|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$4,431.91 |
| Rate for Payer: Aetna Commercial |
$244.58
|
| Rate for Payer: Aetna Medicare |
$504.00
|
| Rate for Payer: BCBS Complete |
$127.03
|
| Rate for Payer: BCBS Trust/PPO |
$4,431.91
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Meridian Medicaid |
$127.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.47
|
| Rate for Payer: Priority Health Narrow Network |
$285.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.83
|
| Rate for Payer: UHC Exchange |
$200.83
|
| Rate for Payer: UHCCP Medicaid |
$120.98
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$434.85 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Aetna Commercial |
$602.10
|
| Rate for Payer: ASR ASR |
$648.93
|
| Rate for Payer: ASR Commercial |
$648.93
|
| Rate for Payer: BCBS Trust/PPO |
$545.17
|
| Rate for Payer: BCN Commercial |
$518.68
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$628.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Healthscope Commercial |
$669.00
|
| Rate for Payer: Healthscope Whirlpool |
$648.93
|
| Rate for Payer: Mclaren Commercial |
$602.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: Nomi Health Commercial |
$548.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.72
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$1,799.92 |
| Rate for Payer: Aetna Commercial |
$199.99
|
| Rate for Payer: Aetna Medicare |
$334.50
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.16
|
| Rate for Payer: Priority Health Narrow Network |
$239.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.52
|
| Rate for Payer: UHC Exchange |
$166.52
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$1,799.92 |
| Rate for Payer: Aetna Commercial |
$199.99
|
| Rate for Payer: Aetna Medicare |
$334.50
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.16
|
| Rate for Payer: Priority Health Narrow Network |
$239.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.52
|
| Rate for Payer: UHC Exchange |
$166.52
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$434.85 |
| Max. Negotiated Rate |
$2,430.48 |
| Rate for Payer: Aetna Commercial |
$602.10
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$648.93
|
| Rate for Payer: ASR Commercial |
$648.93
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$547.84
|
| Rate for Payer: BCN Commercial |
$518.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$628.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$669.00
|
| Rate for Payer: Healthscope Whirlpool |
$648.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$602.10
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: Nomi Health Commercial |
$548.58
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.18
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$468.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$316.55 |
| Rate for Payer: Aetna Commercial |
$174.31
|
| Rate for Payer: Aetna Medicare |
$243.50
|
| Rate for Payer: BCBS Complete |
$102.43
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$209.31
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Meridian Medicaid |
$102.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.98
|
| Rate for Payer: Priority Health Narrow Network |
$199.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.22
|
| Rate for Payer: UHC Exchange |
$136.22
|
| Rate for Payer: UHCCP Medicaid |
$97.55
|
|
|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$1,324.45 |
| Rate for Payer: Aetna Commercial |
$560.78
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: BCBS Complete |
$292.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.45
|
| Rate for Payer: BCN Commercial |
$643.10
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Meridian Medicaid |
$292.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.84
|
| Rate for Payer: Priority Health Narrow Network |
$679.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.67
|
| Rate for Payer: UHC Exchange |
$441.67
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,725.86 |
| Rate for Payer: Aetna Commercial |
$111.83
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.86
|
| Rate for Payer: BCN Commercial |
$122.66
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.23
|
| Rate for Payer: Priority Health Narrow Network |
$128.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.83
|
| Rate for Payer: UHC Exchange |
$107.83
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$215.76 |
| Rate for Payer: Aetna Commercial |
$187.44
|
| Rate for Payer: Aetna Medicare |
$146.00
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$206.71
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Meridian Medicaid |
$95.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.76
|
| Rate for Payer: Priority Health Narrow Network |
$215.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.48
|
| Rate for Payer: UHC Exchange |
$179.48
|
| Rate for Payer: UHCCP Medicaid |
$91.16
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$1,604.98 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.98
|
| Rate for Payer: BCN Commercial |
$26.43
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.90
|
| Rate for Payer: UHC Exchange |
$26.90
|
|
|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$117.15 |
| Max. Negotiated Rate |
$510.25 |
| Rate for Payer: Aetna Commercial |
$215.36
|
| Rate for Payer: Aetna Medicare |
$392.50
|
| Rate for Payer: BCBS Complete |
$123.01
|
| Rate for Payer: BCBS Trust/PPO |
$226.64
|
| Rate for Payer: BCN Commercial |
$265.35
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Meridian Medicaid |
$123.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.33
|
| Rate for Payer: Priority Health Narrow Network |
$272.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.02
|
| Rate for Payer: UHC Exchange |
$208.02
|
| Rate for Payer: UHCCP Medicaid |
$117.15
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$729.31 |
| Max. Negotiated Rate |
$2,350.41 |
| Rate for Payer: Aetna Commercial |
$1,533.52
|
| Rate for Payer: Aetna Medicare |
$1,171.00
|
| Rate for Payer: BCBS Complete |
$765.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.41
|
| Rate for Payer: BCN Commercial |
$1,661.01
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Meridian Medicaid |
$765.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$729.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,037.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,037.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.41
|
| Rate for Payer: UHC Exchange |
$1,352.41
|
| Rate for Payer: UHCCP Medicaid |
$729.31
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$151.66 |
| Max. Negotiated Rate |
$641.36 |
| Rate for Payer: Aetna Commercial |
$297.60
|
| Rate for Payer: Aetna Medicare |
$348.00
|
| Rate for Payer: BCBS Complete |
$159.24
|
| Rate for Payer: BCBS Trust/PPO |
$641.36
|
| Rate for Payer: BCN Commercial |
$586.41
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Meridian Medicaid |
$159.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.20
|
| Rate for Payer: Priority Health Narrow Network |
$421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.09
|
| Rate for Payer: UHC Exchange |
$269.09
|
| Rate for Payer: UHCCP Medicaid |
$151.66
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: ASR ASR |
$1,583.04
|
| Rate for Payer: ASR Commercial |
$1,583.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,329.92
|
| Rate for Payer: BCN Commercial |
$1,265.29
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,534.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Healthscope Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.04
|
| Rate for Payer: Mclaren Commercial |
$1,468.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$1,338.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,436.16
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$281.59 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Aetna Commercial |
$462.52
|
| Rate for Payer: Aetna Medicare |
$816.00
|
| Rate for Payer: BCBS Complete |
$295.67
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Meridian Medicaid |
$295.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.14
|
| Rate for Payer: Priority Health Narrow Network |
$590.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.26
|
| Rate for Payer: UHC Exchange |
$410.26
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| 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 |
$1,583.04
|
| Rate for Payer: ASR Commercial |
$1,583.04
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,336.44
|
| Rate for Payer: BCN Commercial |
$1,265.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,534.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$1,468.80
|
| 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 |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$1,338.24
|
| 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 |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,429.96
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,144.03
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,436.16
|
| 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 MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
19300
|
| Min. Negotiated Rate |
$281.59 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Aetna Commercial |
$462.52
|
| Rate for Payer: Aetna Medicare |
$816.00
|
| Rate for Payer: BCBS Complete |
$295.67
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Meridian Medicaid |
$295.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.14
|
| Rate for Payer: Priority Health Narrow Network |
$590.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.26
|
| Rate for Payer: UHC Exchange |
$410.26
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna Commercial |
$722.42
|
| Rate for Payer: Aetna Medicare |
$554.50
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.87
|
| Rate for Payer: Priority Health Narrow Network |
$899.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.08
|
| Rate for Payer: UHC Exchange |
$671.08
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$720.85 |
| Max. Negotiated Rate |
$1,109.00 |
| Rate for Payer: Aetna Commercial |
$998.10
|
| Rate for Payer: ASR ASR |
$1,075.73
|
| Rate for Payer: ASR Commercial |
$1,075.73
|
| Rate for Payer: BCBS Trust/PPO |
$903.72
|
| Rate for Payer: BCN Commercial |
$859.81
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$1,042.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Healthscope Commercial |
$1,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,075.73
|
| Rate for Payer: Mclaren Commercial |
$998.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: Nomi Health Commercial |
$909.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$975.92
|
|
|
PR MASTECTOMY PARTIAL
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
19301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$720.85 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$998.10
|
| 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 |
$1,075.73
|
| Rate for Payer: ASR Commercial |
$1,075.73
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$908.16
|
| Rate for Payer: BCN Commercial |
$859.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$1,042.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,075.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$998.10
|
| 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 |
$942.65
|
| Rate for Payer: Nomi Health Commercial |
$909.38
|
| 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 |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.71
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$777.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$975.92
|
| 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 MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna Commercial |
$722.42
|
| Rate for Payer: Aetna Medicare |
$554.50
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.87
|
| Rate for Payer: Priority Health Narrow Network |
$899.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$671.08
|
| Rate for Payer: UHC Exchange |
$671.08
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$585.54 |
| Max. Negotiated Rate |
$1,422.75 |
| Rate for Payer: Aetna Commercial |
$993.34
|
| Rate for Payer: Aetna Medicare |
$670.00
|
| Rate for Payer: BCBS Complete |
$614.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.75
|
| Rate for Payer: BCN Commercial |
$1,327.74
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Meridian Medicaid |
$614.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,235.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$932.09
|
| Rate for Payer: UHC Exchange |
$932.09
|
| Rate for Payer: UHCCP Medicaid |
$585.54
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$1,401.52 |
| Rate for Payer: Aetna Commercial |
$1,051.23
|
| Rate for Payer: Aetna Medicare |
$945.50
|
| Rate for Payer: BCBS Complete |
$650.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$1,401.52
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Meridian Medicaid |
$650.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,303.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,303.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,040.56
|
| Rate for Payer: UHC Exchange |
$1,040.56
|
| Rate for Payer: UHCCP Medicaid |
$619.19
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,229.15 |
| Max. Negotiated Rate |
$1,891.00 |
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: ASR ASR |
$1,834.27
|
| Rate for Payer: ASR Commercial |
$1,834.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.98
|
| Rate for Payer: BCN Commercial |
$1,466.09
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,777.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Healthscope Commercial |
$1,891.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,834.27
|
| Rate for Payer: Mclaren Commercial |
$1,701.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.35
|
| Rate for Payer: Nomi Health Commercial |
$1,550.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,664.08
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
19303
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,229.15 |
| Max. Negotiated Rate |
$9,903.88 |
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Aetna Medicare |
$6,389.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: ASR ASR |
$1,834.27
|
| Rate for Payer: ASR Commercial |
$1,834.27
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.54
|
| Rate for Payer: BCN Commercial |
$1,466.09
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,777.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Healthscope Commercial |
$1,891.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,834.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,389.60
|
| Rate for Payer: Mclaren Commercial |
$1,701.90
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,607.35
|
| Rate for Payer: Nomi Health Commercial |
$1,550.62
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Commercial |
$7,028.56
|
| Rate for Payer: PHP Medicaid |
$3,424.83
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,656.89
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,325.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,664.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$9,903.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP DNSP |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
