|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$424.51 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Aetna Commercial |
$722.42
|
| Rate for Payer: BCBS Complete |
$445.74
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Meridian Medicaid |
$445.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.45
|
| Rate for Payer: Priority Health Narrow Network |
$813.45
|
| Rate for Payer: Priority Health SBD |
$813.45
|
| Rate for Payer: UMR Bronson Commercial |
$500.02
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$402.19 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna American Axle |
$706.55
|
| Rate for Payer: Aetna Commercial |
$923.95
|
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.55
|
| 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 |
$3,780.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$934.82
|
| Rate for Payer: Cofinity Commercial |
$760.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$869.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$978.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$760.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$815.25
|
| 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 |
$923.95
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$923.95
|
| 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 |
$760.90
|
| 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 |
$684.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$652.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: UMR Bronson Commercial |
$402.19
|
| Rate for Payer: VA VA |
$3,388.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$815.25
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$424.51 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Aetna Commercial |
$722.42
|
| Rate for Payer: BCBS Complete |
$445.74
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Meridian Medicaid |
$445.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.45
|
| Rate for Payer: Priority Health Narrow Network |
$813.45
|
| Rate for Payer: Priority Health SBD |
$813.45
|
| Rate for Payer: UMR Bronson Commercial |
$500.02
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,314.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$582.77 |
| Max. Negotiated Rate |
$1,422.75 |
| Rate for Payer: Aetna Commercial |
$993.34
|
| Rate for Payer: BCBS Complete |
$611.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.75
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Meridian Medicaid |
$611.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.80
|
| Rate for Payer: Priority Health SBD |
$1,116.80
|
| Rate for Payer: UMR Bronson Commercial |
$604.44
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$815.76 |
| Max. Negotiated Rate |
$1,668.60 |
| Rate for Payer: Aetna American Axle |
$1,205.10
|
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cofinity Commercial |
$1,297.80
|
| Rate for Payer: Cofinity Commercial |
$1,594.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,483.20
|
| Rate for Payer: Healthscope Commercial |
$1,668.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,297.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,390.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,575.90
|
| Rate for Payer: PHP Commercial |
$1,575.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.80
|
| Rate for Payer: Priority Health SBD |
$1,168.02
|
| Rate for Payer: UMR Bronson Commercial |
$815.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,390.50
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$615.14 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$1,051.23
|
| Rate for Payer: BCBS Complete |
$645.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Meridian Medicaid |
$645.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,178.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.85
|
| Rate for Payer: Priority Health SBD |
$1,178.85
|
| Rate for Payer: UMR Bronson Commercial |
$852.84
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$615.14 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$1,051.23
|
| Rate for Payer: BCBS Complete |
$645.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Meridian Medicaid |
$645.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,178.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.85
|
| Rate for Payer: Priority Health SBD |
$1,178.85
|
| Rate for Payer: UMR Bronson Commercial |
$852.84
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$685.98 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna American Axle |
$1,205.10
|
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$7,332.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cofinity Commercial |
$1,594.44
|
| Rate for Payer: Cofinity Commercial |
$1,297.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,483.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Healthscope Commercial |
$1,668.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,297.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,390.50
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,575.90
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Commercial |
$1,575.90
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Priority Health SBD |
$1,168.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,040.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$945.65
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: UMR Bronson Commercial |
$685.98
|
| Rate for Payer: VA VA |
$5,796.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,390.50
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna American Axle |
$702.00
|
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cofinity Commercial |
$756.00
|
| Rate for Payer: Cofinity Commercial |
$928.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.00
|
| Rate for Payer: Healthscope Commercial |
$972.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$756.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$918.00
|
| Rate for Payer: PHP Commercial |
$918.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.00
|
| Rate for Payer: Priority Health SBD |
$680.40
|
| Rate for Payer: UMR Bronson Commercial |
$475.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.00
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 19304
|
| Hospital Charge Code |
19304
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: BCBS Complete |
$432.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.00
|
| Rate for Payer: UMR Bronson Commercial |
$496.80
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna American Axle |
$702.00
|
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.00
|
| Rate for Payer: BCBS Complete |
$432.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cofinity Commercial |
$756.00
|
| Rate for Payer: Cofinity Commercial |
$928.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.00
|
| Rate for Payer: Healthscope Commercial |
$972.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$756.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$810.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$918.00
|
| Rate for Payer: PHP Commercial |
$918.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.00
|
| Rate for Payer: Priority Health SBD |
$680.40
|
| Rate for Payer: UMR Bronson Commercial |
$399.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$810.00
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 19304
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: BCBS Complete |
$432.00
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.00
|
| Rate for Payer: UMR Bronson Commercial |
$496.80
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,004.00
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$757.22 |
| Max. Negotiated Rate |
$18,089.98 |
| Rate for Payer: Aetna Commercial |
$1,296.93
|
| Rate for Payer: BCBS Complete |
$795.08
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Meridian Medicaid |
$795.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$757.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,402.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,453.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,453.02
|
| Rate for Payer: Priority Health SBD |
$1,453.02
|
| Rate for Payer: UMR Bronson Commercial |
$921.84
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
IP
|
$2,004.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$881.76 |
| Max. Negotiated Rate |
$1,803.60 |
| Rate for Payer: Aetna American Axle |
$1,302.60
|
| Rate for Payer: Aetna Commercial |
$1,703.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.60
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cofinity Commercial |
$1,402.80
|
| Rate for Payer: Cofinity Commercial |
$1,723.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.20
|
| Rate for Payer: Healthscope Commercial |
$1,803.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,402.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,503.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,703.40
|
| Rate for Payer: PHP Commercial |
$1,703.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,402.80
|
| Rate for Payer: Priority Health SBD |
$1,262.52
|
| Rate for Payer: UMR Bronson Commercial |
$881.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,503.00
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,004.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
19307
|
| Min. Negotiated Rate |
$757.22 |
| Max. Negotiated Rate |
$18,089.98 |
| Rate for Payer: Aetna Commercial |
$1,296.93
|
| Rate for Payer: BCBS Complete |
$795.08
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Meridian Medicaid |
$795.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$757.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,402.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,453.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,453.02
|
| Rate for Payer: Priority Health SBD |
$1,453.02
|
| Rate for Payer: UMR Bronson Commercial |
$921.84
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
OP
|
$2,004.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$741.48 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna American Axle |
$1,302.60
|
| Rate for Payer: Aetna Commercial |
$1,703.40
|
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$6,728.75
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cofinity Commercial |
$1,402.80
|
| Rate for Payer: Cofinity Commercial |
$1,723.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Healthscope Commercial |
$1,803.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,402.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,503.00
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,703.40
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Commercial |
$1,703.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,402.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Priority Health SBD |
$1,262.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,280.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$1,164.06
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: UMR Bronson Commercial |
$741.48
|
| Rate for Payer: VA VA |
$5,796.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,503.00
|
|
|
PR MASTOIDECTOMY COMPLETE
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 69502
|
| Min. Negotiated Rate |
$606.84 |
| Max. Negotiated Rate |
$4,242.78 |
| Rate for Payer: Aetna Commercial |
$1,083.82
|
| Rate for Payer: BCBS Complete |
$637.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,242.78
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Meridian Medicaid |
$637.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$606.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.13
|
| Rate for Payer: Priority Health SBD |
$1,344.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.46
|
|
|
PR MASTOID OBLITERATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,411.00
|
|
|
Service Code
|
HCPCS 69670
|
| Min. Negotiated Rate |
$606.62 |
| Max. Negotiated Rate |
$3,570.25 |
| Rate for Payer: Aetna Commercial |
$1,073.89
|
| Rate for Payer: BCBS Complete |
$636.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,570.25
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Meridian Medicaid |
$636.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$606.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,387.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,345.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,345.07
|
| Rate for Payer: Priority Health SBD |
$1,345.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,569.06
|
|
|
PR MASTOPEXY
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 19316
|
| Min. Negotiated Rate |
$293.06 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$856.33
|
| Rate for Payer: BCBS Complete |
$533.63
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Meridian Medicaid |
$533.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$975.39
|
| Rate for Payer: Priority Health Narrow Network |
$975.39
|
| Rate for Payer: Priority Health SBD |
$975.39
|
| Rate for Payer: UMR Bronson Commercial |
$874.00
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
HCPCS 19020
|
| Min. Negotiated Rate |
$202.78 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$336.67
|
| Rate for Payer: BCBS Complete |
$212.92
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Meridian Medicaid |
$212.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.20
|
| Rate for Payer: Priority Health Narrow Network |
$387.20
|
| Rate for Payer: Priority Health SBD |
$387.20
|
| Rate for Payer: UMR Bronson Commercial |
$367.08
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
IP
|
$798.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Aetna American Axle |
$518.70
|
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.70
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cofinity Commercial |
$558.60
|
| Rate for Payer: Cofinity Commercial |
$686.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.40
|
| Rate for Payer: Healthscope Commercial |
$718.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$558.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$598.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$678.30
|
| Rate for Payer: PHP Commercial |
$678.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.60
|
| Rate for Payer: Priority Health SBD |
$502.74
|
| Rate for Payer: UMR Bronson Commercial |
$351.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$598.50
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$295.26 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$518.70
|
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.70
|
| 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 |
$2,225.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cofinity Commercial |
$558.60
|
| Rate for Payer: Cofinity Commercial |
$686.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$718.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$558.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$598.50
|
| 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 |
$678.30
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$678.30
|
| 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 |
$558.60
|
| 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 |
$502.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$311.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$295.26
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$598.50
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$202.78 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$336.67
|
| Rate for Payer: BCBS Complete |
$212.92
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Meridian Medicaid |
$212.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.20
|
| Rate for Payer: Priority Health Narrow Network |
$387.20
|
| Rate for Payer: Priority Health SBD |
$387.20
|
| Rate for Payer: UMR Bronson Commercial |
$367.08
|
|
|
PR MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
HCPCS 19305
|
| Min. Negotiated Rate |
$737.62 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$1,253.82
|
| Rate for Payer: BCBS Complete |
$774.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Meridian Medicaid |
$774.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$737.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,418.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.09
|
| Rate for Payer: Priority Health SBD |
$1,418.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,089.74
|
|
|
PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 94200
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$2,544.29 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,544.29
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.59
|
| Rate for Payer: Priority Health Narrow Network |
$3.59
|
| Rate for Payer: Priority Health SBD |
$19.76
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
