|
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 |
$5,788.66 |
| Rate for Payer: Aetna Commercial |
$998.10
|
| Rate for Payer: Aetna Medicare |
$3,734.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: ASR ASR |
$1,075.73
|
| Rate for Payer: ASR Commercial |
$1,075.73
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCBS Trust/PPO |
$908.16
|
| Rate for Payer: BCN Commercial |
$859.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| 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 |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,075.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,734.62
|
| Rate for Payer: Mclaren Commercial |
$998.10
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$942.65
|
| Rate for Payer: Nomi Health Commercial |
$909.38
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$4,108.08
|
| Rate for Payer: PHP Medicaid |
$2,001.76
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| 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 |
$3,734.62
|
| Rate for Payer: Priority Health Narrow Network |
$777.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$975.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$5,788.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP DNSP |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$921.72 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$640.08
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$921.72
|
| Rate for Payer: Cofinity Commercial |
$857.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.08
|
| Rate for Payer: Healthscope Commercial |
$768.10
|
| Rate for Payer: Healthscope Whirlpool |
$768.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
| Rate for Payer: UHCCP DNSP |
$640.08
|
|
|
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
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$921.72 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$640.08
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$921.72
|
| Rate for Payer: Cofinity Commercial |
$857.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.08
|
| Rate for Payer: Healthscope Commercial |
$768.10
|
| Rate for Payer: Healthscope Whirlpool |
$768.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.08
|
| Rate for Payer: UHC Medicare Advantage |
$640.08
|
| Rate for Payer: UHCCP DNSP |
$640.08
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$536.00 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Aetna Commercial |
$1,179.20
|
| Rate for Payer: Aetna Medicare |
$880.00
|
| Rate for Payer: BCBS Complete |
$536.00
|
| Rate for Payer: BCBS MAPPO |
$880.00
|
| Rate for Payer: BCN Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$1,267.20
|
| Rate for Payer: Cofinity Commercial |
$1,179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$1,056.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.00
|
| Rate for Payer: Nomi Health Commercial |
$1,056.00
|
| Rate for Payer: PACE SWMI |
$880.00
|
| Rate for Payer: PHP Medicare Advantage |
$880.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health Medicare |
$880.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$880.00
|
| Rate for Payer: UHC Medicare Advantage |
$880.00
|
| Rate for Payer: UHCCP DNSP |
$880.00
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
19303
|
| Min. Negotiated Rate |
$756.40 |
| Max. Negotiated Rate |
$1,341.36 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$931.50
|
| Rate for Payer: BCBS Complete |
$756.40
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| Rate for Payer: BCN Medicare Advantage |
$931.50
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.36
|
| Rate for Payer: Cofinity Commercial |
$1,248.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.50
|
| Rate for Payer: Healthscope Commercial |
$1,117.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,117.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| Rate for Payer: Nomi Health Commercial |
$1,117.80
|
| Rate for Payer: PACE SWMI |
$931.50
|
| Rate for Payer: PHP Medicare Advantage |
$931.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health Medicare |
$931.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP DNSP |
$931.50
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$756.40 |
| Max. Negotiated Rate |
$1,341.36 |
| Rate for Payer: Aetna Commercial |
$1,248.21
|
| Rate for Payer: Aetna Medicare |
$931.50
|
| Rate for Payer: BCBS Complete |
$756.40
|
| Rate for Payer: BCBS MAPPO |
$931.50
|
| Rate for Payer: BCN Medicare Advantage |
$931.50
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.36
|
| Rate for Payer: Cofinity Commercial |
$1,248.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.50
|
| Rate for Payer: Healthscope Commercial |
$1,117.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,117.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.08
|
| Rate for Payer: Nomi Health Commercial |
$1,117.80
|
| Rate for Payer: PACE SWMI |
$931.50
|
| Rate for Payer: PHP Medicare Advantage |
$931.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.15
|
| Rate for Payer: Priority Health Medicare |
$931.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.50
|
| Rate for Payer: UHC Medicare Advantage |
$931.50
|
| Rate for Payer: UHCCP DNSP |
$931.50
|
|
|
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 |
$9,858.39 |
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Aetna Medicare |
$6,360.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: ASR ASR |
$1,834.27
|
| Rate for Payer: ASR Commercial |
$1,834.27
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.54
|
| Rate for Payer: BCN Commercial |
$1,466.09
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| 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 |
$6,360.25
|
| Rate for Payer: Healthscope Commercial |
$1,891.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,834.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,360.25
|
| Rate for Payer: Mclaren Commercial |
$1,701.90
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| 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 |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Commercial |
$6,996.27
|
| Rate for Payer: PHP Medicaid |
$3,409.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| 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 |
$6,360.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,325.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,664.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$9,858.39
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP DNSP |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: VA VA |
$6,360.25
|
|
|
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, SUBCUTANEOUS
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 19304
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 19304
|
| Hospital Charge Code |
19304
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$716.30 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Aetna Commercial |
$991.80
|
| Rate for Payer: ASR ASR |
$1,068.94
|
| Rate for Payer: ASR Commercial |
$1,068.94
|
| Rate for Payer: BCBS Trust/PPO |
$898.02
|
| Rate for Payer: BCN Commercial |
$854.38
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$1,035.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$1,102.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.94
|
| Rate for Payer: Mclaren Commercial |
$991.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: Nomi Health Commercial |
$903.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.76
|
|
|
PR MASTECTOMY, SUBCUTANEOUS
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 19304
|
| Hospital Charge Code |
19304
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Aetna Commercial |
$991.80
|
| Rate for Payer: Aetna Medicare |
$551.00
|
| Rate for Payer: ASR ASR |
$1,068.94
|
| Rate for Payer: ASR Commercial |
$1,068.94
|
| Rate for Payer: BCBS Complete |
$440.80
|
| Rate for Payer: BCBS Trust/PPO |
$902.43
|
| Rate for Payer: BCN Commercial |
$854.38
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$1,035.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$881.60
|
| Rate for Payer: Healthscope Commercial |
$1,102.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.94
|
| Rate for Payer: Mclaren Commercial |
$991.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.70
|
| Rate for Payer: Nomi Health Commercial |
$903.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$965.57
|
| Rate for Payer: Priority Health Narrow Network |
$772.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.76
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
19307
|
| Min. Negotiated Rate |
$817.60 |
| Max. Negotiated Rate |
$1,644.80 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,142.22
|
| Rate for Payer: BCBS Complete |
$817.60
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.22
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,530.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.22
|
| Rate for Payer: Healthscope Commercial |
$1,370.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| Rate for Payer: Nomi Health Commercial |
$1,370.66
|
| Rate for Payer: PACE SWMI |
$1,142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health Medicare |
$1,142.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.22
|
| Rate for Payer: UHCCP DNSP |
$1,142.22
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$817.60 |
| Max. Negotiated Rate |
$1,644.80 |
| Rate for Payer: Aetna Commercial |
$1,530.57
|
| Rate for Payer: Aetna Medicare |
$1,142.22
|
| Rate for Payer: BCBS Complete |
$817.60
|
| Rate for Payer: BCBS MAPPO |
$1,142.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.22
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,530.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.22
|
| Rate for Payer: Healthscope Commercial |
$1,370.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.33
|
| Rate for Payer: Nomi Health Commercial |
$1,370.66
|
| Rate for Payer: PACE SWMI |
$1,142.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health Medicare |
$1,142.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.22
|
| Rate for Payer: UHCCP DNSP |
$1,142.22
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,328.60 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: ASR ASR |
$1,982.68
|
| Rate for Payer: ASR Commercial |
$1,982.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,665.66
|
| Rate for Payer: BCN Commercial |
$1,584.71
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,921.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.20
|
| Rate for Payer: Healthscope Commercial |
$2,044.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,982.68
|
| Rate for Payer: Mclaren Commercial |
$1,839.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.40
|
| Rate for Payer: Nomi Health Commercial |
$1,676.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,798.72
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 19307
|
| Hospital Charge Code |
19307
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,328.60 |
| Max. Negotiated Rate |
$9,858.39 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Medicare |
$6,360.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: ASR ASR |
$1,982.68
|
| Rate for Payer: ASR Commercial |
$1,982.68
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.83
|
| Rate for Payer: BCN Commercial |
$1,584.71
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,921.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Healthscope Commercial |
$2,044.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,982.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,360.25
|
| Rate for Payer: Mclaren Commercial |
$1,839.60
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.40
|
| Rate for Payer: Nomi Health Commercial |
$1,676.08
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Commercial |
$6,996.27
|
| Rate for Payer: PHP Medicaid |
$3,409.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,790.95
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,432.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,798.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$9,858.39
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP DNSP |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: VA VA |
$6,360.25
|
|
|
PR MASTOIDECTOMY COMPLETE
|
Professional
|
Both
|
$2,704.00
|
|
|
Service Code
|
HCPCS 69502
|
| Min. Negotiated Rate |
$885.73 |
| Max. Negotiated Rate |
$1,757.60 |
| Rate for Payer: Aetna Commercial |
$1,186.88
|
| Rate for Payer: Aetna Medicare |
$885.73
|
| Rate for Payer: BCBS Complete |
$1,081.60
|
| Rate for Payer: BCBS MAPPO |
$885.73
|
| Rate for Payer: BCN Medicare Advantage |
$885.73
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,275.45
|
| Rate for Payer: Cofinity Commercial |
$1,186.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.73
|
| Rate for Payer: Healthscope Commercial |
$1,062.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,062.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.02
|
| Rate for Payer: Nomi Health Commercial |
$1,062.88
|
| Rate for Payer: PACE SWMI |
$885.73
|
| Rate for Payer: PHP Medicare Advantage |
$885.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,757.60
|
| Rate for Payer: Priority Health Medicare |
$885.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.73
|
| Rate for Payer: UHC Medicare Advantage |
$885.73
|
| Rate for Payer: UHCCP DNSP |
$885.73
|
|
|
PR MASTOID OBLITERATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,479.00
|
|
|
Service Code
|
HCPCS 69670
|
| Min. Negotiated Rate |
$882.11 |
| Max. Negotiated Rate |
$2,261.35 |
| Rate for Payer: Aetna Commercial |
$1,182.03
|
| Rate for Payer: Aetna Medicare |
$882.11
|
| Rate for Payer: BCBS Complete |
$1,391.60
|
| Rate for Payer: BCBS MAPPO |
$882.11
|
| Rate for Payer: BCN Medicare Advantage |
$882.11
|
| Rate for Payer: Cash Price |
$2,783.20
|
| Rate for Payer: Cash Price |
$2,783.20
|
| Rate for Payer: Cofinity Commercial |
$1,270.24
|
| Rate for Payer: Cofinity Commercial |
$1,182.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.11
|
| Rate for Payer: Healthscope Commercial |
$1,058.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$926.22
|
| Rate for Payer: Nomi Health Commercial |
$1,058.53
|
| Rate for Payer: PACE SWMI |
$882.11
|
| Rate for Payer: PHP Medicare Advantage |
$882.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,261.35
|
| Rate for Payer: Priority Health Medicare |
$882.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.11
|
| Rate for Payer: UHC Medicare Advantage |
$882.11
|
| Rate for Payer: UHCCP DNSP |
$882.11
|
|
|
PR MASTOPEXY
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 19316
|
| Min. Negotiated Rate |
$759.14 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$1,017.25
|
| Rate for Payer: Aetna Medicare |
$759.14
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$759.14
|
| Rate for Payer: BCN Medicare Advantage |
$759.14
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,093.16
|
| Rate for Payer: Cofinity Commercial |
$1,017.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.14
|
| Rate for Payer: Healthscope Commercial |
$910.97
|
| Rate for Payer: Healthscope Whirlpool |
$910.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.10
|
| Rate for Payer: Nomi Health Commercial |
$910.97
|
| Rate for Payer: PACE SWMI |
$759.14
|
| Rate for Payer: PHP Medicare Advantage |
$759.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$759.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.14
|
| Rate for Payer: UHC Medicare Advantage |
$759.14
|
| Rate for Payer: UHCCP DNSP |
$759.14
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
HCPCS 19020
|
| Min. Negotiated Rate |
$299.98 |
| Max. Negotiated Rate |
$529.10 |
| Rate for Payer: Aetna Commercial |
$401.97
|
| Rate for Payer: Aetna Medicare |
$299.98
|
| Rate for Payer: BCBS Complete |
$325.60
|
| Rate for Payer: BCBS MAPPO |
$299.98
|
| Rate for Payer: BCN Medicare Advantage |
$299.98
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$431.97
|
| Rate for Payer: Cofinity Commercial |
$401.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.98
|
| Rate for Payer: Healthscope Commercial |
$359.98
|
| Rate for Payer: Healthscope Whirlpool |
$359.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.98
|
| Rate for Payer: Nomi Health Commercial |
$359.98
|
| Rate for Payer: PACE SWMI |
$299.98
|
| Rate for Payer: PHP Medicare Advantage |
$299.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health Medicare |
$299.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.98
|
| Rate for Payer: UHC Medicare Advantage |
$299.98
|
| Rate for Payer: UHCCP DNSP |
$299.98
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$529.10 |
| Max. Negotiated Rate |
$814.00 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: ASR ASR |
$789.58
|
| Rate for Payer: ASR Commercial |
$789.58
|
| Rate for Payer: BCBS Trust/PPO |
$663.33
|
| Rate for Payer: BCN Commercial |
$631.09
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$765.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.20
|
| Rate for Payer: Healthscope Commercial |
$814.00
|
| Rate for Payer: Healthscope Whirlpool |
$789.58
|
| Rate for Payer: Mclaren Commercial |
$732.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.90
|
| Rate for Payer: Nomi Health Commercial |
$667.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$716.32
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$529.10 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$789.58
|
| Rate for Payer: ASR Commercial |
$789.58
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$666.58
|
| Rate for Payer: BCN Commercial |
$631.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$765.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$814.00
|
| Rate for Payer: Healthscope Whirlpool |
$789.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$732.60
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.90
|
| Rate for Payer: Nomi Health Commercial |
$667.48
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$713.23
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$570.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$716.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$299.98 |
| Max. Negotiated Rate |
$529.10 |
| Rate for Payer: Aetna Commercial |
$401.97
|
| Rate for Payer: Aetna Medicare |
$299.98
|
| Rate for Payer: BCBS Complete |
$325.60
|
| Rate for Payer: BCBS MAPPO |
$299.98
|
| Rate for Payer: BCN Medicare Advantage |
$299.98
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$431.97
|
| Rate for Payer: Cofinity Commercial |
$401.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.98
|
| Rate for Payer: Healthscope Commercial |
$359.98
|
| Rate for Payer: Healthscope Whirlpool |
$359.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.98
|
| Rate for Payer: Nomi Health Commercial |
$359.98
|
| Rate for Payer: PACE SWMI |
$299.98
|
| Rate for Payer: PHP Medicare Advantage |
$299.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.10
|
| Rate for Payer: Priority Health Medicare |
$299.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.98
|
| Rate for Payer: UHC Medicare Advantage |
$299.98
|
| Rate for Payer: UHCCP DNSP |
$299.98
|
|
|
PR MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 19305
|
| Min. Negotiated Rate |
$966.40 |
| Max. Negotiated Rate |
$1,597.85 |
| Rate for Payer: Aetna Commercial |
$1,486.89
|
| Rate for Payer: Aetna Medicare |
$1,109.62
|
| Rate for Payer: BCBS Complete |
$966.40
|
| Rate for Payer: BCBS MAPPO |
$1,109.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,109.62
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cofinity Commercial |
$1,597.85
|
| Rate for Payer: Cofinity Commercial |
$1,486.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,109.62
|
| Rate for Payer: Healthscope Commercial |
$1,331.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,331.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,165.10
|
| Rate for Payer: Nomi Health Commercial |
$1,331.54
|
| Rate for Payer: PACE SWMI |
$1,109.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,109.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.40
|
| Rate for Payer: Priority Health Medicare |
$1,109.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,109.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,109.62
|
| Rate for Payer: UHCCP DNSP |
$1,109.62
|
|
