|
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 |
$926.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$831.75
|
|
|
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 |
$2,907.19 |
| 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 |
$2,907.19
|
| 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 |
$2,768.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.11
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| 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 |
$2,768.57
|
| 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 |
$926.01
|
| 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 |
$2,768.57
|
| Rate for Payer: VA VA |
$277.25
|
| 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 |
$536.00 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Aetna Commercial |
$1,179.20
|
| Rate for Payer: Aetna Medicare |
$915.20
|
| Rate for Payer: BCBS Complete |
$536.00
|
| Rate for Payer: BCBS MAPPO |
$880.00
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.00
|
| Rate for Payer: Nomi Health Commercial |
$1,056.00
|
| Rate for Payer: PACE SWMI |
$880.00
|
| Rate for Payer: PHP Medicare Advantage |
$880.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health Medicare |
$888.80
|
| 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
|
|
|
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
|
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 |
$4,951.09 |
| 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 |
$4,951.09
|
| 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 |
$4,715.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.39
|
| Rate for Payer: Meridian Medicaid |
$4,951.09
|
| 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 |
$4,715.02
|
| 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 |
$4,715.02
|
| Rate for Payer: VA VA |
$472.75
|
| 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 |
$756.40 |
| Max. Negotiated Rate |
$1,341.36 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$968.76
|
| Rate for Payer: BCBS Complete |
$756.40
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| 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 Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health Medicare |
$940.82
|
| 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
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$756.40 |
| Max. Negotiated Rate |
$1,341.36 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$968.76
|
| Rate for Payer: BCBS Complete |
$756.40
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| 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 Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health Medicare |
$940.82
|
| 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
|
|
|
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
|
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
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$261.73 |
| 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 |
$289.27
|
| 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 |
$261.73
|
| 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 |
$278.25
|
| 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 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 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
|
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 |
$4,951.09 |
| 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 |
$4,951.09
|
| 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 |
$4,715.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.55
|
| Rate for Payer: Meridian Medicaid |
$4,951.09
|
| 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 |
$4,715.02
|
| 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 |
$4,715.02
|
| Rate for Payer: VA VA |
$511.00
|
| 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
|
| Min. Negotiated Rate |
$817.60 |
| Max. Negotiated Rate |
$1,644.80 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,187.91
|
| Rate for Payer: BCBS Complete |
$817.60
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| 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 Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health Medicare |
$1,153.64
|
| 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
|
|
|
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 |
$817.60 |
| Max. Negotiated Rate |
$1,644.80 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,187.91
|
| Rate for Payer: BCBS Complete |
$817.60
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| 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 Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health Medicare |
$1,153.64
|
| 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
|
|
|
PR MASTOIDECTOMY COMPLETE
|
Professional
|
Both
|
$2,704.00
|
|
|
Service Code
|
HCPCS 69502
|
| Min. Negotiated Rate |
$885.73 |
| Max. Negotiated Rate |
$1,757.60 |
| Rate for Payer: Aetna Commercial |
$1,186.88
|
| Rate for Payer: Aetna Medicare |
$921.16
|
| Rate for Payer: BCBS Complete |
$1,081.60
|
| Rate for Payer: BCBS MAPPO |
$885.73
|
| 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 |
$1,186.88
|
| Rate for Payer: Cofinity Commercial |
$1,275.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.02
|
| 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 Cigna Priority Health |
$1,757.60
|
| Rate for Payer: Priority Health Medicare |
$894.59
|
| 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
|
|
|
PR MASTOID OBLITERATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,479.00
|
|
|
Service Code
|
HCPCS 69670
|
| Min. Negotiated Rate |
$882.11 |
| Max. Negotiated Rate |
$2,261.35 |
| Rate for Payer: Aetna Commercial |
$1,182.03
|
| Rate for Payer: Aetna Medicare |
$917.39
|
| Rate for Payer: BCBS Complete |
$1,391.60
|
| Rate for Payer: BCBS MAPPO |
$882.11
|
| Rate for Payer: BCN Medicare Advantage |
$882.11
|
| Rate for Payer: Cash Price |
$2,783.20
|
| Rate for Payer: Cash Price |
$2,783.20
|
| Rate for Payer: Cofinity Commercial |
$1,270.24
|
| Rate for Payer: Cofinity Commercial |
$1,182.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$926.22
|
| Rate for Payer: Nomi Health Commercial |
$1,058.53
|
| Rate for Payer: PACE SWMI |
$882.11
|
| Rate for Payer: PHP Medicare Advantage |
$882.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,261.35
|
| Rate for Payer: Priority Health Medicare |
$890.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.11
|
| Rate for Payer: UHC Exchange |
$882.11
|
| Rate for Payer: UHC Medicare Advantage |
$882.11
|
|
|
PR MASTOPEXY
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 19316
|
| Min. Negotiated Rate |
$759.14 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$1,017.25
|
| Rate for Payer: Aetna Medicare |
$789.51
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$759.14
|
| Rate for Payer: BCN Medicare Advantage |
$759.14
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,093.16
|
| Rate for Payer: Cofinity Commercial |
$1,017.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.10
|
| Rate for Payer: Nomi Health Commercial |
$910.97
|
| Rate for Payer: PACE SWMI |
$759.14
|
| Rate for Payer: PHP Medicare Advantage |
$759.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$766.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.14
|
| Rate for Payer: UHC Exchange |
$759.14
|
| Rate for Payer: UHC Medicare Advantage |
$759.14
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$193.32 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$691.90
|
| Rate for Payer: Aetna Medicare |
$211.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$254.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$254.38
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$203.50
|
| Rate for Payer: BCBS Trust/PPO |
$669.19
|
| Rate for Payer: BCN Commercial |
$632.88
|
| Rate for Payer: BCN Medicare Advantage |
$203.50
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$700.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.50
|
| Rate for Payer: Healthscope Commercial |
$732.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$610.50
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.68
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.90
|
| Rate for Payer: Nomi Health Commercial |
$667.48
|
| Rate for Payer: PACE Senior Care Partners |
$193.32
|
| Rate for Payer: PACE SWMI |
$203.50
|
| Rate for Payer: PHP Commercial |
$691.90
|
| Rate for Payer: PHP Medicare Advantage |
$203.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health HMO/PPO |
$708.18
|
| Rate for Payer: Priority Health Medicare |
$205.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.38
|
| Rate for Payer: Railroad Medicare Medicare |
$203.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.32
|
| Rate for Payer: UHC Core |
$679.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.50
|
| Rate for Payer: UHC Exchange |
$203.50
|
| Rate for Payer: UHC Medicare Advantage |
$203.50
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$203.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$610.50
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$529.10 |
| Max. Negotiated Rate |
$732.60 |
| Rate for Payer: Aetna Commercial |
$691.90
|
| Rate for Payer: BCBS Trust/PPO |
$664.47
|
| Rate for Payer: BCN Commercial |
$629.06
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$700.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.20
|
| Rate for Payer: Healthscope Commercial |
$732.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$610.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.90
|
| Rate for Payer: Nomi Health Commercial |
$667.48
|
| Rate for Payer: PHP Commercial |
$691.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health HMO/PPO |
$708.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.32
|
| Rate for Payer: UHC Core |
$679.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$610.50
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$299.98 |
| Max. Negotiated Rate |
$529.10 |
| Rate for Payer: Aetna Commercial |
$401.97
|
| Rate for Payer: Aetna Medicare |
$311.98
|
| Rate for Payer: BCBS Complete |
$325.60
|
| Rate for Payer: BCBS MAPPO |
$299.98
|
| Rate for Payer: BCN Medicare Advantage |
$299.98
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$431.97
|
| Rate for Payer: Cofinity Commercial |
$401.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.98
|
| Rate for Payer: Nomi Health Commercial |
$359.98
|
| Rate for Payer: PACE SWMI |
$299.98
|
| Rate for Payer: PHP Medicare Advantage |
$299.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health Medicare |
$302.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.98
|
| Rate for Payer: UHC Exchange |
$299.98
|
| Rate for Payer: UHC Medicare Advantage |
$299.98
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
HCPCS 19020
|
| Min. Negotiated Rate |
$299.98 |
| Max. Negotiated Rate |
$529.10 |
| Rate for Payer: Aetna Commercial |
$401.97
|
| Rate for Payer: Aetna Medicare |
$311.98
|
| Rate for Payer: BCBS Complete |
$325.60
|
| Rate for Payer: BCBS MAPPO |
$299.98
|
| Rate for Payer: BCN Medicare Advantage |
$299.98
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$431.97
|
| Rate for Payer: Cofinity Commercial |
$401.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.98
|
| Rate for Payer: Nomi Health Commercial |
$359.98
|
| Rate for Payer: PACE SWMI |
$299.98
|
| Rate for Payer: PHP Medicare Advantage |
$299.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health Medicare |
$302.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.98
|
| Rate for Payer: UHC Exchange |
$299.98
|
| Rate for Payer: UHC Medicare Advantage |
$299.98
|
|
|
PR MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 19305
|
| Min. Negotiated Rate |
$966.40 |
| Max. Negotiated Rate |
$1,597.85 |
| Rate for Payer: Aetna Commercial |
$1,486.89
|
| Rate for Payer: Aetna Medicare |
$1,154.00
|
| Rate for Payer: BCBS Complete |
$966.40
|
| Rate for Payer: BCBS MAPPO |
$1,109.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,109.62
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cofinity Commercial |
$1,597.85
|
| Rate for Payer: Cofinity Commercial |
$1,486.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,109.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,165.10
|
| Rate for Payer: Nomi Health Commercial |
$1,331.54
|
| Rate for Payer: PACE SWMI |
$1,109.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,109.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.40
|
| Rate for Payer: Priority Health Medicare |
$1,120.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,109.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,109.62
|
| Rate for Payer: UHC Exchange |
$1,109.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,109.62
|
|
|
PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 94200
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Medicare |
$14.11
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$13.57
|
| Rate for Payer: BCN Medicare Advantage |
$13.57
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.25
|
| Rate for Payer: Nomi Health Commercial |
$16.28
|
| Rate for Payer: PACE SWMI |
$13.57
|
| Rate for Payer: PHP Medicare Advantage |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Medicare |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.57
|
| Rate for Payer: UHC Exchange |
$13.57
|
| Rate for Payer: UHC Medicare Advantage |
$13.57
|
|
|
PR MAXILLECTOMY W/O ORBITAL EXENTERATION
|
Professional
|
Both
|
$3,304.00
|
|
|
Service Code
|
HCPCS 31225
|
| Min. Negotiated Rate |
$1,321.60 |
| Max. Negotiated Rate |
$2,451.44 |
| Rate for Payer: Aetna Commercial |
$2,281.20
|
| Rate for Payer: Aetna Medicare |
$1,770.49
|
| Rate for Payer: BCBS Complete |
$1,321.60
|
| Rate for Payer: BCBS MAPPO |
$1,702.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,702.39
|
| Rate for Payer: Cash Price |
$2,643.20
|
| Rate for Payer: Cash Price |
$2,643.20
|
| Rate for Payer: Cofinity Commercial |
$2,451.44
|
| Rate for Payer: Cofinity Commercial |
$2,281.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,702.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,787.51
|
| Rate for Payer: Nomi Health Commercial |
$2,042.87
|
| Rate for Payer: PACE SWMI |
$1,702.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,702.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,147.60
|
| Rate for Payer: Priority Health Medicare |
$1,719.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,702.39
|
| Rate for Payer: UHC Exchange |
$1,702.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,702.39
|
|
