|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.26
|
| Rate for Payer: Priority Health Narrow Network |
$84.26
|
| Rate for Payer: Priority Health SBD |
$84.26
|
| Rate for Payer: UMR Bronson Commercial |
$134.78
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$190.45
|
| Rate for Payer: Aetna Commercial |
$249.05
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$651.49
|
| Rate for Payer: BCCCP Commercial |
$159.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$205.10
|
| Rate for Payer: Cofinity Commercial |
$251.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$263.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.75
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$249.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$184.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$67.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$108.41
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.75
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 19100
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.26
|
| Rate for Payer: Priority Health Narrow Network |
$84.26
|
| Rate for Payer: Priority Health SBD |
$84.26
|
| Rate for Payer: UMR Bronson Commercial |
$134.78
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$128.92 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna American Axle |
$190.45
|
| Rate for Payer: Aetna Commercial |
$249.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.45
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$205.10
|
| Rate for Payer: Cofinity Commercial |
$251.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Healthscope Commercial |
$263.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: PHP Commercial |
$249.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health SBD |
$184.59
|
| Rate for Payer: UMR Bronson Commercial |
$128.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.75
|
|
|
PR BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 19081
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$1,836.42 |
| Rate for Payer: Aetna Commercial |
$179.91
|
| Rate for Payer: BCBS Complete |
$107.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.42
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Meridian Medicaid |
$107.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.13
|
| Rate for Payer: Priority Health Narrow Network |
$198.13
|
| Rate for Payer: Priority Health SBD |
$198.13
|
| Rate for Payer: UMR Bronson Commercial |
$348.68
|
|
|
PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 19083
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.20
|
| Rate for Payer: Priority Health Narrow Network |
$186.20
|
| Rate for Payer: Priority Health SBD |
$186.20
|
| Rate for Payer: UMR Bronson Commercial |
$198.72
|
|
|
PR BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 19084
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$543.90 |
| Rate for Payer: Aetna Commercial |
$84.71
|
| Rate for Payer: BCBS Complete |
$50.55
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Meridian Medicaid |
$50.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.13
|
| Rate for Payer: Priority Health Narrow Network |
$94.13
|
| Rate for Payer: Priority Health SBD |
$94.13
|
| Rate for Payer: UMR Bronson Commercial |
$357.42
|
|
|
PR BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 38505
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$656.16 |
| Rate for Payer: Aetna Commercial |
$85.02
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS Trust/PPO |
$656.16
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Meridian Medicaid |
$56.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.98
|
| Rate for Payer: Priority Health Narrow Network |
$183.98
|
| Rate for Payer: Priority Health SBD |
$183.98
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$284.14 |
| Max. Negotiated Rate |
$1,082.20 |
| Rate for Payer: Aetna Commercial |
$545.65
|
| Rate for Payer: BCBS Complete |
$298.35
|
| Rate for Payer: BCBS Trust/PPO |
$486.04
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Meridian Medicaid |
$298.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.58
|
| Rate for Payer: Priority Health Narrow Network |
$957.58
|
| Rate for Payer: Priority Health SBD |
$957.58
|
| Rate for Payer: UMR Bronson Commercial |
$711.16
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$436.81 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna American Axle |
$1,004.90
|
| Rate for Payer: Aetna Commercial |
$1,314.10
|
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,110.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$1,329.56
|
| Rate for Payer: Cofinity Commercial |
$1,082.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$1,391.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.50
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,314.10
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$1,314.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Priority Health SBD |
$973.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$436.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: UMR Bronson Commercial |
$572.02
|
| Rate for Payer: VA VA |
$3,388.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.50
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$680.24 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Aetna American Axle |
$1,004.90
|
| Rate for Payer: Aetna Commercial |
$1,314.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.90
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$1,082.20
|
| Rate for Payer: Cofinity Commercial |
$1,329.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.80
|
| Rate for Payer: Healthscope Commercial |
$1,391.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,314.10
|
| Rate for Payer: PHP Commercial |
$1,314.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health SBD |
$973.98
|
| Rate for Payer: UMR Bronson Commercial |
$680.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.50
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$284.14 |
| Max. Negotiated Rate |
$1,082.20 |
| Rate for Payer: Aetna Commercial |
$545.65
|
| Rate for Payer: BCBS Complete |
$298.35
|
| Rate for Payer: BCBS Trust/PPO |
$486.04
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Meridian Medicaid |
$298.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.58
|
| Rate for Payer: Priority Health Narrow Network |
$957.58
|
| Rate for Payer: Priority Health SBD |
$957.58
|
| Rate for Payer: UMR Bronson Commercial |
$711.16
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 38510
|
| Min. Negotiated Rate |
$267.95 |
| Max. Negotiated Rate |
$1,082.20 |
| Rate for Payer: Aetna Commercial |
$517.41
|
| Rate for Payer: BCBS Complete |
$281.35
|
| Rate for Payer: BCBS Trust/PPO |
$559.47
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Meridian Medicaid |
$281.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.33
|
| Rate for Payer: Priority Health Narrow Network |
$908.33
|
| Rate for Payer: Priority Health SBD |
$908.33
|
| Rate for Payer: UMR Bronson Commercial |
$711.16
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
38510
|
| Min. Negotiated Rate |
$267.95 |
| Max. Negotiated Rate |
$1,082.20 |
| Rate for Payer: Aetna Commercial |
$517.41
|
| Rate for Payer: BCBS Complete |
$281.35
|
| Rate for Payer: BCBS Trust/PPO |
$559.47
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Meridian Medicaid |
$281.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.33
|
| Rate for Payer: Priority Health Narrow Network |
$908.33
|
| Rate for Payer: Priority Health SBD |
$908.33
|
| Rate for Payer: UMR Bronson Commercial |
$711.16
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$411.92 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna American Axle |
$1,004.90
|
| Rate for Payer: Aetna Commercial |
$1,314.10
|
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,872.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$1,082.20
|
| Rate for Payer: Cofinity Commercial |
$1,329.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$1,391.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.50
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,314.10
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$1,314.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Priority Health SBD |
$973.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$411.92
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: UMR Bronson Commercial |
$572.02
|
| Rate for Payer: VA VA |
$3,388.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.50
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$680.24 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Aetna American Axle |
$1,004.90
|
| Rate for Payer: Aetna Commercial |
$1,314.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.90
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$1,082.20
|
| Rate for Payer: Cofinity Commercial |
$1,329.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.80
|
| Rate for Payer: Healthscope Commercial |
$1,391.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,082.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,314.10
|
| Rate for Payer: PHP Commercial |
$1,314.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health SBD |
$973.98
|
| Rate for Payer: UMR Bronson Commercial |
$680.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.50
|
|
|
PR BX/EXC LYMPH NODE OPEN INT MAMMARY NODE
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 38530
|
| Min. Negotiated Rate |
$363.59 |
| Max. Negotiated Rate |
$1,223.40 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: BCBS Complete |
$381.77
|
| Rate for Payer: BCBS Trust/PPO |
$427.39
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Meridian Medicaid |
$381.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,223.40
|
| Rate for Payer: Priority Health SBD |
$1,223.40
|
| Rate for Payer: UMR Bronson Commercial |
$767.28
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
38500
|
| Min. Negotiated Rate |
$164.01 |
| Max. Negotiated Rate |
$649.60 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: BCBS Complete |
$172.21
|
| Rate for Payer: BCBS Trust/PPO |
$512.45
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Meridian Medicaid |
$172.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.13
|
| Rate for Payer: Priority Health Narrow Network |
$554.13
|
| Rate for Payer: Priority Health SBD |
$554.13
|
| Rate for Payer: UMR Bronson Commercial |
$426.88
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$408.32 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: Aetna American Axle |
$603.20
|
| Rate for Payer: Aetna Commercial |
$788.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.20
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$798.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.40
|
| Rate for Payer: Healthscope Commercial |
$835.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.80
|
| Rate for Payer: PHP Commercial |
$788.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.60
|
| Rate for Payer: Priority Health SBD |
$584.64
|
| Rate for Payer: UMR Bronson Commercial |
$408.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.00
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 38500
|
| Min. Negotiated Rate |
$164.01 |
| Max. Negotiated Rate |
$649.60 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: BCBS Complete |
$172.21
|
| Rate for Payer: BCBS Trust/PPO |
$512.45
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Meridian Medicaid |
$172.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.13
|
| Rate for Payer: Priority Health Narrow Network |
$554.13
|
| Rate for Payer: Priority Health SBD |
$554.13
|
| Rate for Payer: UMR Bronson Commercial |
$426.88
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna American Axle |
$603.20
|
| Rate for Payer: Aetna Commercial |
$788.80
|
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,084.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$649.60
|
| Rate for Payer: Cofinity Commercial |
$798.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$835.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.00
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.80
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$788.80
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Priority Health SBD |
$584.64
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$252.13
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: UMR Bronson Commercial |
$343.36
|
| Rate for Payer: VA VA |
$3,388.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.00
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,811.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$300.54 |
| Max. Negotiated Rate |
$1,267.70 |
| Rate for Payer: Aetna Commercial |
$576.38
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS Trust/PPO |
$460.15
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,016.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,016.26
|
| Rate for Payer: Priority Health SBD |
$1,016.26
|
| Rate for Payer: UMR Bronson Commercial |
$833.06
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,811.00
|
|
|
Service Code
|
HCPCS 38520
|
| Min. Negotiated Rate |
$300.54 |
| Max. Negotiated Rate |
$1,267.70 |
| Rate for Payer: Aetna Commercial |
$576.38
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS Trust/PPO |
$460.15
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,016.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,016.26
|
| Rate for Payer: Priority Health SBD |
$1,016.26
|
| Rate for Payer: UMR Bronson Commercial |
$833.06
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Facility
|
IP
|
$1,811.00
|
|
|
Service Code
|
CPT 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$796.84 |
| Max. Negotiated Rate |
$1,629.90 |
| Rate for Payer: Aetna American Axle |
$1,177.15
|
| Rate for Payer: Aetna Commercial |
$1,539.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.15
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cofinity Commercial |
$1,267.70
|
| Rate for Payer: Cofinity Commercial |
$1,557.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.80
|
| Rate for Payer: Healthscope Commercial |
$1,629.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,267.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,539.35
|
| Rate for Payer: PHP Commercial |
$1,539.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.70
|
| Rate for Payer: Priority Health SBD |
$1,140.93
|
| Rate for Payer: UMR Bronson Commercial |
$796.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.25
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Facility
|
OP
|
$1,811.00
|
|
|
Service Code
|
CPT 38520
|
| Hospital Charge Code |
38520
|
| Min. Negotiated Rate |
$462.02 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna American Axle |
$1,177.15
|
| Rate for Payer: Aetna Commercial |
$1,539.35
|
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,743.76
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cofinity Commercial |
$1,267.70
|
| Rate for Payer: Cofinity Commercial |
$1,557.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$1,629.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,267.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.25
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,539.35
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$1,539.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Priority Health SBD |
$1,140.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$462.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: UMR Bronson Commercial |
$670.07
|
| Rate for Payer: VA VA |
$3,388.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.25
|
|
