|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$117.15 |
| Max. Negotiated Rate |
$510.25 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$181.62
|
| Rate for Payer: BCBS Complete |
$123.01
|
| Rate for Payer: BCBS MAPPO |
$174.63
|
| Rate for Payer: BCBS Trust/PPO |
$226.64
|
| Rate for Payer: BCN Commercial |
$265.35
|
| 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: Mclaren Medicaid |
$117.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.36
|
| Rate for Payer: Meridian Medicaid |
$123.01
|
| 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 Choice Medicaid |
$117.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.25
|
| Rate for Payer: Priority Health HMO/PPO |
$272.33
|
| Rate for Payer: Priority Health Medicare |
$176.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$272.33
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$117.15
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$729.31 |
| Max. Negotiated Rate |
$2,350.41 |
| Rate for Payer: Aetna Commercial |
$1,473.10
|
| Rate for Payer: Aetna Medicare |
$1,143.30
|
| Rate for Payer: BCBS Complete |
$765.78
|
| Rate for Payer: BCBS MAPPO |
$1,099.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.41
|
| Rate for Payer: BCN Commercial |
$1,661.01
|
| 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: Mclaren Medicaid |
$729.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,154.30
|
| Rate for Payer: Meridian Medicaid |
$765.78
|
| 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 Choice Medicaid |
$729.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.30
|
| Rate for Payer: Priority Health HMO/PPO |
$2,037.37
|
| Rate for Payer: Priority Health Medicare |
$1,110.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,037.37
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$729.31
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$151.66 |
| Max. Negotiated Rate |
$641.36 |
| Rate for Payer: Aetna Commercial |
$297.25
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: BCBS Complete |
$159.24
|
| Rate for Payer: BCBS MAPPO |
$221.83
|
| Rate for Payer: BCBS Trust/PPO |
$641.36
|
| Rate for Payer: BCN Commercial |
$586.41
|
| 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: Mclaren Medicaid |
$151.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.92
|
| Rate for Payer: Meridian Medicaid |
$159.24
|
| 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 Choice Medicaid |
$151.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health HMO/PPO |
$421.20
|
| Rate for Payer: Priority Health Medicare |
$224.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.20
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$151.66
|
|
|
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 |
$281.59 |
| 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 |
$295.67
|
| Rate for Payer: BCBS MAPPO |
$415.27
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: BCN Medicare Advantage |
$415.27
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$597.99
|
| Rate for Payer: Cofinity Commercial |
$556.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.27
|
| Rate for Payer: Mclaren Medicaid |
$281.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.03
|
| Rate for Payer: Meridian Medicaid |
$295.67
|
| Rate for Payer: Nomi Health Commercial |
$498.32
|
| Rate for Payer: PACE SWMI |
$415.27
|
| Rate for Payer: PHP Medicare Advantage |
$415.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO |
$590.14
|
| Rate for Payer: Priority Health Medicare |
$419.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.14
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
|
|
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 |
$2,848.40 |
| 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 |
$2,848.40
|
| 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 |
$2,712.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.40
|
| Rate for Payer: Meridian Medicaid |
$2,848.40
|
| 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 |
$2,712.59
|
| 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 |
$2,712.59
|
| Rate for Payer: VA VA |
$408.00
|
| 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
|
| Min. Negotiated Rate |
$281.59 |
| 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 |
$295.67
|
| Rate for Payer: BCBS MAPPO |
$415.27
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: BCN Medicare Advantage |
$415.27
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$597.99
|
| Rate for Payer: Cofinity Commercial |
$556.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.27
|
| Rate for Payer: Mclaren Medicaid |
$281.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.03
|
| Rate for Payer: Meridian Medicaid |
$295.67
|
| Rate for Payer: Nomi Health Commercial |
$498.32
|
| Rate for Payer: PACE SWMI |
$415.27
|
| Rate for Payer: PHP Medicare Advantage |
$415.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO |
$590.14
|
| Rate for Payer: Priority Health Medicare |
$419.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.14
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$665.68
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$921.72
|
| Rate for Payer: Cofinity Commercial |
$857.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.08
|
| Rate for Payer: Mclaren Medicaid |
$426.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO |
$899.87
|
| Rate for Payer: Priority Health Medicare |
$646.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$899.87
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$263.39 |
| Max. Negotiated Rate |
$2,848.40 |
| Rate for Payer: Aetna Commercial |
$942.65
|
| Rate for Payer: Aetna Medicare |
$288.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$346.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$346.56
|
| Rate for Payer: BCBS Complete |
$2,848.40
|
| Rate for Payer: BCBS MAPPO |
$277.25
|
| Rate for Payer: BCBS Trust/PPO |
$911.71
|
| Rate for Payer: BCN Commercial |
$862.25
|
| Rate for Payer: BCN Medicare Advantage |
$277.25
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$953.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.25
|
| Rate for Payer: Healthscope Commercial |
$998.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$831.75
|
| Rate for Payer: Mclaren Medicaid |
$2,712.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.11
|
| Rate for Payer: Meridian Medicaid |
$2,848.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: Nomi Health Commercial |
$909.38
|
| Rate for Payer: PACE Senior Care Partners |
$263.39
|
| Rate for Payer: PACE SWMI |
$277.25
|
| Rate for Payer: PHP Commercial |
$942.65
|
| Rate for Payer: PHP Medicare Advantage |
$277.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,712.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO |
$964.83
|
| Rate for Payer: Priority Health Medicare |
$280.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$743.03
|
| Rate for Payer: Railroad Medicare Medicare |
$277.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.92
|
| Rate for Payer: UHC Core |
$926.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$277.25
|
| Rate for Payer: UHC Exchange |
$277.25
|
| Rate for Payer: UHC Medicare Advantage |
$277.25
|
| Rate for Payer: UHCCP Medicaid |
$2,712.59
|
| Rate for Payer: VA VA |
$277.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$831.75
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$665.68
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$921.72
|
| Rate for Payer: Cofinity Commercial |
$857.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.08
|
| Rate for Payer: Mclaren Medicaid |
$426.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO |
$899.87
|
| Rate for Payer: Priority Health Medicare |
$646.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$899.87
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$720.85 |
| Max. Negotiated Rate |
$998.10 |
| Rate for Payer: Aetna Commercial |
$942.65
|
| Rate for Payer: BCBS Trust/PPO |
$905.28
|
| Rate for Payer: BCN Commercial |
$857.04
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$953.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Healthscope Commercial |
$998.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$831.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: Nomi Health Commercial |
$909.38
|
| Rate for Payer: PHP Commercial |
$942.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO |
$964.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$743.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.92
|
| Rate for Payer: UHC Core |
$926.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$831.75
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$585.54 |
| Max. Negotiated Rate |
$1,422.75 |
| Rate for Payer: Aetna Commercial |
$1,179.20
|
| Rate for Payer: Aetna Medicare |
$915.20
|
| Rate for Payer: BCBS Complete |
$614.82
|
| Rate for Payer: BCBS MAPPO |
$880.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.75
|
| Rate for Payer: BCN Commercial |
$1,327.74
|
| Rate for Payer: BCN Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$1,267.20
|
| Rate for Payer: Cofinity Commercial |
$1,179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.00
|
| Rate for Payer: Mclaren Medicaid |
$585.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.00
|
| Rate for Payer: Meridian Medicaid |
$614.82
|
| Rate for Payer: Nomi Health Commercial |
$1,056.00
|
| Rate for Payer: PACE SWMI |
$880.00
|
| Rate for Payer: PHP Medicare Advantage |
$880.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,235.36
|
| Rate for Payer: Priority Health Medicare |
$888.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,235.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$880.00
|
| Rate for Payer: UHC Exchange |
$880.00
|
| Rate for Payer: UHC Medicare Advantage |
$880.00
|
| Rate for Payer: UHCCP Medicaid |
$585.54
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,229.15 |
| Max. Negotiated Rate |
$1,701.90 |
| Rate for Payer: Aetna Commercial |
$1,607.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.62
|
| Rate for Payer: BCN Commercial |
$1,461.36
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,626.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Healthscope Commercial |
$1,701.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,418.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.35
|
| Rate for Payer: Nomi Health Commercial |
$1,550.62
|
| Rate for Payer: PHP Commercial |
$1,607.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,645.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,266.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,664.08
|
| Rate for Payer: UHC Core |
$1,578.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,418.25
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$1,401.52 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$968.76
|
| Rate for Payer: BCBS Complete |
$650.15
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$1,401.52
|
| Rate for Payer: BCN Medicare Advantage |
$931.50
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.36
|
| Rate for Payer: Cofinity Commercial |
$1,248.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.50
|
| Rate for Payer: Mclaren Medicaid |
$619.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| Rate for Payer: Meridian Medicaid |
$650.15
|
| Rate for Payer: Nomi Health Commercial |
$1,117.80
|
| Rate for Payer: PACE SWMI |
$931.50
|
| Rate for Payer: PHP Medicare Advantage |
$931.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,303.98
|
| Rate for Payer: Priority Health Medicare |
$940.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,303.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$931.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Exchange |
$931.50
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP Medicaid |
$619.19
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$1,401.52 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$968.76
|
| Rate for Payer: BCBS Complete |
$650.15
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$1,401.52
|
| Rate for Payer: BCN Medicare Advantage |
$931.50
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.36
|
| Rate for Payer: Cofinity Commercial |
$1,248.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.50
|
| Rate for Payer: Mclaren Medicaid |
$619.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| Rate for Payer: Meridian Medicaid |
$650.15
|
| Rate for Payer: Nomi Health Commercial |
$1,117.80
|
| Rate for Payer: PACE SWMI |
$931.50
|
| Rate for Payer: PHP Medicare Advantage |
$931.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,303.98
|
| Rate for Payer: Priority Health Medicare |
$940.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,303.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$931.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Exchange |
$931.50
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP Medicaid |
$619.19
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$449.11 |
| Max. Negotiated Rate |
$4,850.98 |
| Rate for Payer: Aetna Commercial |
$1,607.35
|
| Rate for Payer: Aetna Medicare |
$491.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$590.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$590.94
|
| Rate for Payer: BCBS Complete |
$4,850.98
|
| Rate for Payer: BCBS MAPPO |
$472.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,554.59
|
| Rate for Payer: BCN Commercial |
$1,470.25
|
| Rate for Payer: BCN Medicare Advantage |
$472.75
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,626.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.75
|
| Rate for Payer: Healthscope Commercial |
$1,701.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,418.25
|
| Rate for Payer: Mclaren Medicaid |
$4,619.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.39
|
| Rate for Payer: Meridian Medicaid |
$4,850.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.35
|
| Rate for Payer: Nomi Health Commercial |
$1,550.62
|
| Rate for Payer: PACE Senior Care Partners |
$449.11
|
| Rate for Payer: PACE SWMI |
$472.75
|
| Rate for Payer: PHP Commercial |
$1,607.35
|
| Rate for Payer: PHP Medicare Advantage |
$472.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,619.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,645.17
|
| Rate for Payer: Priority Health Medicare |
$477.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,266.97
|
| Rate for Payer: Railroad Medicare Medicare |
$472.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,664.08
|
| Rate for Payer: UHC Core |
$1,578.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.75
|
| Rate for Payer: UHC Exchange |
$472.75
|
| Rate for Payer: UHC Medicare Advantage |
$472.75
|
| Rate for Payer: UHCCP Medicaid |
$4,619.68
|
| Rate for Payer: VA VA |
$472.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,418.25
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 19304
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$716.30 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Aetna Commercial |
$936.70
|
| Rate for Payer: BCBS Trust/PPO |
$899.56
|
| Rate for Payer: BCN Commercial |
$851.63
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$947.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$991.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$826.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: Nomi Health Commercial |
$903.64
|
| Rate for Payer: PHP Commercial |
$936.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: Priority Health HMO/PPO |
$958.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$738.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$969.76
|
| Rate for Payer: UHC Core |
$920.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$826.50
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 19304
|
| Hospital Charge Code |
19304
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Aetna Commercial |
$936.70
|
| Rate for Payer: Aetna Medicare |
$286.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.38
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: BCBS MAPPO |
$275.50
|
| Rate for Payer: BCBS Trust/PPO |
$905.95
|
| Rate for Payer: BCN Commercial |
$856.80
|
| Rate for Payer: BCN Medicare Advantage |
$275.50
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$947.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.50
|
| Rate for Payer: Healthscope Commercial |
$991.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$826.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: Nomi Health Commercial |
$903.64
|
| Rate for Payer: PACE Senior Care Partners |
$261.72
|
| Rate for Payer: PACE SWMI |
$275.50
|
| Rate for Payer: PHP Commercial |
$936.70
|
| Rate for Payer: PHP Medicare Advantage |
$275.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: Priority Health HMO/PPO |
$958.74
|
| Rate for Payer: Priority Health Medicare |
$278.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$738.34
|
| Rate for Payer: Railroad Medicare Medicare |
$275.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$969.76
|
| Rate for Payer: UHC Core |
$920.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.50
|
| Rate for Payer: UHC Exchange |
$275.50
|
| Rate for Payer: UHC Medicare Advantage |
$275.50
|
| Rate for Payer: VA VA |
$275.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$826.50
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$760.62 |
| Max. Negotiated Rate |
$18,089.98 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,187.91
|
| Rate for Payer: BCBS Complete |
$798.65
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.22
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,530.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.22
|
| Rate for Payer: Mclaren Medicaid |
$760.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| Rate for Payer: Meridian Medicaid |
$798.65
|
| Rate for Payer: Nomi Health Commercial |
$1,370.66
|
| Rate for Payer: PACE SWMI |
$1,142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,605.14
|
| Rate for Payer: Priority Health Medicare |
$1,153.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,605.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,142.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.22
|
| Rate for Payer: UHC Exchange |
$1,142.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.22
|
| Rate for Payer: UHCCP Medicaid |
$760.62
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,328.60 |
| Max. Negotiated Rate |
$1,839.60 |
| Rate for Payer: Aetna Commercial |
$1,737.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.52
|
| Rate for Payer: BCN Commercial |
$1,579.60
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,757.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.20
|
| Rate for Payer: Healthscope Commercial |
$1,839.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,533.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.40
|
| Rate for Payer: Nomi Health Commercial |
$1,676.08
|
| Rate for Payer: PHP Commercial |
$1,737.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,778.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,369.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,798.72
|
| Rate for Payer: UHC Core |
$1,706.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,533.00
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
19307
|
| Min. Negotiated Rate |
$760.62 |
| Max. Negotiated Rate |
$18,089.98 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,187.91
|
| Rate for Payer: BCBS Complete |
$798.65
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.22
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,530.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.22
|
| Rate for Payer: Mclaren Medicaid |
$760.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| Rate for Payer: Meridian Medicaid |
$798.65
|
| Rate for Payer: Nomi Health Commercial |
$1,370.66
|
| Rate for Payer: PACE SWMI |
$1,142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,605.14
|
| Rate for Payer: Priority Health Medicare |
$1,153.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,605.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,142.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.22
|
| Rate for Payer: UHC Exchange |
$1,142.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.22
|
| Rate for Payer: UHCCP Medicaid |
$760.62
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$485.45 |
| Max. Negotiated Rate |
$4,850.98 |
| Rate for Payer: Aetna Commercial |
$1,737.40
|
| Rate for Payer: Aetna Medicare |
$531.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$638.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$638.75
|
| Rate for Payer: BCBS Complete |
$4,850.98
|
| Rate for Payer: BCBS MAPPO |
$511.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.37
|
| Rate for Payer: BCN Commercial |
$1,589.21
|
| Rate for Payer: BCN Medicare Advantage |
$511.00
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,757.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$511.00
|
| Rate for Payer: Healthscope Commercial |
$1,839.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,533.00
|
| Rate for Payer: Mclaren Medicaid |
$4,619.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.55
|
| Rate for Payer: Meridian Medicaid |
$4,850.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$587.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.40
|
| Rate for Payer: Nomi Health Commercial |
$1,676.08
|
| Rate for Payer: PACE Senior Care Partners |
$485.45
|
| Rate for Payer: PACE SWMI |
$511.00
|
| Rate for Payer: PHP Commercial |
$1,737.40
|
| Rate for Payer: PHP Medicare Advantage |
$511.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,619.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,778.28
|
| Rate for Payer: Priority Health Medicare |
$516.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,369.48
|
| Rate for Payer: Railroad Medicare Medicare |
$511.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,798.72
|
| Rate for Payer: UHC Core |
$1,706.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$511.00
|
| Rate for Payer: UHC Exchange |
$511.00
|
| Rate for Payer: UHC Medicare Advantage |
$511.00
|
| Rate for Payer: UHCCP Medicaid |
$4,619.68
|
| Rate for Payer: VA VA |
$511.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,533.00
|
|
|
PR MASTOIDECTOMY COMPLETE
|
Professional
|
Both
|
$2,704.00
|
|
|
Service Code
|
HCPCS 69502
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$4,242.78 |
| Rate for Payer: Aetna Commercial |
$1,186.88
|
| Rate for Payer: Aetna Medicare |
$921.16
|
| Rate for Payer: BCBS Complete |
$633.15
|
| Rate for Payer: BCBS MAPPO |
$885.73
|
| Rate for Payer: BCBS Trust/PPO |
$4,242.78
|
| Rate for Payer: BCN Commercial |
$1,393.22
|
| Rate for Payer: BCN Medicare Advantage |
$885.73
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,275.45
|
| Rate for Payer: Cofinity Commercial |
$1,186.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.73
|
| Rate for Payer: Mclaren Medicaid |
$603.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.02
|
| Rate for Payer: Meridian Medicaid |
$633.15
|
| Rate for Payer: Nomi Health Commercial |
$1,062.88
|
| Rate for Payer: PACE SWMI |
$885.73
|
| Rate for Payer: PHP Medicare Advantage |
$885.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$603.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,757.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,385.68
|
| Rate for Payer: Priority Health Medicare |
$894.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,385.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.73
|
| Rate for Payer: UHC Exchange |
$885.73
|
| Rate for Payer: UHC Medicare Advantage |
$885.73
|
| Rate for Payer: UHCCP Medicaid |
$603.00
|
|
