHP Commercial |
$942.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health SBD |
$698.67
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$698.67 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Commercial |
$942.65
|
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,275.80
|
| Rate for Payer: BCN Commercial |
$2,275.80
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$953.74
|
| Rate for Payer: Cofinity Commercial |
$776.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$776.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$998.10
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$942.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Priority Health SBD |
$698.67
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.59
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,112.29
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$117,965.00 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$665.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.72
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| 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 |
$1,184.15
|
| Rate for Payer: Healthscope Commercial |
$1,024.13
|
| Rate for Payer: Mclaren Medicaid |
$426.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117,965.00
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.87
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: Priority Health Narrow Network |
$899.87
|
| Rate for Payer: Priority Health SBD |
$899.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Exchange |
$434.51
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$117,965.00 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$665.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.72
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| 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 |
$1,184.15
|
| Rate for Payer: Healthscope Commercial |
$1,024.13
|
| Rate for Payer: Mclaren Medicaid |
$426.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117,965.00
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.87
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: Priority Health Narrow Network |
$899.87
|
| Rate for Payer: Priority Health SBD |
$899.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Exchange |
$434.51
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$585.54 |
| Max. Negotiated Rate |
$162,036.00 |
| Rate for Payer: Aetna Commercial |
$1,179.20
|
| Rate for Payer: Aetna Medicare |
$915.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,179.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.20
|
| Rate for Payer: BCBS Complete |
$614.82
|
| Rate for Payer: BCBS MAPPO |
$880.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.75
|
| Rate for Payer: BCN Commercial |
$1,327.74
|
| Rate for Payer: BCN Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$1,267.20
|
| Rate for Payer: Cofinity Commercial |
$1,179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$1,628.00
|
| Rate for Payer: Healthscope Commercial |
$1,408.00
|
| Rate for Payer: Mclaren Medicaid |
$585.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.00
|
| Rate for Payer: Meridian Medicaid |
$614.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162,036.00
|
| Rate for Payer: Nomi Health Commercial |
$1,056.00
|
| Rate for Payer: PACE SWMI |
$880.00
|
| Rate for Payer: PHP Medicare Advantage |
$880.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.36
|
| Rate for Payer: Priority Health Medicare |
$880.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,235.36
|
| Rate for Payer: Priority Health SBD |
$1,235.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$880.00
|
| Rate for Payer: UHC Exchange |
$929.75
|
| Rate for Payer: UHC Medicare Advantage |
$880.00
|
| Rate for Payer: UHCCP Medicaid |
$585.54
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,031.30 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Commercial |
$1,607.35
|
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,229.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,413.56
|
| Rate for Payer: BCN Commercial |
$4,413.56
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,626.26
|
| Rate for Payer: Cofinity Commercial |
$1,323.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,323.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Healthscope Commercial |
$1,701.90
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.35
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Commercial |
$1,607.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Priority Health SBD |
$1,191.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.30
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,597.34
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$171,207.00 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$968.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.36
|
| Rate for Payer: BCBS Complete |
$650.15
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$1,401.52
|
| Rate for Payer: BCN Medicare Advantage |
$931.50
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.36
|
| Rate for Payer: Cofinity Commercial |
$1,248.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.50
|
| Rate for Payer: Healthscope Commercial |
$1,723.28
|
| Rate for Payer: Healthscope Commercial |
$1,490.40
|
| Rate for Payer: Mclaren Medicaid |
$619.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| Rate for Payer: Meridian Medicaid |
$650.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171,207.00
|
| Rate for Payer: Nomi Health Commercial |
$1,117.80
|
| Rate for Payer: PACE SWMI |
$931.50
|
| Rate for Payer: PHP Medicare Advantage |
$931.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,303.98
|
| Rate for Payer: Priority Health Medicare |
$931.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,303.98
|
| Rate for Payer: Priority Health SBD |
$1,303.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Exchange |
$928.58
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP Medicaid |
$619.19
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,191.33 |
| Max. Negotiated Rate |
$1,701.90 |
| Rate for Payer: Aetna Commercial |
$1,607.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,229.15
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,323.70
|
| Rate for Payer: Cofinity Commercial |
$1,626.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,323.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Healthscope Commercial |
$1,701.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.35
|
| Rate for Payer: PHP Commercial |
$1,607.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health SBD |
$1,191.33
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$171,207.00 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$968.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.36
|
| Rate for Payer: BCBS Complete |
$650.15
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$1,401.52
|
| Rate for Payer: BCN Medicare Advantage |
$931.50
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.36
|
| Rate for Payer: Cofinity Commercial |
$1,248.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.50
|
| Rate for Payer: Healthscope Commercial |
$1,723.28
|
| Rate for Payer: Healthscope Commercial |
$1,490.40
|
| Rate for Payer: Mclaren Medicaid |
$619.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| Rate for Payer: Meridian Medicaid |
$650.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171,207.00
|
| Rate for Payer: Nomi Health Commercial |
$1,117.80
|
| Rate for Payer: PACE SWMI |
$931.50
|
| Rate for Payer: PHP Medicare Advantage |
$931.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,303.98
|
| Rate for Payer: Priority Health Medicare |
$931.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,303.98
|
| Rate for Payer: Priority Health SBD |
$1,303.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Exchange |
$928.58
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP Medicaid |
$619.19
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 19304
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$694.26 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Aetna Commercial |
$936.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.30
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$771.40
|
| Rate for Payer: Cofinity Commercial |
$947.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$771.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$991.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: PHP Commercial |
$936.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: Priority Health SBD |
$694.26
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 19304
|
| Hospital Charge Code |
19304
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Aetna Commercial |
$936.70
|
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.30
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$771.40
|
| Rate for Payer: Cofinity Commercial |
$947.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$771.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$991.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: PHP Commercial |
$936.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: Priority Health SBD |
$694.26
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
19307
|
| Min. Negotiated Rate |
$760.62 |
| Max. Negotiated Rate |
$210,659.00 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,187.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.80
|
| Rate for Payer: BCBS Complete |
$798.65
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.22
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,530.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.22
|
| Rate for Payer: Healthscope Commercial |
$2,113.11
|
| Rate for Payer: Healthscope Commercial |
$1,827.55
|
| Rate for Payer: Mclaren Medicaid |
$760.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| Rate for Payer: Meridian Medicaid |
$798.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210,659.00
|
| Rate for Payer: Nomi Health Commercial |
$1,370.66
|
| Rate for Payer: PACE SWMI |
$1,142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,605.14
|
| Rate for Payer: Priority Health Medicare |
$1,142.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,605.14
|
| Rate for Payer: Priority Health SBD |
$1,605.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,197.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.22
|
| Rate for Payer: UHC Exchange |
$1,197.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.22
|
| Rate for Payer: UHCCP Medicaid |
$760.62
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,287.72 |
| Max. Negotiated Rate |
$1,839.60 |
| Rate for Payer: Aetna Commercial |
$1,737.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.60
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,430.80
|
| Rate for Payer: Cofinity Commercial |
$1,757.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,430.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.20
|
| Rate for Payer: Healthscope Commercial |
$1,839.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.40
|
| Rate for Payer: PHP Commercial |
$1,737.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health SBD |
$1,287.72
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$760.62 |
| Max. Negotiated Rate |
$210,659.00 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,187.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.80
|
| Rate for Payer: BCBS Complete |
$798.65
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.22
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,530.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.22
|
| Rate for Payer: Healthscope Commercial |
$2,113.11
|
| Rate for Payer: Healthscope Commercial |
$1,827.55
|
| Rate for Payer: Mclaren Medicaid |
$760.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| Rate for Payer: Meridian Medicaid |
$798.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210,659.00
|
| Rate for Payer: Nomi Health Commercial |
$1,370.66
|
| Rate for Payer: PACE SWMI |
$1,142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,605.14
|
| Rate for Payer: Priority Health Medicare |
$1,142.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,605.14
|
| Rate for Payer: Priority Health SBD |
$1,605.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,197.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.22
|
| Rate for Payer: UHC Exchange |
$1,197.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.22
|
| Rate for Payer: UHCCP Medicaid |
$760.62
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,267.11 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Commercial |
$1,737.40
|
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,050.21
|
| Rate for Payer: BCN Commercial |
$4,050.21
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,757.84
|
| Rate for Payer: Cofinity Commercial |
$1,430.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,430.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Healthscope Commercial |
$1,839.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.40
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Commercial |
$1,737.40
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Priority Health SBD |
$1,287.72
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.11
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,597.34
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
PR MASTOIDECTOMY COMPLETE
|
Professional
|
Both
|
$2,704.00
|
|
|
Service Code
|
HCPCS 69502
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$167,035.00 |
| Rate for Payer: Aetna Commercial |
$1,186.88
|
| Rate for Payer: Aetna Medicare |
$921.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.45
|
| Rate for Payer: BCBS Complete |
$633.15
|
| Rate for Payer: BCBS MAPPO |
$885.73
|
| Rate for Payer: BCBS Trust/PPO |
$4,242.78
|
| Rate for Payer: BCN Commercial |
$1,393.22
|
| Rate for Payer: BCN Medicare Advantage |
$885.73
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,275.45
|
| Rate for Payer: Cofinity Commercial |
$1,186.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.73
|
| Rate for Payer: Healthscope Commercial |
$1,638.60
|
| Rate for Payer: Healthscope Commercial |
$1,417.17
|
| Rate for Payer: Mclaren Medicaid |
$603.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.02
|
| Rate for Payer: Meridian Medicaid |
$633.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167,035.00
|
| Rate for Payer: Nomi Health Commercial |
$1,062.88
|
| Rate for Payer: PACE SWMI |
$885.73
|
| Rate for Payer: PHP Medicare Advantage |
$885.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$603.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,757.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,385.68
|
| Rate for Payer: Priority Health Medicare |
$885.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,385.68
|
| Rate for Payer: Priority Health SBD |
$1,385.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,200.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.73
|
| Rate for Payer: UHC Exchange |
$1,200.00
|
| Rate for Payer: UHC Medicare Advantage |
$885.73
|
| Rate for Payer: UHCCP Medicaid |
$603.00
|
|
|
PR MASTOID OBLITERATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,479.00
|
|
|
Service Code
|
HCPCS 69670
|
| Min. Negotiated Rate |
$602.79 |
| Max. Negotiated Rate |
$166,585.00 |
| Rate for Payer: Aetna Commercial |
$1,182.03
|
| Rate for Payer: Aetna Medicare |
$917.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,270.24
|
| Rate for Payer: BCBS Complete |
$632.93
|
| Rate for Payer: BCBS MAPPO |
$882.11
|
| Rate for Payer: BCBS Trust/PPO |
$3,570.25
|
| Rate for Payer: BCN Commercial |
$1,394.20
|
| Rate for Payer: BCN Medicare Advantage |
$882.11
|
| Rate for Payer: Cash Price |
$2,783.20
|
| Rate for Payer: Cash Price |
$2,783.20
|
| Rate for Payer: Cofinity Commercial |
$1,270.24
|
| Rate for Payer: Cofinity Commercial |
$1,182.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.11
|
| Rate for Payer: Healthscope Commercial |
$1,631.90
|
| Rate for Payer: Healthscope Commercial |
$1,411.38
|
| Rate for Payer: Mclaren Medicaid |
$602.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$926.22
|
| Rate for Payer: Meridian Medicaid |
$632.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166,585.00
|
| Rate for Payer: Nomi Health Commercial |
$1,058.53
|
| Rate for Payer: PACE SWMI |
$882.11
|
| Rate for Payer: PHP Medicare Advantage |
$882.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$602.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,261.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,385.20
|
| Rate for Payer: Priority Health Medicare |
$882.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,385.20
|
| Rate for Payer: Priority Health SBD |
$1,385.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,142.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.11
|
| Rate for Payer: UHC Exchange |
$1,142.47
|
| Rate for Payer: UHC Medicare Advantage |
$882.11
|
| Rate for Payer: UHCCP Medicaid |
$602.79
|
|
|
PR MASTOPEXY
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 19316
|
| Min. Negotiated Rate |
$293.06 |
| Max. Negotiated Rate |
$140,038.00 |
| Rate for Payer: Aetna Commercial |
$1,017.25
|
| Rate for Payer: Aetna Medicare |
$789.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,017.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,093.16
|
| Rate for Payer: BCBS Complete |
$538.10
|
| Rate for Payer: BCBS MAPPO |
$759.14
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$1,159.64
|
| Rate for Payer: BCN Medicare Advantage |
$759.14
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,093.16
|
| Rate for Payer: Cofinity Commercial |
$1,017.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.14
|
| Rate for Payer: Healthscope Commercial |
$1,404.41
|
| Rate for Payer: Healthscope Commercial |
$1,214.62
|
| Rate for Payer: Mclaren Medicaid |
$512.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.10
|
| Rate for Payer: Meridian Medicaid |
$538.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140,038.00
|
| Rate for Payer: Nomi Health Commercial |
$910.97
|
| Rate for Payer: PACE SWMI |
$759.14
|
| Rate for Payer: PHP Medicare Advantage |
$759.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.32
|
| Rate for Payer: Priority Health Medicare |
$759.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.32
|
| Rate for Payer: Priority Health SBD |
$1,077.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.14
|
| Rate for Payer: UHC Exchange |
$971.62
|
| Rate for Payer: UHC Medicare Advantage |
$759.14
|
| Rate for Payer: UHCCP Medicaid |
$512.48
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
HCPCS 19020
|
| Min. Negotiated Rate |
$203.42 |
| Max. Negotiated Rate |
$55,319.00 |
| Rate for Payer: Aetna Commercial |
$401.97
|
| Rate for Payer: Aetna Medicare |
$311.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.97
|
| Rate for Payer: BCBS Complete |
$213.59
|
| Rate for Payer: BCBS MAPPO |
$299.98
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$692.46
|
| Rate for Payer: BCN Medicare Advantage |
$299.98
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$431.97
|
| Rate for Payer: Cofinity Commercial |
$401.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.98
|
| Rate for Payer: Healthscope Commercial |
$554.96
|
| Rate for Payer: Healthscope Commercial |
$479.97
|
| Rate for Payer: Mclaren Medicaid |
$203.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.98
|
| Rate for Payer: Meridian Medicaid |
$213.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55,319.00
|
| Rate for Payer: Nomi Health Commercial |
$359.98
|
| Rate for Payer: PACE SWMI |
$299.98
|
| Rate for Payer: PHP Medicare Advantage |
$299.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.85
|
| Rate for Payer: Priority Health Medicare |
$299.98
|
| Rate for Payer: Priority Health Narrow Network |
$429.85
|
| Rate for Payer: Priority Health SBD |
$429.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.98
|
| Rate for Payer: UHC Exchange |
$409.31
|
| Rate for Payer: UHC Medicare Advantage |
$299.98
|
| Rate for Payer: UHCCP Medicaid |
$203.42
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$203.42 |
| Max. Negotiated Rate |
$55,319.00 |
| Rate for Payer: Aetna Commercial |
$401.97
|
| Rate for Payer: Aetna Medicare |
$311.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.97
|
| Rate for Payer: BCBS Complete |
$213.59
|
| Rate for Payer: BCBS MAPPO |
$299.98
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$692.46
|
| Rate for Payer: BCN Medicare Advantage |
$299.98
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$431.97
|
| Rate for Payer: Cofinity Commercial |
$401.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.98
|
| Rate for Payer: Healthscope Commercial |
$554.96
|
| Rate for Payer: Healthscope Commercial |
$479.97
|
| Rate for Payer: Mclaren Medicaid |
$203.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.98
|
| Rate for Payer: Meridian Medicaid |
$213.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55,319.00
|
| Rate for Payer: Nomi Health Commercial |
$359.98
|
| Rate for Payer: PACE SWMI |
$299.98
|
| Rate for Payer: PHP Medicare Advantage |
$299.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.85
|
| Rate for Payer: Priority Health Medicare |
$299.98
|
| Rate for Payer: Priority Health Narrow Network |
$429.85
|
| Rate for Payer: Priority Health SBD |
$429.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.98
|
| Rate for Payer: UHC Exchange |
$409.31
|
| Rate for Payer: UHC Medicare Advantage |
$299.98
|
| Rate for Payer: UHCCP Medicaid |
$203.42
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$333.43 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$691.90
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.86
|
| Rate for Payer: BCN Commercial |
$1,339.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$700.04
|
| Rate for Payer: Cofinity Commercial |
$569.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$569.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$732.60
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.90
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$691.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$512.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.43
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
