|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$1,324.45 |
| Rate for Payer: Aetna Commercial |
$539.68
|
| Rate for Payer: Aetna Medicare |
$418.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.96
|
| Rate for Payer: BCBS Complete |
$292.53
|
| Rate for Payer: BCBS MAPPO |
$402.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.45
|
| Rate for Payer: BCN Commercial |
$643.10
|
| 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 |
$539.68
|
| Rate for Payer: Cofinity Commercial |
$579.96
|
| 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: Meridian Medicaid |
$292.53
|
| Rate for Payer: Nomi Health Commercial |
$483.30
|
| Rate for Payer: PACE SWMI |
$402.75
|
| Rate for Payer: PHP Commercial |
$563.85
|
| Rate for Payer: PHP Medicare Advantage |
$402.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.84
|
| Rate for Payer: Priority Health Medicare |
$402.75
|
| Rate for Payer: Priority Health Narrow Network |
$679.84
|
| Rate for Payer: Priority Health SBD |
$679.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.75
|
| Rate for Payer: UHC Medicare Advantage |
$402.75
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
| Rate for Payer: UMR Bronson Commercial |
$315.56
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,725.86 |
| Rate for Payer: Aetna Commercial |
$108.08
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.15
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$80.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.86
|
| Rate for Payer: BCN Commercial |
$122.66
|
| 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 |
$108.08
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| 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: Meridian Medicaid |
$56.13
|
| Rate for Payer: Nomi Health Commercial |
$96.79
|
| Rate for Payer: PACE SWMI |
$80.66
|
| Rate for Payer: PHP Commercial |
$112.92
|
| Rate for Payer: PHP Medicare Advantage |
$80.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.23
|
| Rate for Payer: Priority Health Medicare |
$80.66
|
| Rate for Payer: Priority Health Narrow Network |
$128.23
|
| Rate for Payer: Priority Health SBD |
$128.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.66
|
| Rate for Payer: UHC Medicare Advantage |
$80.66
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$215.76 |
| Rate for Payer: Aetna Commercial |
$184.33
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.09
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: BCBS MAPPO |
$137.56
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$206.71
|
| 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: Meridian Medicaid |
$95.72
|
| Rate for Payer: Nomi Health Commercial |
$165.07
|
| Rate for Payer: PACE SWMI |
$137.56
|
| Rate for Payer: PHP Commercial |
$192.58
|
| Rate for Payer: PHP Medicare Advantage |
$137.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.76
|
| Rate for Payer: Priority Health Medicare |
$137.56
|
| Rate for Payer: Priority Health Narrow Network |
$215.76
|
| Rate for Payer: Priority Health SBD |
$215.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.56
|
| Rate for Payer: UHC Medicare Advantage |
$137.56
|
| Rate for Payer: UHCCP Medicaid |
$91.16
|
| Rate for Payer: UMR Bronson Commercial |
$134.32
|
|
|
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 |
$1,604.98 |
| Rate for Payer: Aetna Commercial |
$34.95
|
| Rate for Payer: Aetna Medicare |
$27.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.56
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$26.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.98
|
| Rate for Payer: BCN Commercial |
$26.43
|
| 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 Commercial |
$36.51
|
| Rate for Payer: PHP Medicare Advantage |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$26.08
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.08
|
| Rate for Payer: UHC Medicare Advantage |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
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: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| 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 |
$234.00
|
| Rate for Payer: Cofinity Commercial |
$251.47
|
| 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: Meridian Medicaid |
$123.01
|
| Rate for Payer: Nomi Health Commercial |
$209.56
|
| Rate for Payer: PACE SWMI |
$174.63
|
| Rate for Payer: PHP Commercial |
$244.48
|
| 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/Tiered Network |
$272.33
|
| Rate for Payer: Priority Health Medicare |
$174.63
|
| Rate for Payer: Priority Health Narrow Network |
$272.33
|
| Rate for Payer: Priority Health SBD |
$272.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.63
|
| Rate for Payer: UHC Medicare Advantage |
$174.63
|
| Rate for Payer: UHCCP Medicaid |
$117.15
|
| Rate for Payer: UMR Bronson Commercial |
$361.10
|
|
|
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: Aetna New Business (MI Preferred) |
$1,473.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,583.04
|
| 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 |
$1,473.10
|
| Rate for Payer: Cofinity Commercial |
$1,583.04
|
| 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: 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 Commercial |
$1,539.06
|
| 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/Tiered Network |
$2,037.37
|
| Rate for Payer: Priority Health Medicare |
$1,099.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,037.37
|
| Rate for Payer: Priority Health SBD |
$2,037.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.33
|
| Rate for Payer: UHCCP Medicaid |
$729.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,077.32
|
|
|
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: Aetna New Business (MI Preferred) |
$297.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.44
|
| 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 |
$297.25
|
| Rate for Payer: Cofinity Commercial |
$319.44
|
| 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: Meridian Medicaid |
$159.24
|
| Rate for Payer: Nomi Health Commercial |
$266.20
|
| Rate for Payer: PACE SWMI |
$221.83
|
| Rate for Payer: PHP Commercial |
$310.56
|
| 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/Tiered Network |
$421.20
|
| Rate for Payer: Priority Health Medicare |
$221.83
|
| Rate for Payer: Priority Health Narrow Network |
$421.20
|
| Rate for Payer: Priority Health SBD |
$421.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.83
|
| Rate for Payer: UHC Medicare Advantage |
$221.83
|
| Rate for Payer: UHCCP Medicaid |
$151.66
|
| Rate for Payer: UMR Bronson Commercial |
$320.16
|
|
|
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: Aetna New Business (MI Preferred) |
$556.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.99
|
| 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 |
$556.46
|
| Rate for Payer: Cofinity Commercial |
$597.99
|
| 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: Meridian Medicaid |
$295.67
|
| Rate for Payer: Nomi Health Commercial |
$498.32
|
| Rate for Payer: PACE SWMI |
$415.27
|
| Rate for Payer: PHP Commercial |
$581.38
|
| 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/Tiered Network |
$590.14
|
| Rate for Payer: Priority Health Medicare |
$415.27
|
| Rate for Payer: Priority Health Narrow Network |
$590.14
|
| Rate for Payer: Priority Health SBD |
$590.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.27
|
| Rate for Payer: UHC Medicare Advantage |
$415.27
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
| Rate for Payer: UMR Bronson Commercial |
$750.72
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$718.08 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna American Axle |
$1,060.80
|
| Rate for Payer: Aetna Commercial |
$1,387.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.40
|
| Rate for Payer: Cofinity Commercial |
$1,403.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,142.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Healthscope Commercial |
$1,468.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,142.40
|
| 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: PHP Commercial |
$1,387.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health SBD |
$1,028.16
|
| Rate for Payer: UMR Bronson Commercial |
$718.08
|
| 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: Aetna New Business (MI Preferred) |
$556.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.99
|
| 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: 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 Commercial |
$581.38
|
| 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/Tiered Network |
$590.14
|
| Rate for Payer: Priority Health Medicare |
$415.27
|
| Rate for Payer: Priority Health Narrow Network |
$590.14
|
| Rate for Payer: Priority Health SBD |
$590.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.27
|
| Rate for Payer: UHC Medicare Advantage |
$415.27
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
| Rate for Payer: UMR Bronson Commercial |
$750.72
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$415.99 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna American Axle |
$1,060.80
|
| Rate for Payer: Aetna Commercial |
$1,387.20
|
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,060.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$5,380.67
|
| Rate for Payer: BCN Commercial |
$5,380.67
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.40
|
| Rate for Payer: Cofinity Commercial |
$1,403.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,142.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,468.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,142.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,224.00
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$1,387.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Priority Health SBD |
$1,028.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.59
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$415.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: UMR Bronson Commercial |
$603.84
|
| Rate for Payer: VA VA |
$3,751.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,224.00
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$487.96 |
| Max. Negotiated Rate |
$998.10 |
| Rate for Payer: Aetna American Axle |
$720.85
|
| Rate for Payer: Aetna Commercial |
$942.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.85
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$776.30
|
| Rate for Payer: Cofinity Commercial |
$953.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$776.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Healthscope Commercial |
$998.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$776.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$831.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: PHP Commercial |
$942.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health SBD |
$698.67
|
| Rate for Payer: UMR Bronson Commercial |
$487.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$831.75
|
|
|
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: Aetna New Business (MI Preferred) |
$857.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.72
|
| 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 |
$857.71
|
| Rate for Payer: Cofinity Commercial |
$921.72
|
| 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: Meridian Medicaid |
$447.52
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Commercial |
$896.11
|
| 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/Tiered Network |
$899.87
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: Priority Health Narrow Network |
$899.87
|
| Rate for Payer: Priority Health SBD |
$899.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
| Rate for Payer: UMR Bronson Commercial |
$510.14
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$410.33 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna American Axle |
$720.85
|
| Rate for Payer: Aetna Commercial |
$942.65
|
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,965.42
|
| Rate for Payer: BCN Commercial |
$3,965.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$776.30
|
| Rate for Payer: Cofinity Commercial |
$953.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$776.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$998.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$776.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$831.75
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$942.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Priority Health SBD |
$698.67
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.59
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$645.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: UMR Bronson Commercial |
$410.33
|
| Rate for Payer: VA VA |
$3,751.85
|
| 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: Aetna New Business (MI Preferred) |
$857.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.72
|
| 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: 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 Commercial |
$896.11
|
| 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/Tiered Network |
$899.87
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: Priority Health Narrow Network |
$899.87
|
| Rate for Payer: Priority Health SBD |
$899.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
| Rate for Payer: UMR Bronson Commercial |
$510.14
|
|
|
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: Aetna New Business (MI Preferred) |
$1,179.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.20
|
| 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 |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$1,267.20
|
| 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: Meridian Medicaid |
$614.82
|
| Rate for Payer: Nomi Health Commercial |
$1,056.00
|
| Rate for Payer: PACE SWMI |
$880.00
|
| Rate for Payer: PHP Commercial |
$1,232.00
|
| 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/Tiered Network |
$1,235.36
|
| Rate for Payer: Priority Health Medicare |
$880.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,235.36
|
| Rate for Payer: Priority Health SBD |
$1,235.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$880.00
|
| Rate for Payer: UHC Medicare Advantage |
$880.00
|
| Rate for Payer: UHCCP Medicaid |
$585.54
|
| Rate for Payer: UMR Bronson Commercial |
$616.40
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$832.04 |
| Max. Negotiated Rate |
$1,701.90 |
| Rate for Payer: Aetna American Axle |
$1,229.15
|
| Rate for Payer: Aetna Commercial |
$1,607.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,229.15
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,323.70
|
| Rate for Payer: Cofinity Commercial |
$1,626.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,323.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Healthscope Commercial |
$1,701.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,323.70
|
| 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: PHP Commercial |
$1,607.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health SBD |
$1,191.33
|
| Rate for Payer: UMR Bronson Commercial |
$832.04
|
| 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: Aetna New Business (MI Preferred) |
$1,248.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.36
|
| 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 |
$1,248.21
|
| Rate for Payer: Cofinity Commercial |
$1,341.36
|
| 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: Meridian Medicaid |
$650.15
|
| Rate for Payer: Nomi Health Commercial |
$1,117.80
|
| Rate for Payer: PACE SWMI |
$931.50
|
| Rate for Payer: PHP Commercial |
$1,304.10
|
| 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/Tiered Network |
$1,303.98
|
| Rate for Payer: Priority Health Medicare |
$931.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,303.98
|
| Rate for Payer: Priority Health SBD |
$1,303.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP Medicaid |
$619.19
|
| Rate for Payer: UMR Bronson Commercial |
$869.86
|
|
|
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: Aetna New Business (MI Preferred) |
$1,248.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.36
|
| 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: 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 Commercial |
$1,304.10
|
| 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/Tiered Network |
$1,303.98
|
| Rate for Payer: Priority Health Medicare |
$931.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,303.98
|
| Rate for Payer: Priority Health SBD |
$1,303.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP Medicaid |
$619.19
|
| Rate for Payer: UMR Bronson Commercial |
$869.86
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$699.67 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna American Axle |
$1,229.15
|
| Rate for Payer: Aetna Commercial |
$1,607.35
|
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,229.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$7,690.31
|
| Rate for Payer: BCN Commercial |
$7,690.31
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,323.70
|
| Rate for Payer: Cofinity Commercial |
$1,626.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,323.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Healthscope Commercial |
$1,701.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,323.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,418.25
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.35
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Commercial |
$1,607.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Priority Health SBD |
$1,191.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.30
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$937.55
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: UMR Bronson Commercial |
$699.67
|
| Rate for Payer: VA VA |
$6,389.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,418.25
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$484.88 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Aetna American Axle |
$716.30
|
| Rate for Payer: Aetna Commercial |
$936.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.30
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$771.40
|
| Rate for Payer: Cofinity Commercial |
$947.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$771.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$991.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$771.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$826.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: PHP Commercial |
$936.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: Priority Health SBD |
$694.26
|
| Rate for Payer: UMR Bronson Commercial |
$484.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$826.50
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$506.92
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$407.74 |
| Max. Negotiated Rate |
$991.80 |
| Rate for Payer: Aetna American Axle |
$716.30
|
| Rate for Payer: Aetna Commercial |
$936.70
|
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.30
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$771.40
|
| Rate for Payer: Cofinity Commercial |
$947.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$771.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$991.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$771.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$826.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: PHP Commercial |
$936.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: Priority Health SBD |
$694.26
|
| Rate for Payer: UMR Bronson Commercial |
$407.74
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$506.92
|
|
|
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 |
$899.36 |
| Max. Negotiated Rate |
$1,839.60 |
| Rate for Payer: Aetna American Axle |
$1,328.60
|
| Rate for Payer: Aetna Commercial |
$1,737.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.60
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,430.80
|
| Rate for Payer: Cofinity Commercial |
$1,757.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,430.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.20
|
| Rate for Payer: Healthscope Commercial |
$1,839.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,430.80
|
| 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: PHP Commercial |
$1,737.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health SBD |
$1,287.72
|
| Rate for Payer: UMR Bronson Commercial |
$899.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,533.00
|
|
