|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$760.90 |
| Max. Negotiated Rate |
$1,087.00 |
| Rate for Payer: Aetna Commercial |
$978.30
|
| Rate for Payer: ASR ASR |
$1,054.39
|
| Rate for Payer: BCBS Trust/PPO |
$842.75
|
| Rate for Payer: BCN Commercial |
$842.75
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$1,021.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$869.60
|
| Rate for Payer: Healthscope Commercial |
$1,087.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,054.39
|
| Rate for Payer: Mclaren Commercial |
$978.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$923.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$956.56
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$424.51 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna Commercial |
$878.18
|
| Rate for Payer: Aetna Medicare |
$655.36
|
| Rate for Payer: BCBS Complete |
$445.74
|
| Rate for Payer: BCBS MAPPO |
$655.36
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: BCN Medicare Advantage |
$655.36
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$878.18
|
| Rate for Payer: Cofinity Commercial |
$943.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.36
|
| Rate for Payer: Healthscope Commercial |
$786.43
|
| Rate for Payer: Healthscope Whirlpool |
$786.43
|
| Rate for Payer: Meridian Medicaid |
$445.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$688.13
|
| Rate for Payer: PACE SWMI |
$655.36
|
| Rate for Payer: PHP Medicare Advantage |
$655.36
|
| 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 Medicare |
$655.36
|
| Rate for Payer: Priority Health Narrow Network |
$813.45
|
| Rate for Payer: UHC Medicare Advantage |
$675.02
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$760.90 |
| Max. Negotiated Rate |
$4,235.21 |
| Rate for Payer: Aetna Commercial |
$978.30
|
| Rate for Payer: Aetna Medicare |
$3,388.17
|
| 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: ASR ASR |
$1,054.39
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$842.75
|
| Rate for Payer: BCN Commercial |
$842.75
|
| 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 |
$1,021.78
|
| 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 |
$1,087.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,054.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,388.17
|
| Rate for Payer: Mclaren Commercial |
$978.30
|
| 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 |
$3,726.99
|
| Rate for Payer: PHP Medicaid |
$1,853.33
|
| 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 |
$989.17
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$771.77
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$956.56
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
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 |
$1,206.27
|
| Rate for Payer: Aetna Medicare |
$900.20
|
| Rate for Payer: BCBS Complete |
$611.91
|
| Rate for Payer: BCBS MAPPO |
$900.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.75
|
| Rate for Payer: BCN Commercial |
$1,327.74
|
| Rate for Payer: BCN Medicare Advantage |
$900.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cofinity Commercial |
$1,296.29
|
| Rate for Payer: Cofinity Commercial |
$1,206.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$900.20
|
| Rate for Payer: Healthscope Commercial |
$1,080.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,080.24
|
| Rate for Payer: Meridian Medicaid |
$611.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$945.21
|
| Rate for Payer: PACE SWMI |
$900.20
|
| Rate for Payer: PHP Medicare Advantage |
$900.20
|
| 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 Medicare |
$900.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.80
|
| Rate for Payer: UHC Medicare Advantage |
$927.21
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,297.80 |
| Max. Negotiated Rate |
$1,854.00 |
| Rate for Payer: Aetna Commercial |
$1,668.60
|
| Rate for Payer: ASR ASR |
$1,798.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,437.41
|
| Rate for Payer: BCN Commercial |
$1,437.41
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cofinity Commercial |
$1,742.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,483.20
|
| Rate for Payer: Healthscope Commercial |
$1,854.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,798.38
|
| Rate for Payer: Mclaren Commercial |
$1,668.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,575.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,297.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,631.52
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,297.80 |
| Max. Negotiated Rate |
$7,245.58 |
| Rate for Payer: Aetna Commercial |
$1,668.60
|
| Rate for Payer: Aetna Medicare |
$5,796.46
|
| 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: ASR ASR |
$1,798.38
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,437.41
|
| Rate for Payer: BCN Commercial |
$1,437.41
|
| 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 |
$1,742.76
|
| 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 |
$1,854.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,798.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,796.46
|
| Rate for Payer: Mclaren Commercial |
$1,668.60
|
| 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 |
$6,376.11
|
| Rate for Payer: PHP Medicaid |
$3,170.66
|
| 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 |
$1,687.14
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,316.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,631.52
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
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 |
$1,401.52 |
| Rate for Payer: Aetna Commercial |
$1,274.54
|
| Rate for Payer: Aetna Medicare |
$951.15
|
| Rate for Payer: BCBS Complete |
$645.90
|
| Rate for Payer: BCBS MAPPO |
$951.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$1,401.52
|
| Rate for Payer: BCN Medicare Advantage |
$951.15
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cofinity Commercial |
$1,369.66
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$951.15
|
| Rate for Payer: Healthscope Commercial |
$1,141.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,141.38
|
| Rate for Payer: Meridian Medicaid |
$645.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$998.71
|
| Rate for Payer: PACE SWMI |
$951.15
|
| Rate for Payer: PHP Medicare Advantage |
$951.15
|
| 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 Medicare |
$951.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.85
|
| Rate for Payer: UHC Medicare Advantage |
$979.68
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$615.14 |
| Max. Negotiated Rate |
$1,401.52 |
| Rate for Payer: Aetna Commercial |
$1,274.54
|
| Rate for Payer: Aetna Medicare |
$951.15
|
| Rate for Payer: BCBS Complete |
$645.90
|
| Rate for Payer: BCBS MAPPO |
$951.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$1,401.52
|
| Rate for Payer: BCN Medicare Advantage |
$951.15
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cofinity Commercial |
$1,369.66
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$951.15
|
| Rate for Payer: Healthscope Commercial |
$1,141.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,141.38
|
| Rate for Payer: Meridian Medicaid |
$645.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$998.71
|
| Rate for Payer: PACE SWMI |
$951.15
|
| Rate for Payer: PHP Medicare Advantage |
$951.15
|
| 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 Medicare |
$951.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.85
|
| Rate for Payer: UHC Medicare Advantage |
$979.68
|
|
|
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
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$972.00
|
| Rate for Payer: ASR ASR |
$1,047.60
|
| Rate for Payer: BCBS Trust/PPO |
$837.32
|
| Rate for Payer: BCN Commercial |
$837.32
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cofinity Commercial |
$1,015.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.00
|
| Rate for Payer: Healthscope Commercial |
$1,080.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.60
|
| Rate for Payer: Mclaren Commercial |
$972.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$918.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$950.40
|
|
|
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
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$972.00
|
| Rate for Payer: ASR ASR |
$1,047.60
|
| Rate for Payer: BCBS Complete |
$432.00
|
| Rate for Payer: BCBS Trust/PPO |
$837.32
|
| Rate for Payer: BCN Commercial |
$837.32
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cofinity Commercial |
$1,015.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$864.00
|
| Rate for Payer: Healthscope Commercial |
$1,080.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.60
|
| Rate for Payer: Mclaren Commercial |
$972.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$918.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.80
|
| Rate for Payer: Priority Health Narrow Network |
$766.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$950.40
|
|
|
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 |
$1,402.80 |
| Max. Negotiated Rate |
$7,245.58 |
| Rate for Payer: Aetna Commercial |
$1,803.60
|
| Rate for Payer: Aetna Medicare |
$5,796.46
|
| 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: ASR ASR |
$1,943.88
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.70
|
| Rate for Payer: BCN Commercial |
$1,553.70
|
| 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 |
$1,883.76
|
| 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 |
$2,004.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,943.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,796.46
|
| Rate for Payer: Mclaren Commercial |
$1,803.60
|
| 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 |
$6,376.11
|
| Rate for Payer: PHP Medicaid |
$3,170.66
|
| 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 |
$1,823.64
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,422.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.52
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
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 |
$1,568.24
|
| Rate for Payer: Aetna Medicare |
$1,170.33
|
| Rate for Payer: BCBS Complete |
$795.08
|
| Rate for Payer: BCBS MAPPO |
$1,170.33
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,170.33
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cofinity Commercial |
$1,685.28
|
| Rate for Payer: Cofinity Commercial |
$1,568.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,170.33
|
| Rate for Payer: Healthscope Commercial |
$1,404.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.40
|
| Rate for Payer: Meridian Medicaid |
$795.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,228.85
|
| Rate for Payer: PACE SWMI |
$1,170.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,170.33
|
| 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 Medicare |
$1,170.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,453.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,205.44
|
|
|
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 |
$1,568.24
|
| Rate for Payer: Aetna Medicare |
$1,170.33
|
| Rate for Payer: BCBS Complete |
$795.08
|
| Rate for Payer: BCBS MAPPO |
$1,170.33
|
| Rate for Payer: BCBS Trust/PPO |
$18,089.98
|
| Rate for Payer: BCN Commercial |
$1,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,170.33
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cofinity Commercial |
$1,568.24
|
| Rate for Payer: Cofinity Commercial |
$1,685.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,170.33
|
| Rate for Payer: Healthscope Commercial |
$1,404.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.40
|
| Rate for Payer: Meridian Medicaid |
$795.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,228.85
|
| Rate for Payer: PACE SWMI |
$1,170.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,170.33
|
| 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 Medicare |
$1,170.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,453.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,205.44
|
|
|
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 |
$1,402.80 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$1,803.60
|
| Rate for Payer: ASR ASR |
$1,943.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.70
|
| Rate for Payer: BCN Commercial |
$1,553.70
|
| Rate for Payer: Cash Price |
$1,603.20
|
| Rate for Payer: Cofinity Commercial |
$1,883.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.20
|
| Rate for Payer: Healthscope Commercial |
$2,004.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,943.88
|
| Rate for Payer: Mclaren Commercial |
$1,803.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,703.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,402.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.52
|
|
|
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 |
$1,243.48
|
| Rate for Payer: Aetna Medicare |
$927.97
|
| Rate for Payer: BCBS Complete |
$637.18
|
| Rate for Payer: BCBS MAPPO |
$927.97
|
| Rate for Payer: BCBS Trust/PPO |
$4,242.78
|
| Rate for Payer: BCN Commercial |
$1,393.22
|
| Rate for Payer: BCN Medicare Advantage |
$927.97
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,336.28
|
| Rate for Payer: Cofinity Commercial |
$1,243.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$927.97
|
| Rate for Payer: Healthscope Commercial |
$1,113.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,113.56
|
| Rate for Payer: Meridian Medicaid |
$637.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$974.37
|
| Rate for Payer: PACE SWMI |
$927.97
|
| Rate for Payer: PHP Medicare Advantage |
$927.97
|
| 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 Medicare |
$927.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.13
|
| Rate for Payer: UHC Medicare Advantage |
$955.81
|
|
|
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 |
$1,240.13
|
| Rate for Payer: Aetna Medicare |
$925.47
|
| Rate for Payer: BCBS Complete |
$636.95
|
| Rate for Payer: BCBS MAPPO |
$925.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,570.25
|
| Rate for Payer: BCN Commercial |
$1,394.20
|
| Rate for Payer: BCN Medicare Advantage |
$925.47
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cofinity Commercial |
$1,332.68
|
| Rate for Payer: Cofinity Commercial |
$1,240.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.47
|
| Rate for Payer: Healthscope Commercial |
$1,110.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.56
|
| Rate for Payer: Meridian Medicaid |
$636.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$971.74
|
| Rate for Payer: PACE SWMI |
$925.47
|
| Rate for Payer: PHP Medicare Advantage |
$925.47
|
| 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 Medicare |
$925.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,345.07
|
| Rate for Payer: UHC Medicare Advantage |
$953.23
|
|
|
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 |
$1,042.51
|
| Rate for Payer: Aetna Medicare |
$777.99
|
| Rate for Payer: BCBS Complete |
$533.63
|
| Rate for Payer: BCBS MAPPO |
$777.99
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$1,159.64
|
| Rate for Payer: BCN Medicare Advantage |
$777.99
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,120.31
|
| Rate for Payer: Cofinity Commercial |
$1,042.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$777.99
|
| Rate for Payer: Healthscope Commercial |
$933.59
|
| Rate for Payer: Healthscope Whirlpool |
$933.59
|
| Rate for Payer: Meridian Medicaid |
$533.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$816.89
|
| Rate for Payer: PACE SWMI |
$777.99
|
| Rate for Payer: PHP Medicare Advantage |
$777.99
|
| 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 Medicare |
$777.99
|
| Rate for Payer: Priority Health Narrow Network |
$975.39
|
| Rate for Payer: UHC Medicare Advantage |
$801.33
|
|
|
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 |
$411.82
|
| Rate for Payer: Aetna Medicare |
$307.33
|
| Rate for Payer: BCBS Complete |
$212.92
|
| Rate for Payer: BCBS MAPPO |
$307.33
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$692.46
|
| Rate for Payer: BCN Medicare Advantage |
$307.33
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cofinity Commercial |
$442.56
|
| Rate for Payer: Cofinity Commercial |
$411.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.33
|
| Rate for Payer: Healthscope Commercial |
$368.80
|
| Rate for Payer: Healthscope Whirlpool |
$368.80
|
| Rate for Payer: Meridian Medicaid |
$212.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$322.70
|
| Rate for Payer: PACE SWMI |
$307.33
|
| Rate for Payer: PHP Medicare Advantage |
$307.33
|
| 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 Medicare |
$307.33
|
| Rate for Payer: Priority Health Narrow Network |
$387.20
|
| Rate for Payer: UHC Medicare Advantage |
$316.55
|
|
|
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 |
$411.82
|
| Rate for Payer: Aetna Medicare |
$307.33
|
| Rate for Payer: BCBS Complete |
$212.92
|
| Rate for Payer: BCBS MAPPO |
$307.33
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$692.46
|
| Rate for Payer: BCN Medicare Advantage |
$307.33
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cofinity Commercial |
$411.82
|
| Rate for Payer: Cofinity Commercial |
$442.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.33
|
| Rate for Payer: Healthscope Commercial |
$368.80
|
| Rate for Payer: Healthscope Whirlpool |
$368.80
|
| Rate for Payer: Meridian Medicaid |
$212.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$322.70
|
| Rate for Payer: PACE SWMI |
$307.33
|
| Rate for Payer: PHP Medicare Advantage |
$307.33
|
| 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 Medicare |
$307.33
|
| Rate for Payer: Priority Health Narrow Network |
$387.20
|
| Rate for Payer: UHC Medicare Advantage |
$316.55
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
IP
|
$798.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$558.60 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna Commercial |
$718.20
|
| Rate for Payer: ASR ASR |
$774.06
|
| Rate for Payer: BCBS Trust/PPO |
$618.69
|
| Rate for Payer: BCN Commercial |
$618.69
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cofinity Commercial |
$750.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.40
|
| Rate for Payer: Healthscope Commercial |
$798.00
|
| Rate for Payer: Healthscope Whirlpool |
$774.06
|
| Rate for Payer: Mclaren Commercial |
$718.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$678.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$702.24
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$558.60 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$718.20
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| 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: ASR ASR |
$774.06
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$618.69
|
| Rate for Payer: BCN Commercial |
$618.69
|
| 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 |
$750.12
|
| 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 |
$798.00
|
| Rate for Payer: Healthscope Whirlpool |
$774.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$718.20
|
| 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 |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| 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 |
$726.18
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$566.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$702.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
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 |
$1,529.96
|
| Rate for Payer: Aetna Medicare |
$1,141.76
|
| Rate for Payer: BCBS Complete |
$774.50
|
| Rate for Payer: BCBS MAPPO |
$1,141.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,685.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.76
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Cash Price |
$1,895.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.13
|
| Rate for Payer: Cofinity Commercial |
$1,529.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.76
|
| Rate for Payer: Healthscope Commercial |
$1,370.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.11
|
| Rate for Payer: Meridian Medicaid |
$774.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,198.85
|
| Rate for Payer: PACE SWMI |
$1,141.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.76
|
| 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 Medicare |
$1,141.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,176.01
|
|
|
PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 94200
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$2,544.29 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$13.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,544.29
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: BCN Medicare Advantage |
$13.85
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$16.62
|
| Rate for Payer: Healthscope Whirlpool |
$16.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.54
|
| Rate for Payer: PACE SWMI |
$13.85
|
| Rate for Payer: PHP Medicare Advantage |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.76
|
| Rate for Payer: Priority Health Medicare |
$13.85
|
| Rate for Payer: Priority Health Narrow Network |
$19.76
|
| Rate for Payer: UHC Medicare Advantage |
$14.27
|
|
