|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,169.98 |
| Max. Negotiated Rate |
$1,512.90 |
| Rate for Payer: Aetna Commercial |
$1,428.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.34
|
| Rate for Payer: BCN Commercial |
$1,388.34
|
| Rate for Payer: Cash Price |
$1,344.80
|
| 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: Lakeland Regional Health Systems Commercial |
$1,260.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,428.85
|
| Rate for Payer: Nomi Health Commercial |
$1,378.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PHP Commercial |
$1,428.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,462.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,169.98
|
| Rate for Payer: UHC Core |
$1,403.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,260.75
|
|
|
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 |
$462.52
|
| Rate for Payer: Aetna Medicare |
$840.50
|
| Rate for Payer: BCBS Complete |
$285.16
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Mclaren Medicaid |
$271.58
|
| Rate for Payer: Meridian Medicaid |
$285.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$602.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$602.54
|
| Rate for Payer: UHC Medicaid |
$271.58
|
| Rate for Payer: UHCCP Medicaid |
$271.58
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$794.83 |
| Max. Negotiated Rate |
$1,027.80 |
| Rate for Payer: Aetna Commercial |
$970.70
|
| Rate for Payer: BCBS Trust/PPO |
$943.18
|
| Rate for Payer: BCN Commercial |
$943.18
|
| Rate for Payer: Cash Price |
$913.60
|
| 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: Lakeland Regional Health Systems Commercial |
$856.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.70
|
| Rate for Payer: Nomi Health Commercial |
$936.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PHP Commercial |
$970.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$993.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$794.83
|
| Rate for Payer: UHC Core |
$953.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$856.50
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$403.42 |
| Max. Negotiated Rate |
$996.46 |
| Rate for Payer: Aetna Commercial |
$722.42
|
| Rate for Payer: Aetna Medicare |
$571.00
|
| Rate for Payer: BCBS Complete |
$423.59
|
| Rate for Payer: BCN Commercial |
$996.46
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Mclaren Medicaid |
$403.42
|
| Rate for Payer: Meridian Medicaid |
$423.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$912.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$912.01
|
| 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 |
$201.33 |
| Max. Negotiated Rate |
$1,027.80 |
| Rate for Payer: Aetna Commercial |
$970.70
|
| Rate for Payer: Aetna Medicare |
$296.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.88
|
| Rate for Payer: BCBS Complete |
$211.38
|
| Rate for Payer: BCBS MAPPO |
$285.50
|
| Rate for Payer: BCBS Trust/PPO |
$938.84
|
| Rate for Payer: BCN Commercial |
$938.84
|
| Rate for Payer: BCN Medicare Advantage |
$285.50
|
| Rate for Payer: Cash Price |
$913.60
|
| 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 |
$285.50
|
| Rate for Payer: Healthscope Commercial |
$1,027.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$856.50
|
| Rate for Payer: Mclaren Medicaid |
$201.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.77
|
| Rate for Payer: Meridian Medicaid |
$211.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$314.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.70
|
| Rate for Payer: Nomi Health Commercial |
$936.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PACE Senior Care Partners |
$271.23
|
| Rate for Payer: PACE SWMI |
$285.50
|
| Rate for Payer: PHP Commercial |
$970.70
|
| Rate for Payer: PHP Medicare Advantage |
$285.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$993.54
|
| Rate for Payer: Priority Health Medicare |
$288.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$794.83
|
| Rate for Payer: Railroad Medicare Medicare |
$285.50
|
| Rate for Payer: UHC Core |
$953.57
|
| Rate for Payer: UHC Exchange |
$285.50
|
| Rate for Payer: UHC Medicaid |
$201.33
|
| Rate for Payer: UHC Medicare Advantage |
$285.50
|
| Rate for Payer: UHCCP Medicaid |
$201.33
|
| Rate for Payer: VA VA |
$285.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$856.50
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$403.42 |
| Max. Negotiated Rate |
$996.46 |
| Rate for Payer: Aetna Commercial |
$722.42
|
| Rate for Payer: Aetna Medicare |
$571.00
|
| Rate for Payer: BCBS Complete |
$423.59
|
| Rate for Payer: BCN Commercial |
$996.46
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Mclaren Medicaid |
$403.42
|
| Rate for Payer: Meridian Medicaid |
$423.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$912.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$912.01
|
| 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 |
$1,368.95 |
| Rate for Payer: Aetna Commercial |
$993.34
|
| Rate for Payer: Aetna Medicare |
$690.00
|
| Rate for Payer: BCBS Complete |
$580.82
|
| Rate for Payer: BCN Commercial |
$1,368.95
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Mclaren Medicaid |
$553.16
|
| Rate for Payer: Meridian Medicaid |
$580.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,252.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,252.95
|
| Rate for Payer: UHC Medicaid |
$553.16
|
| Rate for Payer: UHCCP Medicaid |
$553.16
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,948.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$584.05 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Aetna Commercial |
$1,051.23
|
| Rate for Payer: Aetna Medicare |
$974.00
|
| Rate for Payer: BCBS Complete |
$613.25
|
| Rate for Payer: BCN Commercial |
$1,447.63
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Mclaren Medicaid |
$584.05
|
| Rate for Payer: Meridian Medicaid |
$613.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,324.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.95
|
| 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
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$584.05 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Aetna Commercial |
$1,051.23
|
| Rate for Payer: Aetna Medicare |
$974.00
|
| Rate for Payer: BCBS Complete |
$613.25
|
| Rate for Payer: BCN Commercial |
$1,447.63
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Cash Price |
$1,558.40
|
| Rate for Payer: Mclaren Medicaid |
$584.05
|
| Rate for Payer: Meridian Medicaid |
$613.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,324.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.95
|
| Rate for Payer: UHC Medicaid |
$584.05
|
| Rate for Payer: UHCCP Medicaid |
$584.05
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,948.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$343.43 |
| Max. Negotiated Rate |
$1,753.20 |
| Rate for Payer: Aetna Commercial |
$1,655.80
|
| Rate for Payer: Aetna Medicare |
$506.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$608.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$608.75
|
| Rate for Payer: BCBS Complete |
$360.57
|
| Rate for Payer: BCBS MAPPO |
$487.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.45
|
| Rate for Payer: BCN Commercial |
$1,601.45
|
| Rate for Payer: BCN Medicare Advantage |
$487.00
|
| Rate for Payer: Cash Price |
$1,558.40
|
| 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 |
$487.00
|
| Rate for Payer: Healthscope Commercial |
$1,753.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,461.00
|
| Rate for Payer: Mclaren Medicaid |
$343.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.35
|
| Rate for Payer: Meridian Medicaid |
$360.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$560.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$535.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.80
|
| Rate for Payer: Nomi Health Commercial |
$1,597.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: PACE Senior Care Partners |
$462.65
|
| Rate for Payer: PACE SWMI |
$487.00
|
| Rate for Payer: PHP Commercial |
$1,655.80
|
| Rate for Payer: PHP Medicare Advantage |
$487.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,694.76
|
| Rate for Payer: Priority Health Medicare |
$491.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,355.81
|
| Rate for Payer: Railroad Medicare Medicare |
$487.00
|
| Rate for Payer: UHC Core |
$1,626.58
|
| Rate for Payer: UHC Exchange |
$487.00
|
| Rate for Payer: UHC Medicaid |
$343.43
|
| Rate for Payer: UHC Medicare Advantage |
$487.00
|
| Rate for Payer: UHCCP Medicaid |
$343.43
|
| Rate for Payer: VA VA |
$487.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,461.00
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,948.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,355.81 |
| Max. Negotiated Rate |
$1,753.20 |
| Rate for Payer: Aetna Commercial |
$1,655.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,608.85
|
| Rate for Payer: BCN Commercial |
$1,608.85
|
| Rate for Payer: Cash Price |
$1,558.40
|
| 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: Lakeland Regional Health Systems Commercial |
$1,461.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.80
|
| Rate for Payer: Nomi Health Commercial |
$1,597.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,461.00
|
| Rate for Payer: PHP Commercial |
$1,655.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,694.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,355.81
|
| Rate for Payer: UHC Core |
$1,626.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,461.00
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$1,021.50 |
| Rate for Payer: Aetna Commercial |
$964.75
|
| Rate for Payer: Aetna Medicare |
$295.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$354.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$354.69
|
| Rate for Payer: BCBS Complete |
$210.09
|
| Rate for Payer: BCBS MAPPO |
$283.75
|
| Rate for Payer: BCBS Trust/PPO |
$933.08
|
| Rate for Payer: BCN Commercial |
$933.08
|
| Rate for Payer: BCN Medicare Advantage |
$283.75
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Cofinity Commercial |
$976.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.75
|
| Rate for Payer: Healthscope Commercial |
$1,021.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.25
|
| Rate for Payer: Mclaren Medicaid |
$200.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$297.94
|
| Rate for Payer: Meridian Medicaid |
$210.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.75
|
| Rate for Payer: Nomi Health Commercial |
$930.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.25
|
| Rate for Payer: PACE Senior Care Partners |
$269.56
|
| Rate for Payer: PACE SWMI |
$283.75
|
| Rate for Payer: PHP Commercial |
$964.75
|
| Rate for Payer: PHP Medicare Advantage |
$283.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$987.45
|
| Rate for Payer: Priority Health Medicare |
$286.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$789.96
|
| Rate for Payer: Railroad Medicare Medicare |
$283.75
|
| Rate for Payer: UHC Core |
$947.73
|
| Rate for Payer: UHC Exchange |
$283.75
|
| Rate for Payer: UHC Medicaid |
$200.10
|
| Rate for Payer: UHC Medicare Advantage |
$283.75
|
| Rate for Payer: UHCCP Medicaid |
$200.10
|
| Rate for Payer: VA VA |
$283.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.25
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$789.96 |
| Max. Negotiated Rate |
$1,021.50 |
| Rate for Payer: Aetna Commercial |
$964.75
|
| Rate for Payer: BCBS Trust/PPO |
$937.40
|
| Rate for Payer: BCN Commercial |
$937.40
|
| Rate for Payer: Cash Price |
$908.00
|
| 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: Lakeland Regional Health Systems Commercial |
$851.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.75
|
| Rate for Payer: Nomi Health Commercial |
$930.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.25
|
| Rate for Payer: PHP Commercial |
$964.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$987.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$789.96
|
| Rate for Payer: UHC Core |
$947.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.25
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
HCPCS 19304
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$851.25 |
| Rate for Payer: Aetna Medicare |
$567.50
|
| Rate for Payer: BCBS Complete |
$454.00
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.25
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
HCPCS 19304
|
| Hospital Charge Code |
19304
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$851.25 |
| Rate for Payer: Aetna Medicare |
$567.50
|
| Rate for Payer: BCBS Complete |
$454.00
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.25
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$718.45 |
| Max. Negotiated Rate |
$1,778.29 |
| Rate for Payer: Aetna Commercial |
$1,296.93
|
| Rate for Payer: Aetna Medicare |
$1,052.50
|
| Rate for Payer: BCBS Complete |
$754.37
|
| Rate for Payer: BCN Commercial |
$1,778.29
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Mclaren Medicaid |
$718.45
|
| Rate for Payer: Meridian Medicaid |
$754.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,578.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,627.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,627.59
|
| Rate for Payer: UHC Medicaid |
$718.45
|
| Rate for Payer: UHCCP Medicaid |
$718.45
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$371.11 |
| Max. Negotiated Rate |
$1,894.50 |
| Rate for Payer: Aetna Commercial |
$1,789.25
|
| Rate for Payer: Aetna Medicare |
$547.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$657.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$657.81
|
| Rate for Payer: BCBS Complete |
$389.64
|
| Rate for Payer: BCBS MAPPO |
$526.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,730.52
|
| Rate for Payer: BCN Commercial |
$1,730.52
|
| Rate for Payer: BCN Medicare Advantage |
$526.25
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cofinity Commercial |
$1,810.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,684.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.25
|
| Rate for Payer: Healthscope Commercial |
$1,894.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,578.75
|
| Rate for Payer: Mclaren Medicaid |
$371.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$552.56
|
| Rate for Payer: Meridian Medicaid |
$389.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$605.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$578.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,789.25
|
| Rate for Payer: Nomi Health Commercial |
$1,726.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,578.75
|
| Rate for Payer: PACE Senior Care Partners |
$499.94
|
| Rate for Payer: PACE SWMI |
$526.25
|
| Rate for Payer: PHP Commercial |
$1,789.25
|
| Rate for Payer: PHP Medicare Advantage |
$526.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$371.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,831.35
|
| Rate for Payer: Priority Health Medicare |
$531.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,465.08
|
| Rate for Payer: Railroad Medicare Medicare |
$526.25
|
| Rate for Payer: UHC Core |
$1,757.67
|
| Rate for Payer: UHC Exchange |
$526.25
|
| Rate for Payer: UHC Medicaid |
$371.11
|
| Rate for Payer: UHC Medicare Advantage |
$526.25
|
| Rate for Payer: UHCCP Medicaid |
$371.11
|
| Rate for Payer: VA VA |
$526.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,578.75
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
19307
|
| Min. Negotiated Rate |
$718.45 |
| Max. Negotiated Rate |
$1,778.29 |
| Rate for Payer: Aetna Commercial |
$1,296.93
|
| Rate for Payer: Aetna Medicare |
$1,052.50
|
| Rate for Payer: BCBS Complete |
$754.37
|
| Rate for Payer: BCN Commercial |
$1,778.29
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Mclaren Medicaid |
$718.45
|
| Rate for Payer: Meridian Medicaid |
$754.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,578.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,627.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,627.59
|
| Rate for Payer: UHC Medicaid |
$718.45
|
| Rate for Payer: UHCCP Medicaid |
$718.45
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,465.08 |
| Max. Negotiated Rate |
$1,894.50 |
| Rate for Payer: Aetna Commercial |
$1,789.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.52
|
| Rate for Payer: BCN Commercial |
$1,738.52
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cofinity Commercial |
$1,810.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,684.00
|
| Rate for Payer: Healthscope Commercial |
$1,894.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,578.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,789.25
|
| Rate for Payer: Nomi Health Commercial |
$1,726.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,578.75
|
| Rate for Payer: PHP Commercial |
$1,789.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,831.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,465.08
|
| Rate for Payer: UHC Core |
$1,757.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,578.75
|
|
|
PR MASTOIDECTOMY COMPLETE
|
Professional
|
Both
|
$2,785.00
|
|
|
Service Code
|
HCPCS 69502
|
| Min. Negotiated Rate |
$535.91 |
| Max. Negotiated Rate |
$2,088.75 |
| Rate for Payer: Aetna Commercial |
$1,083.82
|
| Rate for Payer: Aetna Medicare |
$1,392.50
|
| Rate for Payer: BCBS Complete |
$562.71
|
| Rate for Payer: BCN Commercial |
$1,409.78
|
| Rate for Payer: Cash Price |
$2,228.00
|
| Rate for Payer: Cash Price |
$2,228.00
|
| Rate for Payer: Mclaren Medicaid |
$535.91
|
| Rate for Payer: Meridian Medicaid |
$562.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,088.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,393.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,393.01
|
| Rate for Payer: UHC Medicaid |
$535.91
|
| Rate for Payer: UHCCP Medicaid |
$535.91
|
|
|
PR MASTOID OBLITERATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,583.00
|
|
|
Service Code
|
HCPCS 69670
|
| Min. Negotiated Rate |
$535.70 |
| Max. Negotiated Rate |
$2,687.25 |
| Rate for Payer: Aetna Commercial |
$1,073.89
|
| Rate for Payer: Aetna Medicare |
$1,791.50
|
| Rate for Payer: BCBS Complete |
$562.49
|
| Rate for Payer: BCN Commercial |
$1,409.29
|
| Rate for Payer: Cash Price |
$2,866.40
|
| Rate for Payer: Cash Price |
$2,866.40
|
| Rate for Payer: Mclaren Medicaid |
$535.70
|
| Rate for Payer: Meridian Medicaid |
$562.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,687.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,392.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,392.52
|
| Rate for Payer: UHC Medicaid |
$535.70
|
| Rate for Payer: UHCCP Medicaid |
$535.70
|
|
|
PR MASTOPEXY
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 19316
|
| Min. Negotiated Rate |
$464.98 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Aetna Commercial |
$856.33
|
| Rate for Payer: Aetna Medicare |
$998.00
|
| Rate for Payer: BCBS Complete |
$488.23
|
| Rate for Payer: BCN Commercial |
$1,198.15
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Mclaren Medicaid |
$464.98
|
| Rate for Payer: Meridian Medicaid |
$488.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,096.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,096.61
|
| Rate for Payer: UHC Medicaid |
$464.98
|
| Rate for Payer: UHCCP Medicaid |
$464.98
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 19020
|
| Min. Negotiated Rate |
$201.71 |
| Max. Negotiated Rate |
$628.50 |
| Rate for Payer: Aetna Commercial |
$336.67
|
| Rate for Payer: Aetna Medicare |
$419.00
|
| Rate for Payer: BCBS Complete |
$211.80
|
| Rate for Payer: BCN Commercial |
$475.57
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Mclaren Medicaid |
$201.71
|
| Rate for Payer: Meridian Medicaid |
$211.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$628.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$435.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$435.27
|
| Rate for Payer: UHC Medicaid |
$201.71
|
| Rate for Payer: UHCCP Medicaid |
$201.71
|
|
|
PR MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
HCPCS 19305
|
| Min. Negotiated Rate |
$699.28 |
| Max. Negotiated Rate |
$1,866.00 |
| Rate for Payer: Aetna Commercial |
$1,253.82
|
| Rate for Payer: Aetna Medicare |
$1,244.00
|
| Rate for Payer: BCBS Complete |
$734.24
|
| Rate for Payer: BCN Commercial |
$1,727.50
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Mclaren Medicaid |
$699.28
|
| Rate for Payer: Meridian Medicaid |
$734.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,866.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$699.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,581.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,581.11
|
| Rate for Payer: UHC Medicaid |
$699.28
|
| Rate for Payer: UHCCP Medicaid |
$699.28
|
|
|
PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 94200
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCN Commercial |
$22.41
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.67
|
|
