|
PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$5,240.00
|
|
|
Service Code
|
HCPCS 58953
|
| Min. Negotiated Rate |
$1,924.47 |
| Max. Negotiated Rate |
$3,406.00 |
| Rate for Payer: Aetna Commercial |
$2,578.79
|
| Rate for Payer: Aetna Medicare |
$2,001.45
|
| Rate for Payer: BCBS Complete |
$2,096.00
|
| Rate for Payer: BCBS MAPPO |
$1,924.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,924.47
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Cofinity Commercial |
$2,771.24
|
| Rate for Payer: Cofinity Commercial |
$2,578.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,924.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,020.69
|
| Rate for Payer: Nomi Health Commercial |
$2,309.36
|
| Rate for Payer: PACE SWMI |
$1,924.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,924.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,406.00
|
| Rate for Payer: Priority Health Medicare |
$1,943.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,924.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,924.47
|
| Rate for Payer: UHC Exchange |
$1,924.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,924.47
|
|
|
PR BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 58956
|
| Min. Negotiated Rate |
$972.00 |
| Max. Negotiated Rate |
$1,883.82 |
| Rate for Payer: Aetna Commercial |
$1,753.00
|
| Rate for Payer: Aetna Medicare |
$1,360.54
|
| Rate for Payer: BCBS Complete |
$972.00
|
| Rate for Payer: BCBS MAPPO |
$1,308.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.21
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cofinity Commercial |
$1,883.82
|
| Rate for Payer: Cofinity Commercial |
$1,753.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.62
|
| Rate for Payer: Nomi Health Commercial |
$1,569.85
|
| Rate for Payer: PACE SWMI |
$1,308.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,579.50
|
| Rate for Payer: Priority Health Medicare |
$1,321.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,308.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.21
|
| Rate for Payer: UHC Exchange |
$1,308.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.21
|
|
|
PR BUDESONIDE NON-COMP UNIT
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J7626
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna Commercial |
$1.81
|
| Rate for Payer: Aetna Medicare |
$1.40
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$1.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.42
|
| Rate for Payer: Nomi Health Commercial |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.35
|
| Rate for Payer: PHP Medicare Advantage |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: Priority Health Medicare |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.35
|
| Rate for Payer: UHC Medicare Advantage |
$1.35
|
|
|
PR BURR HOLE FOR VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$1,871.00
|
|
|
Service Code
|
HCPCS 61120
|
| Min. Negotiated Rate |
$744.17 |
| Max. Negotiated Rate |
$1,216.15 |
| Rate for Payer: Aetna Commercial |
$997.19
|
| Rate for Payer: Aetna Medicare |
$773.94
|
| Rate for Payer: BCBS Complete |
$748.40
|
| Rate for Payer: BCBS MAPPO |
$744.17
|
| Rate for Payer: BCN Medicare Advantage |
$744.17
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cofinity Commercial |
$997.19
|
| Rate for Payer: Cofinity Commercial |
$1,071.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.38
|
| Rate for Payer: Nomi Health Commercial |
$893.00
|
| Rate for Payer: PACE SWMI |
$744.17
|
| Rate for Payer: PHP Medicare Advantage |
$744.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.15
|
| Rate for Payer: Priority Health Medicare |
$751.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.17
|
| Rate for Payer: UHC Exchange |
$744.17
|
| Rate for Payer: UHC Medicare Advantage |
$744.17
|
|
|
PR BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 61210
|
| Min. Negotiated Rate |
$363.16 |
| Max. Negotiated Rate |
$1,660.10 |
| Rate for Payer: Aetna Commercial |
$486.63
|
| Rate for Payer: Aetna Medicare |
$377.69
|
| Rate for Payer: BCBS Complete |
$1,021.60
|
| Rate for Payer: BCBS MAPPO |
$363.16
|
| Rate for Payer: BCN Medicare Advantage |
$363.16
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$522.95
|
| Rate for Payer: Cofinity Commercial |
$486.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.32
|
| Rate for Payer: Nomi Health Commercial |
$435.79
|
| Rate for Payer: PACE SWMI |
$363.16
|
| Rate for Payer: PHP Medicare Advantage |
$363.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health Medicare |
$366.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.16
|
| Rate for Payer: UHC Exchange |
$363.16
|
| Rate for Payer: UHC Medicare Advantage |
$363.16
|
|
|
PR BURR HOLE/TREPHINE STTL EXPL N/FLWD OTH SURG
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 61250
|
| Min. Negotiated Rate |
$862.39 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$1,155.60
|
| Rate for Payer: Aetna Medicare |
$896.89
|
| Rate for Payer: BCBS Complete |
$1,090.00
|
| Rate for Payer: BCBS MAPPO |
$862.39
|
| Rate for Payer: BCN Medicare Advantage |
$862.39
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,241.84
|
| Rate for Payer: Cofinity Commercial |
$1,155.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.51
|
| Rate for Payer: Nomi Health Commercial |
$1,034.87
|
| Rate for Payer: PACE SWMI |
$862.39
|
| Rate for Payer: PHP Medicare Advantage |
$862.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health Medicare |
$871.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$862.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.39
|
| Rate for Payer: UHC Exchange |
$862.39
|
| Rate for Payer: UHC Medicare Advantage |
$862.39
|
|
|
PR BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION
|
Professional
|
Both
|
$4,613.00
|
|
|
Service Code
|
HCPCS 61140
|
| Min. Negotiated Rate |
$1,261.54 |
| Max. Negotiated Rate |
$2,998.45 |
| Rate for Payer: Aetna Commercial |
$1,690.46
|
| Rate for Payer: Aetna Medicare |
$1,312.00
|
| Rate for Payer: BCBS Complete |
$1,845.20
|
| Rate for Payer: BCBS MAPPO |
$1,261.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,261.54
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cofinity Commercial |
$1,816.62
|
| Rate for Payer: Cofinity Commercial |
$1,690.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,261.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,324.62
|
| Rate for Payer: Nomi Health Commercial |
$1,513.85
|
| Rate for Payer: PACE SWMI |
$1,261.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,261.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,998.45
|
| Rate for Payer: Priority Health Medicare |
$1,274.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,261.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,261.54
|
| Rate for Payer: UHC Exchange |
$1,261.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,261.54
|
|
|
PR BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST
|
Professional
|
Both
|
$4,121.00
|
|
|
Service Code
|
HCPCS 61150
|
| Min. Negotiated Rate |
$1,342.16 |
| Max. Negotiated Rate |
$2,678.65 |
| Rate for Payer: Aetna Commercial |
$1,798.49
|
| Rate for Payer: Aetna Medicare |
$1,395.85
|
| Rate for Payer: BCBS Complete |
$1,648.40
|
| Rate for Payer: BCBS MAPPO |
$1,342.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.16
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Cofinity Commercial |
$1,932.71
|
| Rate for Payer: Cofinity Commercial |
$1,798.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,409.27
|
| Rate for Payer: Nomi Health Commercial |
$1,610.59
|
| Rate for Payer: PACE SWMI |
$1,342.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.65
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,342.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.16
|
| Rate for Payer: UHC Exchange |
$1,342.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.16
|
|
|
PR BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL
|
Professional
|
Both
|
$3,685.00
|
|
|
Service Code
|
HCPCS 61156
|
| Min. Negotiated Rate |
$1,233.42 |
| Max. Negotiated Rate |
$2,395.25 |
| Rate for Payer: Aetna Commercial |
$1,652.78
|
| Rate for Payer: Aetna Medicare |
$1,282.76
|
| Rate for Payer: BCBS Complete |
$1,474.00
|
| Rate for Payer: BCBS MAPPO |
$1,233.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,233.42
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cofinity Commercial |
$1,776.12
|
| Rate for Payer: Cofinity Commercial |
$1,652.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,233.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,295.09
|
| Rate for Payer: Nomi Health Commercial |
$1,480.10
|
| Rate for Payer: PACE SWMI |
$1,233.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,233.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,395.25
|
| Rate for Payer: Priority Health Medicare |
$1,245.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,233.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,233.42
|
| Rate for Payer: UHC Exchange |
$1,233.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,233.42
|
|
|
PR BURR HOLE W/EVAC&/DRG HEMATOMA EXTRADURAL/SDRL
|
Professional
|
Both
|
$4,188.00
|
|
|
Service Code
|
HCPCS 61154
|
| Min. Negotiated Rate |
$1,266.67 |
| Max. Negotiated Rate |
$2,722.20 |
| Rate for Payer: Aetna Commercial |
$1,697.34
|
| Rate for Payer: Aetna Medicare |
$1,317.34
|
| Rate for Payer: BCBS Complete |
$1,675.20
|
| Rate for Payer: BCBS MAPPO |
$1,266.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.67
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,824.00
|
| Rate for Payer: Cofinity Commercial |
$1,697.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,330.00
|
| Rate for Payer: Nomi Health Commercial |
$1,520.00
|
| Rate for Payer: PACE SWMI |
$1,266.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,722.20
|
| Rate for Payer: Priority Health Medicare |
$1,279.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,266.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,266.67
|
| Rate for Payer: UHC Exchange |
$1,266.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.67
|
|
|
PR BUTORPHANOL TARTRATE 1 MG
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J0595
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Aetna Medicare |
$6.69
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$6.43
|
| Rate for Payer: BCN Medicare Advantage |
$6.43
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$8.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.75
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| Rate for Payer: PACE SWMI |
$6.43
|
| Rate for Payer: PHP Medicare Advantage |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$6.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.43
|
| Rate for Payer: UHC Exchange |
$6.43
|
| Rate for Payer: UHC Medicare Advantage |
$6.43
|
|
|
PR BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 49180
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$104.95
|
| Rate for Payer: Aetna Medicare |
$81.45
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$78.32
|
| Rate for Payer: BCN Medicare Advantage |
$78.32
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$112.78
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.24
|
| Rate for Payer: Nomi Health Commercial |
$93.98
|
| Rate for Payer: PACE SWMI |
$78.32
|
| Rate for Payer: PHP Medicare Advantage |
$78.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Medicare |
$79.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.32
|
| Rate for Payer: UHC Exchange |
$78.32
|
| Rate for Payer: UHC Medicare Advantage |
$78.32
|
|
|
PR BX ANORECTAL WALL ANAL APPROACH
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 45100
|
| Min. Negotiated Rate |
$290.18 |
| Max. Negotiated Rate |
$499.85 |
| Rate for Payer: Aetna Commercial |
$388.84
|
| Rate for Payer: Aetna Medicare |
$301.79
|
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: BCBS MAPPO |
$290.18
|
| Rate for Payer: BCN Medicare Advantage |
$290.18
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$417.86
|
| Rate for Payer: Cofinity Commercial |
$388.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.69
|
| Rate for Payer: Nomi Health Commercial |
$348.22
|
| Rate for Payer: PACE SWMI |
$290.18
|
| Rate for Payer: PHP Medicare Advantage |
$290.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health Medicare |
$293.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.18
|
| Rate for Payer: UHC Exchange |
$290.18
|
| Rate for Payer: UHC Medicare Advantage |
$290.18
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: Aetna Medicare |
$69.18
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$66.52
|
| Rate for Payer: BCN Medicare Advantage |
$66.52
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$95.79
|
| Rate for Payer: Cofinity Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.85
|
| Rate for Payer: Nomi Health Commercial |
$79.82
|
| Rate for Payer: PACE SWMI |
$66.52
|
| Rate for Payer: PHP Medicare Advantage |
$66.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$67.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.52
|
| Rate for Payer: UHC Exchange |
$66.52
|
| Rate for Payer: UHC Medicare Advantage |
$66.52
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna Medicare |
$77.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.44
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$74.75
|
| Rate for Payer: BCBS Trust/PPO |
$245.81
|
| Rate for Payer: BCN Commercial |
$232.47
|
| Rate for Payer: BCN Medicare Advantage |
$74.75
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.75
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.49
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: Nomi Health Commercial |
$245.18
|
| Rate for Payer: PACE Senior Care Partners |
$71.01
|
| Rate for Payer: PACE SWMI |
$74.75
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: PHP Medicare Advantage |
$74.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO |
$260.13
|
| Rate for Payer: Priority Health Medicare |
$75.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.33
|
| Rate for Payer: Railroad Medicare Medicare |
$74.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.12
|
| Rate for Payer: UHC Core |
$249.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.75
|
| Rate for Payer: UHC Exchange |
$74.75
|
| Rate for Payer: UHC Medicare Advantage |
$74.75
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$74.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$231.07
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: Nomi Health Commercial |
$245.18
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO |
$260.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.12
|
| Rate for Payer: UHC Core |
$249.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 19100
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: Aetna Medicare |
$69.18
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$66.52
|
| Rate for Payer: BCN Medicare Advantage |
$66.52
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$95.79
|
| Rate for Payer: Cofinity Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.85
|
| Rate for Payer: Nomi Health Commercial |
$79.82
|
| Rate for Payer: PACE SWMI |
$66.52
|
| Rate for Payer: PHP Medicare Advantage |
$66.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$67.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.52
|
| Rate for Payer: UHC Exchange |
$66.52
|
| Rate for Payer: UHC Medicare Advantage |
$66.52
|
|
|
PR BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 19081
|
| Min. Negotiated Rate |
$154.30 |
| Max. Negotiated Rate |
$502.45 |
| Rate for Payer: Aetna Commercial |
$206.76
|
| Rate for Payer: Aetna Medicare |
$160.47
|
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: BCBS MAPPO |
$154.30
|
| Rate for Payer: BCN Medicare Advantage |
$154.30
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$222.19
|
| Rate for Payer: Cofinity Commercial |
$206.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.01
|
| Rate for Payer: Nomi Health Commercial |
$185.16
|
| Rate for Payer: PACE SWMI |
$154.30
|
| Rate for Payer: PHP Medicare Advantage |
$154.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.45
|
| Rate for Payer: Priority Health Medicare |
$155.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.30
|
| Rate for Payer: UHC Exchange |
$154.30
|
| Rate for Payer: UHC Medicare Advantage |
$154.30
|
|
|
PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 19083
|
| Min. Negotiated Rate |
$144.96 |
| Max. Negotiated Rate |
$286.65 |
| Rate for Payer: Aetna Commercial |
$194.25
|
| Rate for Payer: Aetna Medicare |
$150.76
|
| Rate for Payer: BCBS Complete |
$176.40
|
| Rate for Payer: BCBS MAPPO |
$144.96
|
| Rate for Payer: BCN Medicare Advantage |
$144.96
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$208.74
|
| Rate for Payer: Cofinity Commercial |
$194.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.21
|
| Rate for Payer: Nomi Health Commercial |
$173.95
|
| Rate for Payer: PACE SWMI |
$144.96
|
| Rate for Payer: PHP Medicare Advantage |
$144.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health Medicare |
$146.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.96
|
| Rate for Payer: UHC Exchange |
$144.96
|
| Rate for Payer: UHC Medicare Advantage |
$144.96
|
|
|
PR BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 19084
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$515.45 |
| Rate for Payer: Aetna Commercial |
$97.82
|
| Rate for Payer: Aetna Medicare |
$75.92
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: BCBS MAPPO |
$73.00
|
| Rate for Payer: BCN Medicare Advantage |
$73.00
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Cofinity Commercial |
$105.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.65
|
| Rate for Payer: Nomi Health Commercial |
$87.60
|
| Rate for Payer: PACE SWMI |
$73.00
|
| Rate for Payer: PHP Medicare Advantage |
$73.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Medicare |
$73.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.00
|
| Rate for Payer: UHC Exchange |
$73.00
|
| Rate for Payer: UHC Medicare Advantage |
$73.00
|
|
|
PR BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 38505
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Commercial |
$108.65
|
| Rate for Payer: Aetna Medicare |
$84.32
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$81.08
|
| Rate for Payer: BCN Medicare Advantage |
$81.08
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$116.76
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.13
|
| Rate for Payer: Nomi Health Commercial |
$97.30
|
| Rate for Payer: PACE SWMI |
$81.08
|
| Rate for Payer: PHP Medicare Advantage |
$81.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health Medicare |
$81.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.08
|
| Rate for Payer: UHC Exchange |
$81.08
|
| Rate for Payer: UHC Medicare Advantage |
$81.08
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$427.74 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$573.17
|
| Rate for Payer: Aetna Medicare |
$444.85
|
| Rate for Payer: BCBS Complete |
$630.80
|
| Rate for Payer: BCBS MAPPO |
$427.74
|
| Rate for Payer: BCN Medicare Advantage |
$427.74
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$615.95
|
| Rate for Payer: Cofinity Commercial |
$573.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.13
|
| Rate for Payer: Nomi Health Commercial |
$513.29
|
| Rate for Payer: PACE SWMI |
$427.74
|
| Rate for Payer: PHP Medicare Advantage |
$427.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$432.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.74
|
| Rate for Payer: UHC Exchange |
$427.74
|
| Rate for Payer: UHC Medicare Advantage |
$427.74
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$427.74 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$573.17
|
| Rate for Payer: Aetna Medicare |
$444.85
|
| Rate for Payer: BCBS Complete |
$630.80
|
| Rate for Payer: BCBS MAPPO |
$427.74
|
| Rate for Payer: BCN Medicare Advantage |
$427.74
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$615.95
|
| Rate for Payer: Cofinity Commercial |
$573.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.13
|
| Rate for Payer: Nomi Health Commercial |
$513.29
|
| Rate for Payer: PACE SWMI |
$427.74
|
| Rate for Payer: PHP Medicare Advantage |
$427.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health Medicare |
$432.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.74
|
| Rate for Payer: UHC Exchange |
$427.74
|
| Rate for Payer: UHC Medicare Advantage |
$427.74
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,025.05 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.31
|
| Rate for Payer: BCN Commercial |
$1,218.71
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: Nomi Health Commercial |
$1,293.14
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,371.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,056.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.76
|
| Rate for Payer: UHC Core |
$1,316.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.75
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$374.54 |
| Max. Negotiated Rate |
$2,907.19 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: Aetna Medicare |
$410.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.81
|
| Rate for Payer: BCBS Complete |
$2,907.19
|
| Rate for Payer: BCBS MAPPO |
$394.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.45
|
| Rate for Payer: BCN Commercial |
$1,226.12
|
| Rate for Payer: BCN Medicare Advantage |
$394.25
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.25
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.75
|
| Rate for Payer: Mclaren Medicaid |
$2,768.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.96
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: Nomi Health Commercial |
$1,293.14
|
| Rate for Payer: PACE Senior Care Partners |
$374.54
|
| Rate for Payer: PACE SWMI |
$394.25
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: PHP Medicare Advantage |
$394.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,768.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,371.99
|
| Rate for Payer: Priority Health Medicare |
$398.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,056.59
|
| Rate for Payer: Railroad Medicare Medicare |
$394.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.76
|
| Rate for Payer: UHC Core |
$1,316.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.25
|
| Rate for Payer: UHC Exchange |
$394.25
|
| Rate for Payer: UHC Medicare Advantage |
$394.25
|
| Rate for Payer: UHCCP Medicaid |
$2,768.57
|
| Rate for Payer: VA VA |
$394.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.75
|
|
