|
PR MAKENA, 10 MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1726
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.65
|
| Rate for Payer: UHC Exchange |
$19.65
|
|
|
PR MAMMAPLASTY AUGMENTATION - GEL
|
Professional
|
Both
|
$3,605.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,442.00 |
| Max. Negotiated Rate |
$2,703.75 |
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,703.75
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$94.60
|
| Rate for Payer: Aetna Medicare |
$70.60
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS MAPPO |
$70.60
|
| Rate for Payer: BCN Commercial |
$119.02
|
| Rate for Payer: BCN Medicare Advantage |
$70.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Cofinity Commercial |
$101.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.60
|
| Rate for Payer: Healthscope Commercial |
$84.72
|
| Rate for Payer: Healthscope Whirlpool |
$84.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.13
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.66
|
| Rate for Payer: Nomi Health Commercial |
$84.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$70.60
|
| Rate for Payer: PHP Medicare Advantage |
$70.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.23
|
| Rate for Payer: Priority Health Medicare |
$70.60
|
| Rate for Payer: Priority Health Narrow Network |
$127.23
|
| Rate for Payer: Railroad Medicare Medicare |
$70.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.60
|
| Rate for Payer: UHC Exchange |
$131.53
|
| Rate for Payer: UHC Medicaid |
$46.65
|
| Rate for Payer: UHCCP DNSP |
$70.60
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
|
|
PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 27860
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$486.75 |
| Rate for Payer: Aetna Commercial |
$201.66
|
| Rate for Payer: Aetna Medicare |
$150.49
|
| Rate for Payer: BCBS Complete |
$103.55
|
| Rate for Payer: BCBS MAPPO |
$150.49
|
| Rate for Payer: BCN Commercial |
$249.49
|
| Rate for Payer: BCN Medicare Advantage |
$150.49
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cofinity Commercial |
$216.71
|
| Rate for Payer: Cofinity Commercial |
$201.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.49
|
| Rate for Payer: Healthscope Commercial |
$180.59
|
| Rate for Payer: Healthscope Whirlpool |
$180.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.01
|
| Rate for Payer: Meridian Medicaid |
$103.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$165.54
|
| Rate for Payer: Nomi Health Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.75
|
| Rate for Payer: PACE SWMI |
$150.49
|
| Rate for Payer: PHP Medicare Advantage |
$150.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$266.70
|
| Rate for Payer: Priority Health Medicare |
$150.49
|
| Rate for Payer: Priority Health Narrow Network |
$266.70
|
| Rate for Payer: Railroad Medicare Medicare |
$150.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$150.49
|
| Rate for Payer: UHC Exchange |
$296.88
|
| Rate for Payer: UHC Medicaid |
$98.62
|
| Rate for Payer: UHCCP DNSP |
$150.49
|
| Rate for Payer: UHCCP Medicaid |
$98.62
|
|
|
PR MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 24300
|
| Min. Negotiated Rate |
$284.57 |
| Max. Negotiated Rate |
$732.49 |
| Rate for Payer: Aetna Commercial |
$568.63
|
| Rate for Payer: Aetna Medicare |
$424.35
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS MAPPO |
$424.35
|
| Rate for Payer: BCN Commercial |
$685.22
|
| Rate for Payer: BCN Medicare Advantage |
$424.35
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$611.06
|
| Rate for Payer: Cofinity Commercial |
$568.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.35
|
| Rate for Payer: Healthscope Commercial |
$509.22
|
| Rate for Payer: Healthscope Whirlpool |
$509.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.57
|
| Rate for Payer: Meridian Medicaid |
$298.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$466.79
|
| Rate for Payer: Nomi Health Commercial |
$509.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: PACE SWMI |
$424.35
|
| Rate for Payer: PHP Medicare Advantage |
$424.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$732.49
|
| Rate for Payer: Priority Health Medicare |
$424.35
|
| Rate for Payer: Priority Health Narrow Network |
$732.49
|
| Rate for Payer: Railroad Medicare Medicare |
$424.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$729.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$424.35
|
| Rate for Payer: UHC Exchange |
$729.29
|
| Rate for Payer: UHC Medicaid |
$284.57
|
| Rate for Payer: UHCCP DNSP |
$424.35
|
| Rate for Payer: UHCCP Medicaid |
$284.57
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$233.02 |
| Max. Negotiated Rate |
$597.80 |
| Rate for Payer: Aetna Commercial |
$462.51
|
| Rate for Payer: Aetna Medicare |
$345.16
|
| Rate for Payer: BCBS Complete |
$244.67
|
| Rate for Payer: BCBS MAPPO |
$345.16
|
| Rate for Payer: BCN Commercial |
$559.23
|
| Rate for Payer: BCN Medicare Advantage |
$345.16
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$497.03
|
| Rate for Payer: Cofinity Commercial |
$462.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.16
|
| Rate for Payer: Healthscope Commercial |
$414.19
|
| Rate for Payer: Healthscope Whirlpool |
$414.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.42
|
| Rate for Payer: Meridian Medicaid |
$244.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$379.68
|
| Rate for Payer: Nomi Health Commercial |
$414.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: PACE SWMI |
$345.16
|
| Rate for Payer: PHP Medicare Advantage |
$345.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$597.80
|
| Rate for Payer: Priority Health Medicare |
$345.16
|
| Rate for Payer: Priority Health Narrow Network |
$597.80
|
| Rate for Payer: Railroad Medicare Medicare |
$345.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$345.16
|
| Rate for Payer: UHC Exchange |
$579.99
|
| Rate for Payer: UHC Medicaid |
$233.02
|
| Rate for Payer: UHCCP DNSP |
$345.16
|
| Rate for Payer: UHCCP Medicaid |
$233.02
|
|
|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna Commercial |
$231.86
|
| Rate for Payer: Aetna Medicare |
$173.03
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$173.03
|
| Rate for Payer: BCN Commercial |
$282.86
|
| Rate for Payer: BCN Medicare Advantage |
$173.03
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$249.16
|
| Rate for Payer: Cofinity Commercial |
$231.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.03
|
| Rate for Payer: Healthscope Commercial |
$207.64
|
| Rate for Payer: Healthscope Whirlpool |
$207.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.68
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$190.33
|
| Rate for Payer: Nomi Health Commercial |
$207.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$778.50
|
| Rate for Payer: PACE SWMI |
$173.03
|
| Rate for Payer: PHP Medicare Advantage |
$173.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$302.37
|
| Rate for Payer: Priority Health Medicare |
$173.03
|
| Rate for Payer: Priority Health Narrow Network |
$302.37
|
| Rate for Payer: Railroad Medicare Medicare |
$173.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.03
|
| Rate for Payer: UHC Exchange |
$316.84
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP DNSP |
$173.03
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Aetna Commercial |
$193.87
|
| Rate for Payer: Aetna Medicare |
$144.68
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS MAPPO |
$144.68
|
| Rate for Payer: BCN Commercial |
$237.54
|
| Rate for Payer: BCN Medicare Advantage |
$144.68
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$208.34
|
| Rate for Payer: Cofinity Commercial |
$193.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.68
|
| Rate for Payer: Healthscope Commercial |
$173.62
|
| Rate for Payer: Healthscope Whirlpool |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.91
|
| Rate for Payer: Meridian Medicaid |
$100.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.15
|
| Rate for Payer: Nomi Health Commercial |
$173.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.75
|
| Rate for Payer: PACE SWMI |
$144.68
|
| Rate for Payer: PHP Medicare Advantage |
$144.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.92
|
| Rate for Payer: Priority Health Medicare |
$144.68
|
| Rate for Payer: Priority Health Narrow Network |
$253.92
|
| Rate for Payer: Railroad Medicare Medicare |
$144.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$144.68
|
| Rate for Payer: UHC Exchange |
$260.77
|
| Rate for Payer: UHC Medicaid |
$95.64
|
| Rate for Payer: UHCCP DNSP |
$144.68
|
| Rate for Payer: UHCCP Medicaid |
$95.64
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$376.50 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: Aetna Medicare |
$151.19
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS MAPPO |
$151.19
|
| Rate for Payer: BCN Commercial |
$250.56
|
| Rate for Payer: BCN Medicare Advantage |
$151.19
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$217.71
|
| Rate for Payer: Cofinity Commercial |
$202.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.19
|
| Rate for Payer: Healthscope Commercial |
$181.43
|
| Rate for Payer: Healthscope Whirlpool |
$181.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.75
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.31
|
| Rate for Payer: Nomi Health Commercial |
$181.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$376.50
|
| Rate for Payer: PACE SWMI |
$151.19
|
| Rate for Payer: PHP Medicare Advantage |
$151.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$243.81
|
| Rate for Payer: Priority Health Medicare |
$151.19
|
| Rate for Payer: Priority Health Narrow Network |
$243.81
|
| Rate for Payer: Railroad Medicare Medicare |
$151.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.19
|
| Rate for Payer: UHC Exchange |
$227.97
|
| Rate for Payer: UHC Medicaid |
$97.98
|
| Rate for Payer: UHCCP DNSP |
$151.19
|
| Rate for Payer: UHCCP Medicaid |
$97.98
|
|
|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$278.82 |
| Max. Negotiated Rate |
$723.74 |
| Rate for Payer: Aetna Commercial |
$557.88
|
| Rate for Payer: Aetna Medicare |
$416.33
|
| Rate for Payer: BCBS Complete |
$292.76
|
| Rate for Payer: BCBS MAPPO |
$416.33
|
| Rate for Payer: BCN Commercial |
$651.36
|
| Rate for Payer: BCN Medicare Advantage |
$416.33
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$599.52
|
| Rate for Payer: Cofinity Commercial |
$557.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.33
|
| Rate for Payer: Healthscope Commercial |
$499.60
|
| Rate for Payer: Healthscope Whirlpool |
$499.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.15
|
| Rate for Payer: Meridian Medicaid |
$292.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.96
|
| Rate for Payer: Nomi Health Commercial |
$499.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.25
|
| Rate for Payer: PACE SWMI |
$416.33
|
| Rate for Payer: PHP Medicare Advantage |
$416.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$696.28
|
| Rate for Payer: Priority Health Medicare |
$416.33
|
| Rate for Payer: Priority Health Narrow Network |
$696.28
|
| Rate for Payer: Railroad Medicare Medicare |
$416.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$723.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.33
|
| Rate for Payer: UHC Exchange |
$723.74
|
| Rate for Payer: UHC Medicaid |
$278.82
|
| Rate for Payer: UHCCP DNSP |
$416.33
|
| Rate for Payer: UHCCP Medicaid |
$278.82
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$149.62 |
| Rate for Payer: Aetna Commercial |
$94.83
|
| Rate for Payer: Aetna Medicare |
$70.77
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCN Commercial |
$124.99
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$94.83
|
| Rate for Payer: Cofinity Commercial |
$101.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Healthscope Commercial |
$84.92
|
| Rate for Payer: Healthscope Whirlpool |
$84.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Nomi Health Commercial |
$84.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.61
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health Narrow Network |
$133.61
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Exchange |
$149.62
|
| Rate for Payer: UHC Medicaid |
$45.16
|
| Rate for Payer: UHCCP DNSP |
$70.77
|
| Rate for Payer: UHCCP Medicaid |
$45.16
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$249.05 |
| Rate for Payer: Aetna Commercial |
$164.62
|
| Rate for Payer: Aetna Medicare |
$122.85
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS MAPPO |
$122.85
|
| Rate for Payer: BCN Commercial |
$213.13
|
| Rate for Payer: BCN Medicare Advantage |
$122.85
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$176.90
|
| Rate for Payer: Cofinity Commercial |
$164.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.85
|
| Rate for Payer: Healthscope Commercial |
$147.42
|
| Rate for Payer: Healthscope Whirlpool |
$147.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.99
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.13
|
| Rate for Payer: Nomi Health Commercial |
$147.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: PACE SWMI |
$122.85
|
| Rate for Payer: PHP Medicare Advantage |
$122.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.83
|
| Rate for Payer: Priority Health Medicare |
$122.85
|
| Rate for Payer: Priority Health Narrow Network |
$227.83
|
| Rate for Payer: Railroad Medicare Medicare |
$122.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$122.85
|
| Rate for Payer: UHC Exchange |
$249.05
|
| Rate for Payer: UHC Medicaid |
$78.38
|
| Rate for Payer: UHCCP DNSP |
$122.85
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$35.68
|
| Rate for Payer: Aetna Medicare |
$26.63
|
| Rate for Payer: BCBS MAPPO |
$26.63
|
| Rate for Payer: BCN Commercial |
$28.04
|
| Rate for Payer: BCN Medicare Advantage |
$26.63
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.68
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$31.96
|
| Rate for Payer: Healthscope Whirlpool |
$31.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.29
|
| Rate for Payer: Nomi Health Commercial |
$31.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PACE SWMI |
$26.63
|
| Rate for Payer: PHP Medicare Advantage |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$26.63
|
| Rate for Payer: Priority Health Narrow Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$26.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.63
|
| Rate for Payer: UHC Exchange |
$25.02
|
| Rate for Payer: UHCCP DNSP |
$26.63
|
|
|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$215.85
|
| Rate for Payer: Aetna Medicare |
$161.08
|
| Rate for Payer: BCBS Complete |
$109.59
|
| Rate for Payer: BCBS MAPPO |
$161.08
|
| Rate for Payer: BCN Commercial |
$273.89
|
| Rate for Payer: BCN Medicare Advantage |
$161.08
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$231.96
|
| Rate for Payer: Cofinity Commercial |
$215.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.08
|
| Rate for Payer: Healthscope Commercial |
$193.30
|
| Rate for Payer: Healthscope Whirlpool |
$193.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.13
|
| Rate for Payer: Meridian Medicaid |
$109.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$177.19
|
| Rate for Payer: Nomi Health Commercial |
$193.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.75
|
| Rate for Payer: PACE SWMI |
$161.08
|
| Rate for Payer: PHP Medicare Advantage |
$161.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$277.40
|
| Rate for Payer: Priority Health Medicare |
$161.08
|
| Rate for Payer: Priority Health Narrow Network |
$277.40
|
| Rate for Payer: Railroad Medicare Medicare |
$161.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.08
|
| Rate for Payer: UHC Exchange |
$319.57
|
| Rate for Payer: UHC Medicaid |
$104.37
|
| Rate for Payer: UHCCP DNSP |
$161.08
|
| Rate for Payer: UHCCP Medicaid |
$104.37
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$2,412.00
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$684.16 |
| Max. Negotiated Rate |
$2,077.53 |
| Rate for Payer: Aetna Commercial |
$1,425.01
|
| Rate for Payer: Aetna Medicare |
$1,063.44
|
| Rate for Payer: BCBS Complete |
$718.37
|
| Rate for Payer: BCBS MAPPO |
$1,063.44
|
| Rate for Payer: BCN Commercial |
$1,705.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.44
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Cofinity Commercial |
$1,425.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.44
|
| Rate for Payer: Healthscope Commercial |
$1,276.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,276.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,116.61
|
| Rate for Payer: Meridian Medicaid |
$718.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,169.78
|
| Rate for Payer: Nomi Health Commercial |
$1,276.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.00
|
| Rate for Payer: PACE SWMI |
$1,063.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$684.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,077.53
|
| Rate for Payer: Priority Health Medicare |
$1,063.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,077.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,063.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,010.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,063.44
|
| Rate for Payer: UHC Exchange |
$2,010.87
|
| Rate for Payer: UHC Medicaid |
$684.16
|
| Rate for Payer: UHCCP DNSP |
$1,063.44
|
| Rate for Payer: UHCCP Medicaid |
$684.16
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$537.75 |
| Rate for Payer: Aetna Commercial |
$272.56
|
| Rate for Payer: Aetna Medicare |
$203.40
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS MAPPO |
$203.40
|
| Rate for Payer: BCN Commercial |
$354.56
|
| Rate for Payer: BCN Medicare Advantage |
$203.40
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cofinity Commercial |
$292.90
|
| Rate for Payer: Cofinity Commercial |
$272.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.40
|
| Rate for Payer: Healthscope Commercial |
$244.08
|
| Rate for Payer: Healthscope Whirlpool |
$244.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.57
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$223.74
|
| Rate for Payer: Nomi Health Commercial |
$244.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$537.75
|
| Rate for Payer: PACE SWMI |
$203.40
|
| Rate for Payer: PHP Medicare Advantage |
$203.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$432.02
|
| Rate for Payer: Priority Health Medicare |
$203.40
|
| Rate for Payer: Priority Health Narrow Network |
$432.02
|
| Rate for Payer: Railroad Medicare Medicare |
$203.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$203.40
|
| Rate for Payer: UHC Exchange |
$386.52
|
| Rate for Payer: UHC Medicaid |
$134.19
|
| Rate for Payer: UHCCP DNSP |
$203.40
|
| Rate for Payer: UHCCP Medicaid |
$134.19
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,681.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
19300
|
| Min. Negotiated Rate |
$271.58 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Aetna Commercial |
$552.87
|
| Rate for Payer: Aetna Medicare |
$412.59
|
| Rate for Payer: BCBS Complete |
$285.16
|
| Rate for Payer: BCBS MAPPO |
$412.59
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Medicare Advantage |
$412.59
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Commercial |
$594.13
|
| Rate for Payer: Cofinity Commercial |
$552.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.59
|
| Rate for Payer: Healthscope Commercial |
$495.11
|
| Rate for Payer: Healthscope Whirlpool |
$495.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.22
|
| Rate for Payer: Meridian Medicaid |
$285.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$453.85
|
| Rate for Payer: Nomi Health Commercial |
$495.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PACE SWMI |
$412.59
|
| Rate for Payer: PHP Medicare Advantage |
$412.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$602.54
|
| Rate for Payer: Priority Health Medicare |
$412.59
|
| Rate for Payer: Priority Health Narrow Network |
$602.54
|
| Rate for Payer: Railroad Medicare Medicare |
$412.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$412.59
|
| Rate for Payer: UHC Exchange |
$732.68
|
| Rate for Payer: UHC Medicaid |
$271.58
|
| Rate for Payer: UHCCP DNSP |
$412.59
|
| Rate for Payer: UHCCP Medicaid |
$271.58
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,178.38 |
| Max. Negotiated Rate |
$4,876.69 |
| Rate for Payer: Aetna Commercial |
$1,512.90
|
| Rate for Payer: Aetna Medicare |
$3,901.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: ASR ASR |
$1,630.57
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.98
|
| Rate for Payer: BCN Commercial |
$1,385.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Commercial |
$1,580.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,344.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$1,630.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,681.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,901.35
|
| Rate for Payer: Mclaren Commercial |
$1,512.90
|
| Rate for Payer: Mclaren Medicaid |
$3,901.35
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$2,142.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,428.85
|
| Rate for Payer: Nomi Health Commercial |
$1,378.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$4,291.48
|
| Rate for Payer: PHP Medicaid |
$2,091.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,472.89
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,178.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP DNSP |
$3,901.35
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,260.75 |
| Max. Negotiated Rate |
$1,681.00 |
| Rate for Payer: Aetna Commercial |
$1,512.90
|
| Rate for Payer: ASR ASR |
$1,630.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.44
|
| Rate for Payer: BCN Commercial |
$1,380.44
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Commercial |
$1,580.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,344.80
|
| Rate for Payer: Healthscope Commercial |
$1,630.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,681.00
|
| Rate for Payer: Mclaren Commercial |
$1,512.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,428.85
|
| Rate for Payer: Nomi Health Commercial |
$1,378.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,681.00
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$271.58 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Aetna Commercial |
$552.87
|
| Rate for Payer: Aetna Medicare |
$412.59
|
| Rate for Payer: BCBS Complete |
$285.16
|
| Rate for Payer: BCBS MAPPO |
$412.59
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Medicare Advantage |
$412.59
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,344.80
|
| Rate for Payer: Cofinity Commercial |
$594.13
|
| Rate for Payer: Cofinity Commercial |
$552.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.59
|
| Rate for Payer: Healthscope Commercial |
$495.11
|
| Rate for Payer: Healthscope Whirlpool |
$495.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.22
|
| Rate for Payer: Meridian Medicaid |
$285.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$453.85
|
| Rate for Payer: Nomi Health Commercial |
$495.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,260.75
|
| Rate for Payer: PACE SWMI |
$412.59
|
| Rate for Payer: PHP Medicare Advantage |
$412.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$602.54
|
| Rate for Payer: Priority Health Medicare |
$412.59
|
| Rate for Payer: Priority Health Narrow Network |
$602.54
|
| Rate for Payer: Railroad Medicare Medicare |
$412.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$412.59
|
| Rate for Payer: UHC Exchange |
$732.68
|
| Rate for Payer: UHC Medicaid |
$271.58
|
| Rate for Payer: UHCCP DNSP |
$412.59
|
| Rate for Payer: UHCCP Medicaid |
$271.58
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$856.50 |
| Max. Negotiated Rate |
$1,142.00 |
| Rate for Payer: Aetna Commercial |
$1,027.80
|
| Rate for Payer: ASR ASR |
$1,107.74
|
| Rate for Payer: BCBS Trust/PPO |
$937.81
|
| Rate for Payer: BCN Commercial |
$937.81
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$1,073.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$913.60
|
| Rate for Payer: Healthscope Commercial |
$1,107.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,142.00
|
| Rate for Payer: Mclaren Commercial |
$1,027.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.70
|
| Rate for Payer: Nomi Health Commercial |
$936.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$403.42 |
| Max. Negotiated Rate |
$1,161.99 |
| Rate for Payer: Aetna Commercial |
$836.98
|
| Rate for Payer: Aetna Medicare |
$624.61
|
| Rate for Payer: BCBS Complete |
$423.59
|
| Rate for Payer: BCBS MAPPO |
$624.61
|
| Rate for Payer: BCN Commercial |
$996.46
|
| Rate for Payer: BCN Medicare Advantage |
$624.61
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$899.44
|
| Rate for Payer: Cofinity Commercial |
$836.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.61
|
| Rate for Payer: Healthscope Commercial |
$749.53
|
| Rate for Payer: Healthscope Whirlpool |
$749.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.84
|
| Rate for Payer: Meridian Medicaid |
$423.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.07
|
| Rate for Payer: Nomi Health Commercial |
$749.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PACE SWMI |
$624.61
|
| Rate for Payer: PHP Medicare Advantage |
$624.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$912.01
|
| Rate for Payer: Priority Health Medicare |
$624.61
|
| Rate for Payer: Priority Health Narrow Network |
$912.01
|
| Rate for Payer: Railroad Medicare Medicare |
$624.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,161.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$624.61
|
| Rate for Payer: UHC Exchange |
$1,161.99
|
| Rate for Payer: UHC Medicaid |
$403.42
|
| Rate for Payer: UHCCP DNSP |
$624.61
|
| Rate for Payer: UHCCP Medicaid |
$403.42
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$403.42 |
| Max. Negotiated Rate |
$1,161.99 |
| Rate for Payer: Aetna Commercial |
$836.98
|
| Rate for Payer: Aetna Medicare |
$624.61
|
| Rate for Payer: BCBS Complete |
$423.59
|
| Rate for Payer: BCBS MAPPO |
$624.61
|
| Rate for Payer: BCN Commercial |
$996.46
|
| Rate for Payer: BCN Medicare Advantage |
$624.61
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$899.44
|
| Rate for Payer: Cofinity Commercial |
$836.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.61
|
| Rate for Payer: Healthscope Commercial |
$749.53
|
| Rate for Payer: Healthscope Whirlpool |
$749.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.84
|
| Rate for Payer: Meridian Medicaid |
$423.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.07
|
| Rate for Payer: Nomi Health Commercial |
$749.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PACE SWMI |
$624.61
|
| Rate for Payer: PHP Medicare Advantage |
$624.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$912.01
|
| Rate for Payer: Priority Health Medicare |
$624.61
|
| Rate for Payer: Priority Health Narrow Network |
$912.01
|
| Rate for Payer: Railroad Medicare Medicare |
$624.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,161.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$624.61
|
| Rate for Payer: UHC Exchange |
$1,161.99
|
| Rate for Payer: UHC Medicaid |
$403.42
|
| Rate for Payer: UHCCP DNSP |
$624.61
|
| Rate for Payer: UHCCP Medicaid |
$403.42
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$800.54 |
| Max. Negotiated Rate |
$4,876.69 |
| Rate for Payer: Aetna Commercial |
$1,027.80
|
| Rate for Payer: Aetna Medicare |
$3,901.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: ASR ASR |
$1,107.74
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$941.58
|
| Rate for Payer: BCN Commercial |
$941.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$1,073.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$913.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$1,107.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,142.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,901.35
|
| Rate for Payer: Mclaren Commercial |
$1,027.80
|
| Rate for Payer: Mclaren Medicaid |
$3,901.35
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$2,142.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.70
|
| Rate for Payer: Nomi Health Commercial |
$936.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$4,291.48
|
| Rate for Payer: PHP Medicaid |
$2,091.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,000.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health Narrow Network |
$800.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP DNSP |
$3,901.35
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$553.16 |
| Max. Negotiated Rate |
$1,597.81 |
| Rate for Payer: Aetna Commercial |
$1,148.27
|
| Rate for Payer: Aetna Medicare |
$856.92
|
| Rate for Payer: BCBS Complete |
$580.82
|
| Rate for Payer: BCBS MAPPO |
$856.92
|
| Rate for Payer: BCN Commercial |
$1,368.95
|
| Rate for Payer: BCN Medicare Advantage |
$856.92
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cofinity Commercial |
$1,233.96
|
| Rate for Payer: Cofinity Commercial |
$1,148.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.92
|
| Rate for Payer: Healthscope Commercial |
$1,028.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,028.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$899.77
|
| Rate for Payer: Meridian Medicaid |
$580.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$942.61
|
| Rate for Payer: Nomi Health Commercial |
$1,028.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.00
|
| Rate for Payer: PACE SWMI |
$856.92
|
| Rate for Payer: PHP Medicare Advantage |
$856.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,252.95
|
| Rate for Payer: Priority Health Medicare |
$856.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,252.95
|
| Rate for Payer: Railroad Medicare Medicare |
$856.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,597.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$856.92
|
| Rate for Payer: UHC Exchange |
$1,597.81
|
| Rate for Payer: UHC Medicaid |
$553.16
|
| Rate for Payer: UHCCP DNSP |
$856.92
|
| Rate for Payer: UHCCP Medicaid |
$553.16
|
|
