|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Facility
|
OP
|
$4,652.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
44202
|
| Min. Negotiated Rate |
$1,860.80 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,954.20
|
| Rate for Payer: Aetna Medicare |
$2,326.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,023.80
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$3,256.40
|
| Rate for Payer: Cofinity Commercial |
$4,000.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,256.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,721.60
|
| Rate for Payer: Healthscope Commercial |
$4,186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,954.20
|
| Rate for Payer: PHP Commercial |
$3,954.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health SBD |
$2,930.76
|
|
|
PR LAPS ESOPHAGEAL LENGTHENING ADDL
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS 43283
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$281.59 |
| Rate for Payer: Aetna Commercial |
$203.96
|
| Rate for Payer: Aetna Medicare |
$158.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.96
|
| Rate for Payer: BCBS Complete |
$117.60
|
| Rate for Payer: BCBS MAPPO |
$152.21
|
| Rate for Payer: BCN Medicare Advantage |
$152.21
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$219.18
|
| Rate for Payer: Cofinity Commercial |
$203.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.21
|
| Rate for Payer: Healthscope Commercial |
$281.59
|
| Rate for Payer: Healthscope Commercial |
$243.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.10
|
| Rate for Payer: Nomi Health Commercial |
$182.65
|
| Rate for Payer: PACE SWMI |
$152.21
|
| Rate for Payer: PHP Medicare Advantage |
$152.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health Medicare |
$152.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.21
|
| Rate for Payer: UHC Medicare Advantage |
$152.21
|
|
|
PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED
|
Professional
|
Both
|
$2,403.00
|
|
|
Service Code
|
HCPCS 43279
|
| Min. Negotiated Rate |
$961.20 |
| Max. Negotiated Rate |
$2,304.47 |
| Rate for Payer: Aetna Commercial |
$1,669.18
|
| Rate for Payer: Aetna Medicare |
$1,295.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,793.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,669.18
|
| Rate for Payer: BCBS Complete |
$961.20
|
| Rate for Payer: BCBS MAPPO |
$1,245.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,245.66
|
| Rate for Payer: Cash Price |
$1,922.40
|
| Rate for Payer: Cash Price |
$1,922.40
|
| Rate for Payer: Cofinity Commercial |
$1,793.75
|
| Rate for Payer: Cofinity Commercial |
$1,669.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,245.66
|
| Rate for Payer: Healthscope Commercial |
$1,993.06
|
| Rate for Payer: Healthscope Commercial |
$2,304.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,307.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,561.95
|
| Rate for Payer: Nomi Health Commercial |
$1,494.79
|
| Rate for Payer: PACE SWMI |
$1,245.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,245.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,561.95
|
| Rate for Payer: Priority Health Medicare |
$1,245.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,245.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,245.66
|
|
|
PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$2,228.00
|
|
|
Service Code
|
HCPCS 58662
|
| Min. Negotiated Rate |
$686.08 |
| Max. Negotiated Rate |
$1,448.20 |
| Rate for Payer: Aetna Commercial |
$919.35
|
| Rate for Payer: Aetna Medicare |
$713.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.35
|
| Rate for Payer: BCBS Complete |
$891.20
|
| Rate for Payer: BCBS MAPPO |
$686.08
|
| Rate for Payer: BCN Medicare Advantage |
$686.08
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cofinity Commercial |
$987.96
|
| Rate for Payer: Cofinity Commercial |
$919.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.08
|
| Rate for Payer: Healthscope Commercial |
$1,269.25
|
| Rate for Payer: Healthscope Commercial |
$1,097.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,448.20
|
| Rate for Payer: Nomi Health Commercial |
$823.30
|
| Rate for Payer: PACE SWMI |
$686.08
|
| Rate for Payer: PHP Medicare Advantage |
$686.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: Priority Health Medicare |
$686.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.08
|
| Rate for Payer: UHC Medicare Advantage |
$686.08
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT
|
Professional
|
Both
|
$1,726.00
|
|
|
Service Code
|
HCPCS 43774
|
| Min. Negotiated Rate |
$690.40 |
| Max. Negotiated Rate |
$1,732.88 |
| Rate for Payer: Aetna Commercial |
$1,255.16
|
| Rate for Payer: Aetna Medicare |
$974.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,255.16
|
| Rate for Payer: BCBS Complete |
$690.40
|
| Rate for Payer: BCBS MAPPO |
$936.69
|
| Rate for Payer: BCN Medicare Advantage |
$936.69
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cofinity Commercial |
$1,348.83
|
| Rate for Payer: Cofinity Commercial |
$1,255.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$936.69
|
| Rate for Payer: Healthscope Commercial |
$1,498.70
|
| Rate for Payer: Healthscope Commercial |
$1,732.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$983.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,121.90
|
| Rate for Payer: Nomi Health Commercial |
$1,124.03
|
| Rate for Payer: PACE SWMI |
$936.69
|
| Rate for Payer: PHP Medicare Advantage |
$936.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.90
|
| Rate for Payer: Priority Health Medicare |
$936.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$936.69
|
| Rate for Payer: UHC Medicare Advantage |
$936.69
|
|
|
PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$4,667.00
|
|
|
Service Code
|
HCPCS 43775
|
| Min. Negotiated Rate |
$1,079.76 |
| Max. Negotiated Rate |
$3,033.55 |
| Rate for Payer: Aetna Commercial |
$1,446.88
|
| Rate for Payer: Aetna Medicare |
$1,122.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.88
|
| Rate for Payer: BCBS Complete |
$1,866.80
|
| Rate for Payer: BCBS MAPPO |
$1,079.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,079.76
|
| Rate for Payer: Cash Price |
$3,733.60
|
| Rate for Payer: Cash Price |
$3,733.60
|
| Rate for Payer: Cofinity Commercial |
$1,554.85
|
| Rate for Payer: Cofinity Commercial |
$1,446.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,079.76
|
| Rate for Payer: Healthscope Commercial |
$1,997.56
|
| Rate for Payer: Healthscope Commercial |
$1,727.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,133.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,033.55
|
| Rate for Payer: Nomi Health Commercial |
$1,295.71
|
| Rate for Payer: PACE SWMI |
$1,079.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,079.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,033.55
|
| Rate for Payer: Priority Health Medicare |
$1,079.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,079.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.76
|
|
|
PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM
|
Professional
|
Both
|
$3,090.00
|
|
|
Service Code
|
HCPCS 43644
|
| Min. Negotiated Rate |
$1,236.00 |
| Max. Negotiated Rate |
$3,127.09 |
| Rate for Payer: Aetna Commercial |
$2,265.03
|
| Rate for Payer: Aetna Medicare |
$1,757.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,434.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,265.03
|
| Rate for Payer: BCBS Complete |
$1,236.00
|
| Rate for Payer: BCBS MAPPO |
$1,690.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,690.32
|
| Rate for Payer: Cash Price |
$2,472.00
|
| Rate for Payer: Cash Price |
$2,472.00
|
| Rate for Payer: Cofinity Commercial |
$2,434.06
|
| Rate for Payer: Cofinity Commercial |
$2,265.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,690.32
|
| Rate for Payer: Healthscope Commercial |
$2,704.51
|
| Rate for Payer: Healthscope Commercial |
$3,127.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,008.50
|
| Rate for Payer: Nomi Health Commercial |
$2,028.38
|
| Rate for Payer: PACE SWMI |
$1,690.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,690.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,008.50
|
| Rate for Payer: Priority Health Medicare |
$1,690.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,690.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,690.32
|
|
|
PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ
|
Professional
|
Both
|
$3,336.00
|
|
|
Service Code
|
HCPCS 43645
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$3,335.53 |
| Rate for Payer: Aetna Commercial |
$2,416.01
|
| Rate for Payer: Aetna Medicare |
$1,875.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,596.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,416.01
|
| Rate for Payer: BCBS Complete |
$1,334.40
|
| Rate for Payer: BCBS MAPPO |
$1,802.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,802.99
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cofinity Commercial |
$2,596.31
|
| Rate for Payer: Cofinity Commercial |
$2,416.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,802.99
|
| Rate for Payer: Healthscope Commercial |
$3,335.53
|
| Rate for Payer: Healthscope Commercial |
$2,884.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,893.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.40
|
| Rate for Payer: Nomi Health Commercial |
$2,163.59
|
| Rate for Payer: PACE SWMI |
$1,802.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,802.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,168.40
|
| Rate for Payer: Priority Health Medicare |
$1,802.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,802.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,802.99
|
|
|
PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 49324
|
| Min. Negotiated Rate |
$296.80 |
| Max. Negotiated Rate |
$693.92 |
| Rate for Payer: Aetna Commercial |
$502.62
|
| Rate for Payer: Aetna Medicare |
$390.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.62
|
| Rate for Payer: BCBS Complete |
$296.80
|
| Rate for Payer: BCBS MAPPO |
$375.09
|
| Rate for Payer: BCN Medicare Advantage |
$375.09
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cofinity Commercial |
$540.13
|
| Rate for Payer: Cofinity Commercial |
$502.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.09
|
| Rate for Payer: Healthscope Commercial |
$600.14
|
| Rate for Payer: Healthscope Commercial |
$693.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.30
|
| Rate for Payer: Nomi Health Commercial |
$450.11
|
| Rate for Payer: PACE SWMI |
$375.09
|
| Rate for Payer: PHP Medicare Advantage |
$375.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.30
|
| Rate for Payer: Priority Health Medicare |
$375.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.09
|
| Rate for Payer: UHC Medicare Advantage |
$375.09
|
|
|
PR LAPS LIGATION SPERMATIC VEINS VARICOCELE
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 55550
|
| Min. Negotiated Rate |
$354.80 |
| Max. Negotiated Rate |
$761.07 |
| Rate for Payer: Aetna Commercial |
$551.26
|
| Rate for Payer: Aetna Medicare |
$427.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$551.26
|
| Rate for Payer: BCBS Complete |
$354.80
|
| Rate for Payer: BCBS MAPPO |
$411.39
|
| Rate for Payer: BCN Medicare Advantage |
$411.39
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Cofinity Commercial |
$551.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.39
|
| Rate for Payer: Healthscope Commercial |
$761.07
|
| Rate for Payer: Healthscope Commercial |
$658.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.55
|
| Rate for Payer: Nomi Health Commercial |
$493.67
|
| Rate for Payer: PACE SWMI |
$411.39
|
| Rate for Payer: PHP Medicare Advantage |
$411.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.55
|
| Rate for Payer: Priority Health Medicare |
$411.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.39
|
| Rate for Payer: UHC Medicare Advantage |
$411.39
|
|
|
PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 44213
|
| Min. Negotiated Rate |
$179.34 |
| Max. Negotiated Rate |
$336.70 |
| Rate for Payer: Aetna Commercial |
$240.32
|
| Rate for Payer: Aetna Medicare |
$186.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.32
|
| Rate for Payer: BCBS Complete |
$207.20
|
| Rate for Payer: BCBS MAPPO |
$179.34
|
| Rate for Payer: BCN Medicare Advantage |
$179.34
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$258.25
|
| Rate for Payer: Cofinity Commercial |
$240.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.34
|
| Rate for Payer: Healthscope Commercial |
$286.94
|
| Rate for Payer: Healthscope Commercial |
$331.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.70
|
| Rate for Payer: Nomi Health Commercial |
$215.21
|
| Rate for Payer: PACE SWMI |
$179.34
|
| Rate for Payer: PHP Medicare Advantage |
$179.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health Medicare |
$179.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.34
|
| Rate for Payer: UHC Medicare Advantage |
$179.34
|
|
|
PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Professional
|
Both
|
$1,908.00
|
|
|
Service Code
|
HCPCS 58545
|
| Min. Negotiated Rate |
$763.20 |
| Max. Negotiated Rate |
$1,604.45 |
| Rate for Payer: Aetna Commercial |
$1,162.14
|
| Rate for Payer: Aetna Medicare |
$901.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,162.14
|
| Rate for Payer: BCBS Complete |
$763.20
|
| Rate for Payer: BCBS MAPPO |
$867.27
|
| Rate for Payer: BCN Medicare Advantage |
$867.27
|
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Cofinity Commercial |
$1,248.87
|
| Rate for Payer: Cofinity Commercial |
$1,162.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$867.27
|
| Rate for Payer: Healthscope Commercial |
$1,604.45
|
| Rate for Payer: Healthscope Commercial |
$1,387.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,240.20
|
| Rate for Payer: Nomi Health Commercial |
$1,040.72
|
| Rate for Payer: PACE SWMI |
$867.27
|
| Rate for Payer: PHP Medicare Advantage |
$867.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,240.20
|
| Rate for Payer: Priority Health Medicare |
$867.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.27
|
| Rate for Payer: UHC Medicare Advantage |
$867.27
|
|
|
PR LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS
|
Professional
|
Both
|
$2,402.00
|
|
|
Service Code
|
HCPCS 58546
|
| Min. Negotiated Rate |
$960.80 |
| Max. Negotiated Rate |
$1,982.48 |
| Rate for Payer: Aetna Commercial |
$1,435.96
|
| Rate for Payer: Aetna Medicare |
$1,114.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,543.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.96
|
| Rate for Payer: BCBS Complete |
$960.80
|
| Rate for Payer: BCBS MAPPO |
$1,071.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.61
|
| Rate for Payer: Cash Price |
$1,921.60
|
| Rate for Payer: Cash Price |
$1,921.60
|
| Rate for Payer: Cofinity Commercial |
$1,543.12
|
| Rate for Payer: Cofinity Commercial |
$1,435.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.61
|
| Rate for Payer: Healthscope Commercial |
$1,714.58
|
| Rate for Payer: Healthscope Commercial |
$1,982.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,561.30
|
| Rate for Payer: Nomi Health Commercial |
$1,285.93
|
| Rate for Payer: PACE SWMI |
$1,071.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,561.30
|
| Rate for Payer: Priority Health Medicare |
$1,071.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.61
|
|
|
PR LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY
|
Professional
|
Both
|
$5,631.00
|
|
|
Service Code
|
HCPCS 45395
|
| Min. Negotiated Rate |
$1,862.63 |
| Max. Negotiated Rate |
$3,660.15 |
| Rate for Payer: Aetna Commercial |
$2,495.92
|
| Rate for Payer: Aetna Medicare |
$1,937.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,495.92
|
| Rate for Payer: BCBS Complete |
$2,252.40
|
| Rate for Payer: BCBS MAPPO |
$1,862.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,862.63
|
| Rate for Payer: Cash Price |
$4,504.80
|
| Rate for Payer: Cash Price |
$4,504.80
|
| Rate for Payer: Cofinity Commercial |
$2,682.19
|
| Rate for Payer: Cofinity Commercial |
$2,495.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,862.63
|
| Rate for Payer: Healthscope Commercial |
$3,445.87
|
| Rate for Payer: Healthscope Commercial |
$2,980.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,955.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,660.15
|
| Rate for Payer: Nomi Health Commercial |
$2,235.16
|
| Rate for Payer: PACE SWMI |
$1,862.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,862.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,660.15
|
| Rate for Payer: Priority Health Medicare |
$1,862.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,862.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,862.63
|
|
|
PR LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR
|
Professional
|
Both
|
$6,102.00
|
|
|
Service Code
|
HCPCS 45397
|
| Min. Negotiated Rate |
$2,018.79 |
| Max. Negotiated Rate |
$3,966.30 |
| Rate for Payer: Aetna Commercial |
$2,705.18
|
| Rate for Payer: Aetna Medicare |
$2,099.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,907.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,705.18
|
| Rate for Payer: BCBS Complete |
$2,440.80
|
| Rate for Payer: BCBS MAPPO |
$2,018.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,018.79
|
| Rate for Payer: Cash Price |
$4,881.60
|
| Rate for Payer: Cash Price |
$4,881.60
|
| Rate for Payer: Cofinity Commercial |
$2,907.06
|
| Rate for Payer: Cofinity Commercial |
$2,705.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,018.79
|
| Rate for Payer: Healthscope Commercial |
$3,230.06
|
| Rate for Payer: Healthscope Commercial |
$3,734.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,119.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,966.30
|
| Rate for Payer: Nomi Health Commercial |
$2,422.55
|
| Rate for Payer: PACE SWMI |
$2,018.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,018.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,966.30
|
| Rate for Payer: Priority Health Medicare |
$2,018.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,018.79
|
| Rate for Payer: UHC Medicare Advantage |
$2,018.79
|
|
|
PR LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
HCPCS 49652
|
| Min. Negotiated Rate |
$484.40 |
| Max. Negotiated Rate |
$787.15 |
| Rate for Payer: Aetna Medicare |
$605.50
|
| Rate for Payer: BCBS Complete |
$484.40
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.15
|
|
|
PR LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,444.00
|
|
|
Service Code
|
HCPCS 49655
|
| Min. Negotiated Rate |
$1,377.60 |
| Max. Negotiated Rate |
$2,238.60 |
| Rate for Payer: Aetna Medicare |
$1,722.00
|
| Rate for Payer: BCBS Complete |
$1,377.60
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,238.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,238.60
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH
|
Professional
|
Both
|
$4,970.00
|
|
|
Service Code
|
HCPCS 43282
|
| Min. Negotiated Rate |
$1,681.61 |
| Max. Negotiated Rate |
$3,230.50 |
| Rate for Payer: Aetna Commercial |
$2,253.36
|
| Rate for Payer: Aetna Medicare |
$1,748.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,421.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,253.36
|
| Rate for Payer: BCBS Complete |
$1,988.00
|
| Rate for Payer: BCBS MAPPO |
$1,681.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.61
|
| Rate for Payer: Cash Price |
$3,976.00
|
| Rate for Payer: Cash Price |
$3,976.00
|
| Rate for Payer: Cofinity Commercial |
$2,253.36
|
| Rate for Payer: Cofinity Commercial |
$2,421.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.61
|
| Rate for Payer: Healthscope Commercial |
$3,110.98
|
| Rate for Payer: Healthscope Commercial |
$2,690.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,230.50
|
| Rate for Payer: Nomi Health Commercial |
$2,017.93
|
| Rate for Payer: PACE SWMI |
$1,681.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,230.50
|
| Rate for Payer: Priority Health Medicare |
$1,681.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.61
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$3,166.00
|
|
|
Service Code
|
HCPCS 43281
|
| Min. Negotiated Rate |
$1,266.40 |
| Max. Negotiated Rate |
$2,758.92 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Medicare |
$1,550.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,147.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,998.36
|
| Rate for Payer: BCBS Complete |
$1,266.40
|
| Rate for Payer: BCBS MAPPO |
$1,491.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,491.31
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cash Price |
$2,532.80
|
| Rate for Payer: Cofinity Commercial |
$2,147.49
|
| Rate for Payer: Cofinity Commercial |
$1,998.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,491.31
|
| Rate for Payer: Healthscope Commercial |
$2,386.10
|
| Rate for Payer: Healthscope Commercial |
$2,758.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,565.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,057.90
|
| Rate for Payer: Nomi Health Commercial |
$1,789.57
|
| Rate for Payer: PACE SWMI |
$1,491.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,491.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,057.90
|
| Rate for Payer: Priority Health Medicare |
$1,491.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,491.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,491.31
|
|
|
PR LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,082.00
|
|
|
Service Code
|
HCPCS 49657
|
| Min. Negotiated Rate |
$1,632.80 |
| Max. Negotiated Rate |
$2,653.30 |
| Rate for Payer: Aetna Medicare |
$2,041.00
|
| Rate for Payer: BCBS Complete |
$1,632.80
|
| Rate for Payer: Cash Price |
$3,265.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,653.30
|
|
|
PR LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE
|
Professional
|
Both
|
$1,493.00
|
|
|
Service Code
|
HCPCS 49656
|
| Min. Negotiated Rate |
$597.20 |
| Max. Negotiated Rate |
$970.45 |
| Rate for Payer: Aetna Medicare |
$746.50
|
| Rate for Payer: BCBS Complete |
$597.20
|
| Rate for Payer: Cash Price |
$1,194.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$970.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.45
|
|
|
PR LAPS SUPRACERVICAL HYSTERECTOMY >250
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 58543
|
| Min. Negotiated Rate |
$808.77 |
| Max. Negotiated Rate |
$1,496.22 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna Medicare |
$841.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,083.75
|
| Rate for Payer: BCBS Complete |
$902.40
|
| Rate for Payer: BCBS MAPPO |
$808.77
|
| Rate for Payer: BCN Medicare Advantage |
$808.77
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cofinity Commercial |
$1,164.63
|
| Rate for Payer: Cofinity Commercial |
$1,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$808.77
|
| Rate for Payer: Healthscope Commercial |
$1,496.22
|
| Rate for Payer: Healthscope Commercial |
$1,294.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,466.40
|
| Rate for Payer: Nomi Health Commercial |
$970.52
|
| Rate for Payer: PACE SWMI |
$808.77
|
| Rate for Payer: PHP Medicare Advantage |
$808.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health Medicare |
$808.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$808.77
|
| Rate for Payer: UHC Medicare Advantage |
$808.77
|
|
|
PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY
|
Professional
|
Both
|
$2,458.00
|
|
|
Service Code
|
HCPCS 58544
|
| Min. Negotiated Rate |
$870.53 |
| Max. Negotiated Rate |
$1,610.48 |
| Rate for Payer: Aetna Commercial |
$1,166.51
|
| Rate for Payer: Aetna Medicare |
$905.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,166.51
|
| Rate for Payer: BCBS Complete |
$983.20
|
| Rate for Payer: BCBS MAPPO |
$870.53
|
| Rate for Payer: BCN Medicare Advantage |
$870.53
|
| Rate for Payer: Cash Price |
$1,966.40
|
| Rate for Payer: Cash Price |
$1,966.40
|
| Rate for Payer: Cofinity Commercial |
$1,253.56
|
| Rate for Payer: Cofinity Commercial |
$1,166.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.53
|
| Rate for Payer: Healthscope Commercial |
$1,392.85
|
| Rate for Payer: Healthscope Commercial |
$1,610.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,597.70
|
| Rate for Payer: Nomi Health Commercial |
$1,044.64
|
| Rate for Payer: PACE SWMI |
$870.53
|
| Rate for Payer: PHP Medicare Advantage |
$870.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.70
|
| Rate for Payer: Priority Health Medicare |
$870.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.53
|
| Rate for Payer: UHC Medicare Advantage |
$870.53
|
|
|
PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
HCPCS 58542
|
| Min. Negotiated Rate |
$796.36 |
| Max. Negotiated Rate |
$1,473.27 |
| Rate for Payer: Aetna Commercial |
$1,067.12
|
| Rate for Payer: Aetna Medicare |
$828.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,146.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,067.12
|
| Rate for Payer: BCBS Complete |
$890.80
|
| Rate for Payer: BCBS MAPPO |
$796.36
|
| Rate for Payer: BCN Medicare Advantage |
$796.36
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Cash Price |
$1,781.60
|
| Rate for Payer: Cofinity Commercial |
$1,146.76
|
| Rate for Payer: Cofinity Commercial |
$1,067.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.36
|
| Rate for Payer: Healthscope Commercial |
$1,473.27
|
| Rate for Payer: Healthscope Commercial |
$1,274.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,447.55
|
| Rate for Payer: Nomi Health Commercial |
$955.63
|
| Rate for Payer: PACE SWMI |
$796.36
|
| Rate for Payer: PHP Medicare Advantage |
$796.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,447.55
|
| Rate for Payer: Priority Health Medicare |
$796.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.36
|
| Rate for Payer: UHC Medicare Advantage |
$796.36
|
|
|
PR LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY
|
Professional
|
Both
|
$1,554.00
|
|
|
Service Code
|
HCPCS 38571
|
| Min. Negotiated Rate |
$621.60 |
| Max. Negotiated Rate |
$1,172.68 |
| Rate for Payer: Aetna Commercial |
$849.40
|
| Rate for Payer: Aetna Medicare |
$659.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.40
|
| Rate for Payer: BCBS Complete |
$621.60
|
| Rate for Payer: BCBS MAPPO |
$633.88
|
| Rate for Payer: BCN Medicare Advantage |
$633.88
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Cofinity Commercial |
$912.79
|
| Rate for Payer: Cofinity Commercial |
$849.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$633.88
|
| Rate for Payer: Healthscope Commercial |
$1,014.21
|
| Rate for Payer: Healthscope Commercial |
$1,172.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$665.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,010.10
|
| Rate for Payer: Nomi Health Commercial |
$760.66
|
| Rate for Payer: PACE SWMI |
$633.88
|
| Rate for Payer: PHP Medicare Advantage |
$633.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,010.10
|
| Rate for Payer: Priority Health Medicare |
$633.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$633.88
|
| Rate for Payer: UHC Medicare Advantage |
$633.88
|
|
