|
PR BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 61210
|
| Min. Negotiated Rate |
$235.79 |
| Max. Negotiated Rate |
$1,660.10 |
| Rate for Payer: Aetna Commercial |
$475.20
|
| Rate for Payer: Aetna Medicare |
$1,277.00
|
| Rate for Payer: BCBS Complete |
$247.58
|
| Rate for Payer: BCBS Trust/PPO |
$324.90
|
| Rate for Payer: BCN Commercial |
$745.05
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Meridian Medicaid |
$247.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.29
|
| Rate for Payer: Priority Health Narrow Network |
$627.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.40
|
| Rate for Payer: UHC Exchange |
$439.40
|
| Rate for Payer: UHCCP Medicaid |
$235.79
|
|
|
PR BURR HOLE/TREPHINE STTL EXPL N/FLWD OTH SURG
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 61250
|
| Min. Negotiated Rate |
$570.41 |
| Max. Negotiated Rate |
$1,771.25 |
| Rate for Payer: Aetna Commercial |
$1,119.93
|
| Rate for Payer: Aetna Medicare |
$1,362.50
|
| Rate for Payer: BCBS Complete |
$598.93
|
| Rate for Payer: BCBS Trust/PPO |
$918.19
|
| Rate for Payer: BCN Commercial |
$1,288.16
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Meridian Medicaid |
$598.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,512.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.80
|
| Rate for Payer: UHC Exchange |
$978.80
|
| Rate for Payer: UHCCP Medicaid |
$570.41
|
|
|
PR BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION
|
Professional
|
Both
|
$4,613.00
|
|
|
Service Code
|
HCPCS 61140
|
| Min. Negotiated Rate |
$832.83 |
| Max. Negotiated Rate |
$2,998.45 |
| Rate for Payer: Aetna Commercial |
$1,640.54
|
| Rate for Payer: Aetna Medicare |
$2,306.50
|
| Rate for Payer: BCBS Complete |
$874.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,274.79
|
| Rate for Payer: BCN Commercial |
$2,604.62
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Meridian Medicaid |
$874.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$832.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,998.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,213.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,213.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,444.07
|
| Rate for Payer: UHC Exchange |
$1,444.07
|
| Rate for Payer: UHCCP Medicaid |
$832.83
|
|
|
PR BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST
|
Professional
|
Both
|
$4,121.00
|
|
|
Service Code
|
HCPCS 61150
|
| Min. Negotiated Rate |
$614.94 |
| Max. Negotiated Rate |
$2,768.67 |
| Rate for Payer: Aetna Commercial |
$1,745.51
|
| Rate for Payer: Aetna Medicare |
$2,060.50
|
| Rate for Payer: BCBS Complete |
$927.26
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: BCN Commercial |
$2,768.67
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Meridian Medicaid |
$927.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$883.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,344.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,344.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,556.77
|
| Rate for Payer: UHC Exchange |
$1,556.77
|
| Rate for Payer: UHCCP Medicaid |
$883.10
|
|
|
PR BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL
|
Professional
|
Both
|
$3,685.00
|
|
|
Service Code
|
HCPCS 61156
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$2,525.30 |
| Rate for Payer: Aetna Commercial |
$1,606.58
|
| Rate for Payer: Aetna Medicare |
$1,842.50
|
| Rate for Payer: BCBS Complete |
$851.89
|
| Rate for Payer: BCBS Trust/PPO |
$284.75
|
| Rate for Payer: BCN Commercial |
$2,525.30
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Meridian Medicaid |
$851.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,395.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,152.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,152.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,439.92
|
| Rate for Payer: UHC Exchange |
$1,439.92
|
| Rate for Payer: UHCCP Medicaid |
$811.32
|
|
|
PR BURR HOLE W/EVAC&/DRG HEMATOMA EXTRADURAL/SDRL
|
Professional
|
Both
|
$4,188.00
|
|
|
Service Code
|
HCPCS 61154
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$2,722.20 |
| Rate for Payer: Aetna Commercial |
$1,645.02
|
| Rate for Payer: Aetna Medicare |
$2,094.00
|
| Rate for Payer: BCBS Complete |
$879.16
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: BCN Commercial |
$2,621.56
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Meridian Medicaid |
$879.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,722.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,224.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,224.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,447.15
|
| Rate for Payer: UHC Exchange |
$1,447.15
|
| Rate for Payer: UHCCP Medicaid |
$837.30
|
|
|
PR BUTORPHANOL TARTRATE 1 MG
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J0595
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.72
|
| Rate for Payer: BCN Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.82
|
| Rate for Payer: UHC Exchange |
$3.82
|
|
|
PR BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 49180
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$553.66 |
| Rate for Payer: Aetna Commercial |
$112.01
|
| Rate for Payer: Aetna Medicare |
$170.00
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS Trust/PPO |
$553.66
|
| Rate for Payer: BCN Commercial |
$256.56
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.38
|
| Rate for Payer: Priority Health Narrow Network |
$144.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.66
|
| Rate for Payer: UHC Exchange |
$113.66
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR BX ANORECTAL WALL ANAL APPROACH
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 45100
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$547.67 |
| Rate for Payer: Aetna Commercial |
$399.52
|
| Rate for Payer: Aetna Medicare |
$384.50
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS Trust/PPO |
$534.64
|
| Rate for Payer: BCN Commercial |
$443.72
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$547.67
|
| Rate for Payer: Priority Health Narrow Network |
$547.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.91
|
| Rate for Payer: UHC Exchange |
$343.91
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: Aetna Commercial |
$269.10
|
| Rate for Payer: ASR ASR |
$290.03
|
| Rate for Payer: ASR Commercial |
$290.03
|
| Rate for Payer: BCBS Trust/PPO |
$243.66
|
| Rate for Payer: BCN Commercial |
$231.81
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$281.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$299.00
|
| Rate for Payer: Healthscope Whirlpool |
$290.03
|
| Rate for Payer: Mclaren Commercial |
$269.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: Nomi Health Commercial |
$245.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.12
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$221.86
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.01
|
| Rate for Payer: Priority Health Narrow Network |
$93.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.46
|
| Rate for Payer: UHC Exchange |
$75.46
|
| Rate for Payer: UHCCP Medicaid |
$43.67
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$140.71 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$269.10
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$290.03
|
| Rate for Payer: ASR Commercial |
$290.03
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$244.85
|
| Rate for Payer: BCCCP Commercial |
$140.71
|
| Rate for Payer: BCN Commercial |
$231.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$281.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$299.00
|
| Rate for Payer: Healthscope Whirlpool |
$290.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$269.10
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: Nomi Health Commercial |
$245.18
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.73
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$562.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 19100
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$456.13 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$221.86
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.01
|
| Rate for Payer: Priority Health Narrow Network |
$93.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.46
|
| Rate for Payer: UHC Exchange |
$75.46
|
| Rate for Payer: UHCCP Medicaid |
$43.67
|
|
|
PR BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 19081
|
| Min. Negotiated Rate |
$102.67 |
| Max. Negotiated Rate |
$1,836.42 |
| Rate for Payer: Aetna Commercial |
$179.91
|
| Rate for Payer: Aetna Medicare |
$386.50
|
| Rate for Payer: BCBS Complete |
$107.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.42
|
| Rate for Payer: BCN Commercial |
$741.81
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Meridian Medicaid |
$107.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.28
|
| Rate for Payer: Priority Health Narrow Network |
$216.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.72
|
| Rate for Payer: UHC Exchange |
$212.72
|
| Rate for Payer: UHCCP Medicaid |
$102.67
|
|
|
PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 19083
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$741.81 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Aetna Medicare |
$220.50
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$741.81
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.53
|
| Rate for Payer: Priority Health Narrow Network |
$204.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.21
|
| Rate for Payer: UHC Exchange |
$199.21
|
| Rate for Payer: UHCCP Medicaid |
$96.49
|
|
|
PR BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 19084
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$566.87 |
| Rate for Payer: Aetna Commercial |
$84.71
|
| Rate for Payer: Aetna Medicare |
$396.50
|
| Rate for Payer: BCBS Complete |
$50.99
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$566.87
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Meridian Medicaid |
$50.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.04
|
| Rate for Payer: Priority Health Narrow Network |
$102.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.78
|
| Rate for Payer: UHC Exchange |
$94.78
|
| Rate for Payer: UHCCP Medicaid |
$48.56
|
|
|
PR BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 38505
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$656.16 |
| Rate for Payer: Aetna Commercial |
$85.02
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$656.16
|
| Rate for Payer: BCN Commercial |
$259.00
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.44
|
| Rate for Payer: Priority Health Narrow Network |
$168.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.88
|
| Rate for Payer: UHC Exchange |
$83.88
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$545.65
|
| Rate for Payer: Aetna Medicare |
$788.50
|
| Rate for Payer: BCBS Complete |
$300.36
|
| Rate for Payer: BCBS Trust/PPO |
$486.04
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Meridian Medicaid |
$300.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.12
|
| Rate for Payer: Priority Health Narrow Network |
$888.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.96
|
| Rate for Payer: UHC Exchange |
$471.96
|
| Rate for Payer: UHCCP Medicaid |
$286.06
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,025.05 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$1,419.30
|
| Rate for Payer: Aetna Medicare |
$3,751.85
|
| 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: ASR ASR |
$1,529.69
|
| Rate for Payer: ASR Commercial |
$1,529.69
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,291.41
|
| Rate for Payer: BCN Commercial |
$1,222.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,482.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,577.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,529.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$1,419.30
|
| 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 |
$1,340.45
|
| Rate for Payer: Nomi Health Commercial |
$1,293.14
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$4,127.04
|
| Rate for Payer: PHP Medicaid |
$2,010.99
|
| 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 |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,381.77
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,105.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,387.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,815.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP DNSP |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$545.65
|
| Rate for Payer: Aetna Medicare |
$788.50
|
| Rate for Payer: BCBS Complete |
$300.36
|
| Rate for Payer: BCBS Trust/PPO |
$486.04
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Meridian Medicaid |
$300.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.12
|
| Rate for Payer: Priority Health Narrow Network |
$888.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.96
|
| Rate for Payer: UHC Exchange |
$471.96
|
| Rate for Payer: UHCCP Medicaid |
$286.06
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,025.05 |
| Max. Negotiated Rate |
$1,577.00 |
| Rate for Payer: Aetna Commercial |
$1,419.30
|
| Rate for Payer: ASR ASR |
$1,529.69
|
| Rate for Payer: ASR Commercial |
$1,529.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.10
|
| Rate for Payer: BCN Commercial |
$1,222.65
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,482.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Healthscope Commercial |
$1,577.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,529.69
|
| Rate for Payer: Mclaren Commercial |
$1,419.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: Nomi Health Commercial |
$1,293.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,387.76
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,025.05 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$1,419.30
|
| Rate for Payer: Aetna Medicare |
$3,751.85
|
| 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: ASR ASR |
$1,529.69
|
| Rate for Payer: ASR Commercial |
$1,529.69
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,291.41
|
| Rate for Payer: BCN Commercial |
$1,222.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,482.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,577.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,529.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$1,419.30
|
| 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 |
$1,340.45
|
| Rate for Payer: Nomi Health Commercial |
$1,293.14
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$4,127.04
|
| Rate for Payer: PHP Medicaid |
$2,010.99
|
| 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 |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,381.77
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,105.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,387.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,815.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP DNSP |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38510
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$517.41
|
| Rate for Payer: Aetna Medicare |
$788.50
|
| Rate for Payer: BCBS Complete |
$282.92
|
| Rate for Payer: BCBS Trust/PPO |
$559.47
|
| Rate for Payer: BCN Commercial |
$777.00
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Meridian Medicaid |
$282.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.52
|
| Rate for Payer: Priority Health Narrow Network |
$837.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.26
|
| Rate for Payer: UHC Exchange |
$470.26
|
| Rate for Payer: UHCCP Medicaid |
$269.45
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
38510
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$1,025.05 |
| Rate for Payer: Aetna Commercial |
$517.41
|
| Rate for Payer: Aetna Medicare |
$788.50
|
| Rate for Payer: BCBS Complete |
$282.92
|
| Rate for Payer: BCBS Trust/PPO |
$559.47
|
| Rate for Payer: BCN Commercial |
$777.00
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Meridian Medicaid |
$282.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.52
|
| Rate for Payer: Priority Health Narrow Network |
$837.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.26
|
| Rate for Payer: UHC Exchange |
$470.26
|
| Rate for Payer: UHCCP Medicaid |
$269.45
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,025.05 |
| Max. Negotiated Rate |
$1,577.00 |
| Rate for Payer: Aetna Commercial |
$1,419.30
|
| Rate for Payer: ASR ASR |
$1,529.69
|
| Rate for Payer: ASR Commercial |
$1,529.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.10
|
| Rate for Payer: BCN Commercial |
$1,222.65
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,482.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Healthscope Commercial |
$1,577.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,529.69
|
| Rate for Payer: Mclaren Commercial |
$1,419.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: Nomi Health Commercial |
$1,293.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,387.76
|
|
