|
PR MAMMAPLASTY AUGMENTATION - GEL
|
Professional
|
Both
|
$4,937.00
|
|
|
Service Code
|
HCPCS 00261
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,974.80 |
| Max. Negotiated Rate |
$3,209.05 |
| Rate for Payer: Aetna Medicare |
$2,468.50
|
| Rate for Payer: BCBS Complete |
$1,974.80
|
| Rate for Payer: Cash Price |
$3,949.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,209.05
|
|
|
PR MAMMAPLASTY AUGMENTATION - SALINE
|
Professional
|
Both
|
$3,774.00
|
|
|
Service Code
|
HCPCS 00262
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,509.60 |
| Max. Negotiated Rate |
$2,453.10 |
| Rate for Payer: Aetna Medicare |
$1,887.00
|
| Rate for Payer: BCBS Complete |
$1,509.60
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,453.10
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$77.38
|
| Rate for Payer: BCBS Complete |
$164.00
|
| Rate for Payer: BCBS MAPPO |
$74.40
|
| Rate for Payer: BCN Medicare Advantage |
$74.40
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.12
|
| Rate for Payer: Nomi Health Commercial |
$89.28
|
| Rate for Payer: PACE SWMI |
$74.40
|
| Rate for Payer: PHP Medicare Advantage |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$75.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.40
|
| Rate for Payer: UHC Exchange |
$74.40
|
| Rate for Payer: UHC Medicare Advantage |
$74.40
|
|
|
PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 27860
|
| Min. Negotiated Rate |
$157.39 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$210.90
|
| Rate for Payer: Aetna Medicare |
$163.69
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: BCBS MAPPO |
$157.39
|
| Rate for Payer: BCN Medicare Advantage |
$157.39
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$210.90
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.26
|
| Rate for Payer: Nomi Health Commercial |
$188.87
|
| Rate for Payer: PACE SWMI |
$157.39
|
| Rate for Payer: PHP Medicare Advantage |
$157.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health Medicare |
$158.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.39
|
| Rate for Payer: UHC Exchange |
$157.39
|
| Rate for Payer: UHC Medicare Advantage |
$157.39
|
|
|
PR MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 24300
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$609.67 |
| Rate for Payer: Aetna Commercial |
$567.33
|
| Rate for Payer: Aetna Medicare |
$440.32
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$423.38
|
| Rate for Payer: BCN Medicare Advantage |
$423.38
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$609.67
|
| Rate for Payer: Cofinity Commercial |
$567.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.55
|
| Rate for Payer: Nomi Health Commercial |
$508.06
|
| Rate for Payer: PACE SWMI |
$423.38
|
| Rate for Payer: PHP Medicare Advantage |
$423.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$427.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.38
|
| Rate for Payer: UHC Exchange |
$423.38
|
| Rate for Payer: UHC Medicare Advantage |
$423.38
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$494.48 |
| Rate for Payer: Aetna Commercial |
$460.14
|
| Rate for Payer: Aetna Medicare |
$357.13
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$343.39
|
| Rate for Payer: BCN Medicare Advantage |
$343.39
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$494.48
|
| Rate for Payer: Cofinity Commercial |
$460.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.56
|
| Rate for Payer: Nomi Health Commercial |
$412.07
|
| Rate for Payer: PACE SWMI |
$343.39
|
| Rate for Payer: PHP Medicare Advantage |
$343.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$346.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.39
|
| Rate for Payer: UHC Exchange |
$343.39
|
| Rate for Payer: UHC Medicare Advantage |
$343.39
|
|
|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$178.04 |
| Max. Negotiated Rate |
$655.20 |
| Rate for Payer: Aetna Commercial |
$238.57
|
| Rate for Payer: Aetna Medicare |
$185.16
|
| Rate for Payer: BCBS Complete |
$403.20
|
| Rate for Payer: BCBS MAPPO |
$178.04
|
| Rate for Payer: BCN Medicare Advantage |
$178.04
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cofinity Commercial |
$256.38
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.94
|
| Rate for Payer: Nomi Health Commercial |
$213.65
|
| Rate for Payer: PACE SWMI |
$178.04
|
| Rate for Payer: PHP Medicare Advantage |
$178.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.20
|
| Rate for Payer: Priority Health Medicare |
$179.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.04
|
| Rate for Payer: UHC Exchange |
$178.04
|
| Rate for Payer: UHC Medicare Advantage |
$178.04
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$434.85 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$154.89
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$148.93
|
| Rate for Payer: BCN Medicare Advantage |
$148.93
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$214.46
|
| Rate for Payer: Cofinity Commercial |
$199.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.38
|
| Rate for Payer: Nomi Health Commercial |
$178.72
|
| Rate for Payer: PACE SWMI |
$148.93
|
| Rate for Payer: PHP Medicare Advantage |
$148.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$150.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.93
|
| Rate for Payer: UHC Exchange |
$148.93
|
| Rate for Payer: UHC Medicare Advantage |
$148.93
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$434.85 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$154.89
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$148.93
|
| Rate for Payer: BCN Medicare Advantage |
$148.93
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$214.46
|
| Rate for Payer: Cofinity Commercial |
$199.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.38
|
| Rate for Payer: Nomi Health Commercial |
$178.72
|
| Rate for Payer: PACE SWMI |
$148.93
|
| Rate for Payer: PHP Medicare Advantage |
$148.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$150.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.93
|
| Rate for Payer: UHC Exchange |
$148.93
|
| Rate for Payer: UHC Medicare Advantage |
$148.93
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$1,215.03 |
| Rate for Payer: Aetna Commercial |
$568.65
|
| Rate for Payer: Aetna Medicare |
$173.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.06
|
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: BCBS MAPPO |
$167.25
|
| Rate for Payer: BCBS Trust/PPO |
$549.98
|
| Rate for Payer: BCN Commercial |
$520.15
|
| Rate for Payer: BCN Medicare Advantage |
$167.25
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$575.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.25
|
| Rate for Payer: Healthscope Commercial |
$602.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.75
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.61
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: Nomi Health Commercial |
$548.58
|
| Rate for Payer: PACE Senior Care Partners |
$158.89
|
| Rate for Payer: PACE SWMI |
$167.25
|
| Rate for Payer: PHP Commercial |
$568.65
|
| Rate for Payer: PHP Medicare Advantage |
$167.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO |
$582.03
|
| Rate for Payer: Priority Health Medicare |
$168.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.23
|
| Rate for Payer: Railroad Medicare Medicare |
$167.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.72
|
| Rate for Payer: UHC Core |
$558.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.25
|
| Rate for Payer: UHC Exchange |
$167.25
|
| Rate for Payer: UHC Medicare Advantage |
$167.25
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
| Rate for Payer: VA VA |
$167.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.75
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$434.85 |
| Max. Negotiated Rate |
$602.10 |
| Rate for Payer: Aetna Commercial |
$568.65
|
| Rate for Payer: BCBS Trust/PPO |
$546.10
|
| Rate for Payer: BCN Commercial |
$517.00
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$575.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Healthscope Commercial |
$602.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$501.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: Nomi Health Commercial |
$548.58
|
| Rate for Payer: PHP Commercial |
$568.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO |
$582.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.72
|
| Rate for Payer: UHC Core |
$558.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$501.75
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$146.87 |
| Max. Negotiated Rate |
$316.55 |
| Rate for Payer: Aetna Commercial |
$196.81
|
| Rate for Payer: Aetna Medicare |
$152.74
|
| Rate for Payer: BCBS Complete |
$194.80
|
| Rate for Payer: BCBS MAPPO |
$146.87
|
| Rate for Payer: BCN Medicare Advantage |
$146.87
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$211.49
|
| Rate for Payer: Cofinity Commercial |
$196.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.21
|
| Rate for Payer: Nomi Health Commercial |
$176.24
|
| Rate for Payer: PACE SWMI |
$146.87
|
| Rate for Payer: PHP Medicare Advantage |
$146.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.55
|
| Rate for Payer: Priority Health Medicare |
$148.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.87
|
| Rate for Payer: UHC Exchange |
$146.87
|
| Rate for Payer: UHC Medicare Advantage |
$146.87
|
|
|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$579.96 |
| Rate for Payer: Aetna Commercial |
$539.68
|
| Rate for Payer: Aetna Medicare |
$418.86
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$402.75
|
| Rate for Payer: BCN Medicare Advantage |
$402.75
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$579.96
|
| Rate for Payer: Cofinity Commercial |
$539.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.89
|
| Rate for Payer: Nomi Health Commercial |
$483.30
|
| Rate for Payer: PACE SWMI |
$402.75
|
| Rate for Payer: PHP Medicare Advantage |
$402.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$406.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.75
|
| Rate for Payer: UHC Exchange |
$402.75
|
| Rate for Payer: UHC Medicare Advantage |
$402.75
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$116.15 |
| Rate for Payer: Aetna Commercial |
$108.08
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$80.66
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.69
|
| Rate for Payer: Nomi Health Commercial |
$96.79
|
| Rate for Payer: PACE SWMI |
$80.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$81.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.66
|
| Rate for Payer: UHC Exchange |
$80.66
|
| Rate for Payer: UHC Medicare Advantage |
$80.66
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$198.09 |
| Rate for Payer: Aetna Commercial |
$184.33
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$137.56
|
| Rate for Payer: BCN Medicare Advantage |
$137.56
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$198.09
|
| Rate for Payer: Cofinity Commercial |
$184.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.44
|
| Rate for Payer: Nomi Health Commercial |
$165.07
|
| Rate for Payer: PACE SWMI |
$137.56
|
| Rate for Payer: PHP Medicare Advantage |
$137.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$138.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.56
|
| Rate for Payer: UHC Exchange |
$137.56
|
| Rate for Payer: UHC Medicare Advantage |
$137.56
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$34.95
|
| Rate for Payer: Aetna Medicare |
$27.12
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$26.08
|
| Rate for Payer: BCN Medicare Advantage |
$26.08
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$37.56
|
| Rate for Payer: Cofinity Commercial |
$34.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.38
|
| Rate for Payer: Nomi Health Commercial |
$31.30
|
| Rate for Payer: PACE SWMI |
$26.08
|
| Rate for Payer: PHP Medicare Advantage |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$26.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.08
|
| Rate for Payer: UHC Exchange |
$26.08
|
| Rate for Payer: UHC Medicare Advantage |
$26.08
|
|
|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$174.63 |
| Max. Negotiated Rate |
$510.25 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$181.62
|
| Rate for Payer: BCBS Complete |
$314.00
|
| Rate for Payer: BCBS MAPPO |
$174.63
|
| Rate for Payer: BCN Medicare Advantage |
$174.63
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cofinity Commercial |
$251.47
|
| Rate for Payer: Cofinity Commercial |
$234.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.36
|
| Rate for Payer: Nomi Health Commercial |
$209.56
|
| Rate for Payer: PACE SWMI |
$174.63
|
| Rate for Payer: PHP Medicare Advantage |
$174.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.25
|
| Rate for Payer: Priority Health Medicare |
$176.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.63
|
| Rate for Payer: UHC Exchange |
$174.63
|
| Rate for Payer: UHC Medicare Advantage |
$174.63
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$936.80 |
| Max. Negotiated Rate |
$1,583.04 |
| Rate for Payer: Aetna Commercial |
$1,473.10
|
| Rate for Payer: Aetna Medicare |
$1,143.30
|
| Rate for Payer: BCBS Complete |
$936.80
|
| Rate for Payer: BCBS MAPPO |
$1,099.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.33
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cofinity Commercial |
$1,583.04
|
| Rate for Payer: Cofinity Commercial |
$1,473.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,154.30
|
| Rate for Payer: Nomi Health Commercial |
$1,319.20
|
| Rate for Payer: PACE SWMI |
$1,099.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.30
|
| Rate for Payer: Priority Health Medicare |
$1,110.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,099.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.33
|
| Rate for Payer: UHC Exchange |
$1,099.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.33
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$221.83 |
| Max. Negotiated Rate |
$452.40 |
| Rate for Payer: Aetna Commercial |
$297.25
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: BCBS Complete |
$278.40
|
| Rate for Payer: BCBS MAPPO |
$221.83
|
| Rate for Payer: BCN Medicare Advantage |
$221.83
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cofinity Commercial |
$319.44
|
| Rate for Payer: Cofinity Commercial |
$297.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.92
|
| Rate for Payer: Nomi Health Commercial |
$266.20
|
| Rate for Payer: PACE SWMI |
$221.83
|
| Rate for Payer: PHP Medicare Advantage |
$221.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health Medicare |
$224.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.83
|
| Rate for Payer: UHC Exchange |
$221.83
|
| Rate for Payer: UHC Medicare Advantage |
$221.83
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,387.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.20
|
| Rate for Payer: BCN Commercial |
$1,261.21
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,403.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Healthscope Commercial |
$1,468.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$1,338.24
|
| Rate for Payer: PHP Commercial |
$1,387.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,419.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,093.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,436.16
|
| Rate for Payer: UHC Core |
$1,362.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,224.00
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
19300
|
| Min. Negotiated Rate |
$415.27 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Aetna Commercial |
$556.46
|
| Rate for Payer: Aetna Medicare |
$431.88
|
| Rate for Payer: BCBS Complete |
$652.80
|
| Rate for Payer: BCBS MAPPO |
$415.27
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.03
|
| 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 Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health Medicare |
$419.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.27
|
| Rate for Payer: UHC Exchange |
$415.27
|
| Rate for Payer: UHC Medicare Advantage |
$415.27
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$415.27 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Aetna Commercial |
$556.46
|
| Rate for Payer: Aetna Medicare |
$431.88
|
| Rate for Payer: BCBS Complete |
$652.80
|
| Rate for Payer: BCBS MAPPO |
$415.27
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.03
|
| 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 Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health Medicare |
$419.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.27
|
| Rate for Payer: UHC Exchange |
$415.27
|
| Rate for Payer: UHC Medicare Advantage |
$415.27
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$2,907.19 |
| Rate for Payer: Aetna Commercial |
$1,387.20
|
| Rate for Payer: Aetna Medicare |
$424.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$510.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$510.00
|
| Rate for Payer: BCBS Complete |
$2,907.19
|
| Rate for Payer: BCBS MAPPO |
$408.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.67
|
| Rate for Payer: BCN Commercial |
$1,268.88
|
| Rate for Payer: BCN Medicare Advantage |
$408.00
|
| 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: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$1,468.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,224.00
|
| Rate for Payer: Mclaren Medicaid |
$2,768.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.40
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$469.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$1,338.24
|
| Rate for Payer: PACE Senior Care Partners |
$387.60
|
| Rate for Payer: PACE SWMI |
$408.00
|
| Rate for Payer: PHP Commercial |
$1,387.20
|
| Rate for Payer: PHP Medicare Advantage |
$408.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,768.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,419.84
|
| Rate for Payer: Priority Health Medicare |
$412.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,093.44
|
| Rate for Payer: Railroad Medicare Medicare |
$408.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,436.16
|
| Rate for Payer: UHC Core |
$1,362.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.00
|
| Rate for Payer: UHC Exchange |
$408.00
|
| Rate for Payer: UHC Medicare Advantage |
$408.00
|
| Rate for Payer: UHCCP Medicaid |
$2,768.57
|
| Rate for Payer: VA VA |
$408.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,224.00
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$921.72 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$665.68
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| 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 Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health Medicare |
$646.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Exchange |
$640.08
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$921.72 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$665.68
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| 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 Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health Medicare |
$646.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Exchange |
$640.08
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
|
