|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
49650
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,119.17 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Aetna Commercial |
$1,366.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.05
|
| Rate for Payer: BCN Commercial |
$1,328.05
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cofinity Commercial |
$1,382.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,286.40
|
| Rate for Payer: Healthscope Commercial |
$1,447.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,206.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,366.80
|
| Rate for Payer: Nomi Health Commercial |
$1,318.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,206.00
|
| Rate for Payer: PHP Commercial |
$1,366.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,398.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,119.17
|
| Rate for Payer: UHC Core |
$1,342.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,206.00
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
49650
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$283.49 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Aetna Commercial |
$1,366.80
|
| Rate for Payer: Aetna Medicare |
$418.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$502.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$502.50
|
| Rate for Payer: BCBS Complete |
$297.64
|
| Rate for Payer: BCBS MAPPO |
$402.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.94
|
| Rate for Payer: BCN Commercial |
$1,321.94
|
| Rate for Payer: BCN Medicare Advantage |
$402.00
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cofinity Commercial |
$1,382.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,286.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.00
|
| Rate for Payer: Healthscope Commercial |
$1,447.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,206.00
|
| Rate for Payer: Mclaren Medicaid |
$283.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.10
|
| Rate for Payer: Meridian Medicaid |
$297.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$462.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$442.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,366.80
|
| Rate for Payer: Nomi Health Commercial |
$1,318.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,206.00
|
| Rate for Payer: PACE Senior Care Partners |
$381.90
|
| Rate for Payer: PACE SWMI |
$402.00
|
| Rate for Payer: PHP Commercial |
$1,366.80
|
| Rate for Payer: PHP Medicare Advantage |
$402.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,398.96
|
| Rate for Payer: Priority Health Medicare |
$406.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,119.17
|
| Rate for Payer: Railroad Medicare Medicare |
$402.00
|
| Rate for Payer: UHC Core |
$1,342.68
|
| Rate for Payer: UHC Exchange |
$402.00
|
| Rate for Payer: UHC Medicaid |
$283.49
|
| Rate for Payer: UHC Medicare Advantage |
$402.00
|
| Rate for Payer: UHCCP Medicaid |
$283.49
|
| Rate for Payer: VA VA |
$402.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,206.00
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,608.00
|
|
|
Service Code
|
HCPCS 49650
|
| Min. Negotiated Rate |
$270.51 |
| Max. Negotiated Rate |
$1,206.00 |
| Rate for Payer: Aetna Commercial |
$580.39
|
| Rate for Payer: Aetna Medicare |
$804.00
|
| Rate for Payer: BCBS Complete |
$284.04
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Mclaren Medicaid |
$270.51
|
| Rate for Payer: Meridian Medicaid |
$284.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,206.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$802.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.13
|
| Rate for Payer: UHC Medicaid |
$270.51
|
| Rate for Payer: UHCCP Medicaid |
$270.51
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,608.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$270.51 |
| Max. Negotiated Rate |
$1,206.00 |
| Rate for Payer: Aetna Commercial |
$580.39
|
| Rate for Payer: Aetna Medicare |
$804.00
|
| Rate for Payer: BCBS Complete |
$284.04
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Mclaren Medicaid |
$270.51
|
| Rate for Payer: Meridian Medicaid |
$284.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,206.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$802.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.13
|
| Rate for Payer: UHC Medicaid |
$270.51
|
| Rate for Payer: UHCCP Medicaid |
$270.51
|
|
|
PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 49321
|
| Min. Negotiated Rate |
$210.02 |
| Max. Negotiated Rate |
$1,212.75 |
| Rate for Payer: Aetna Commercial |
$463.87
|
| Rate for Payer: Aetna Medicare |
$808.50
|
| Rate for Payer: BCBS Complete |
$220.52
|
| Rate for Payer: BCN Commercial |
$520.39
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Mclaren Medicaid |
$210.02
|
| Rate for Payer: Meridian Medicaid |
$220.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,212.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$634.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$634.06
|
| Rate for Payer: UHC Medicaid |
$210.02
|
| Rate for Payer: UHCCP Medicaid |
$210.02
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM
|
Professional
|
Both
|
$3,059.00
|
|
|
Service Code
|
HCPCS 58572
|
| Min. Negotiated Rate |
$603.00 |
| Max. Negotiated Rate |
$2,294.25 |
| Rate for Payer: Aetna Commercial |
$1,237.81
|
| Rate for Payer: Aetna Medicare |
$1,529.50
|
| Rate for Payer: BCBS Complete |
$633.15
|
| Rate for Payer: BCN Commercial |
$1,562.17
|
| Rate for Payer: Cash Price |
$2,447.20
|
| Rate for Payer: Cash Price |
$2,447.20
|
| Rate for Payer: Mclaren Medicaid |
$603.00
|
| Rate for Payer: Meridian Medicaid |
$633.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,294.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$603.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,582.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,582.14
|
| Rate for Payer: UHC Medicaid |
$603.00
|
| Rate for Payer: UHCCP Medicaid |
$603.00
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$3,569.00
|
|
|
Service Code
|
HCPCS 58573
|
| Min. Negotiated Rate |
$705.03 |
| Max. Negotiated Rate |
$2,676.75 |
| Rate for Payer: Aetna Commercial |
$1,450.88
|
| Rate for Payer: Aetna Medicare |
$1,784.50
|
| Rate for Payer: BCBS Complete |
$740.28
|
| Rate for Payer: BCN Commercial |
$1,826.60
|
| Rate for Payer: Cash Price |
$2,855.20
|
| Rate for Payer: Cash Price |
$2,855.20
|
| Rate for Payer: Mclaren Medicaid |
$705.03
|
| Rate for Payer: Meridian Medicaid |
$740.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,676.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$705.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,849.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,849.94
|
| Rate for Payer: UHC Medicaid |
$705.03
|
| Rate for Payer: UHCCP Medicaid |
$705.03
|
|
|
PR LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$2,768.00
|
|
|
Service Code
|
HCPCS 58660
|
| Min. Negotiated Rate |
$400.23 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$813.78
|
| Rate for Payer: Aetna Medicare |
$1,384.00
|
| Rate for Payer: BCBS Complete |
$420.24
|
| Rate for Payer: BCN Commercial |
$1,030.82
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Cash Price |
$2,214.40
|
| Rate for Payer: Mclaren Medicaid |
$400.23
|
| Rate for Payer: Meridian Medicaid |
$420.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,076.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,043.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.99
|
| Rate for Payer: UHC Medicaid |
$400.23
|
| Rate for Payer: UHCCP Medicaid |
$400.23
|
|
|
PR LAPAROSCOPY W/OMENTOPEXY
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 49326
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$340.38 |
| Rate for Payer: Aetna Commercial |
$255.96
|
| Rate for Payer: Aetna Medicare |
$177.00
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCN Commercial |
$279.37
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Mclaren Medicaid |
$107.99
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$340.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$340.38
|
| Rate for Payer: UHC Medicaid |
$107.99
|
| Rate for Payer: UHCCP Medicaid |
$107.99
|
|
|
PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 58671
|
| Min. Negotiated Rate |
$212.36 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Aetna Commercial |
$442.77
|
| Rate for Payer: Aetna Medicare |
$786.00
|
| Rate for Payer: BCBS Complete |
$222.98
|
| Rate for Payer: BCN Commercial |
$558.74
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Mclaren Medicaid |
$212.36
|
| Rate for Payer: Meridian Medicaid |
$222.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$565.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.88
|
| Rate for Payer: UHC Medicaid |
$212.36
|
| Rate for Payer: UHCCP Medicaid |
$212.36
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,826.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
58661
|
| Min. Negotiated Rate |
$373.82 |
| Max. Negotiated Rate |
$2,119.50 |
| Rate for Payer: Aetna Commercial |
$780.25
|
| Rate for Payer: Aetna Medicare |
$1,413.00
|
| Rate for Payer: BCBS Complete |
$392.51
|
| Rate for Payer: BCN Commercial |
$978.53
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Mclaren Medicaid |
$373.82
|
| Rate for Payer: Meridian Medicaid |
$392.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,119.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$991.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$991.04
|
| Rate for Payer: UHC Medicaid |
$373.82
|
| Rate for Payer: UHCCP Medicaid |
$373.82
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
58661
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$498.22 |
| Max. Negotiated Rate |
$2,543.40 |
| Rate for Payer: Aetna Commercial |
$2,402.10
|
| Rate for Payer: Aetna Medicare |
$734.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$883.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$883.12
|
| Rate for Payer: BCBS Complete |
$523.09
|
| Rate for Payer: BCBS MAPPO |
$706.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,323.25
|
| Rate for Payer: BCN Commercial |
$2,323.25
|
| Rate for Payer: BCN Medicare Advantage |
$706.50
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Cofinity Commercial |
$2,430.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,260.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.50
|
| Rate for Payer: Healthscope Commercial |
$2,543.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,119.50
|
| Rate for Payer: Mclaren Medicaid |
$498.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.83
|
| Rate for Payer: Meridian Medicaid |
$523.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$812.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$777.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,402.10
|
| Rate for Payer: Nomi Health Commercial |
$2,317.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,119.50
|
| Rate for Payer: PACE Senior Care Partners |
$671.17
|
| Rate for Payer: PACE SWMI |
$706.50
|
| Rate for Payer: PHP Commercial |
$2,402.10
|
| Rate for Payer: PHP Medicare Advantage |
$706.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,458.62
|
| Rate for Payer: Priority Health Medicare |
$713.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,966.90
|
| Rate for Payer: Railroad Medicare Medicare |
$706.50
|
| Rate for Payer: UHC Core |
$2,359.71
|
| Rate for Payer: UHC Exchange |
$706.50
|
| Rate for Payer: UHC Medicaid |
$498.22
|
| Rate for Payer: UHC Medicare Advantage |
$706.50
|
| Rate for Payer: UHCCP Medicaid |
$498.22
|
| Rate for Payer: VA VA |
$706.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,119.50
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,826.00
|
|
|
Service Code
|
HCPCS 58661
|
| Min. Negotiated Rate |
$373.82 |
| Max. Negotiated Rate |
$2,119.50 |
| Rate for Payer: Aetna Commercial |
$780.25
|
| Rate for Payer: Aetna Medicare |
$1,413.00
|
| Rate for Payer: BCBS Complete |
$392.51
|
| Rate for Payer: BCN Commercial |
$978.53
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Mclaren Medicaid |
$373.82
|
| Rate for Payer: Meridian Medicaid |
$392.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,119.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$991.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$991.04
|
| Rate for Payer: UHC Medicaid |
$373.82
|
| Rate for Payer: UHCCP Medicaid |
$373.82
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
58661
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,966.90 |
| Max. Negotiated Rate |
$2,543.40 |
| Rate for Payer: Aetna Commercial |
$2,402.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,333.99
|
| Rate for Payer: BCN Commercial |
$2,333.99
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Cofinity Commercial |
$2,430.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,260.80
|
| Rate for Payer: Healthscope Commercial |
$2,543.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,119.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,402.10
|
| Rate for Payer: Nomi Health Commercial |
$2,317.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,119.50
|
| Rate for Payer: PHP Commercial |
$2,402.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,458.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,966.90
|
| Rate for Payer: UHC Core |
$2,359.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,119.50
|
|
|
PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,549.00
|
|
|
Service Code
|
HCPCS 58570
|
| Min. Negotiated Rate |
$463.70 |
| Max. Negotiated Rate |
$1,911.75 |
| Rate for Payer: Aetna Commercial |
$956.81
|
| Rate for Payer: Aetna Medicare |
$1,274.50
|
| Rate for Payer: BCBS Complete |
$486.88
|
| Rate for Payer: BCN Commercial |
$1,213.58
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Mclaren Medicaid |
$463.70
|
| Rate for Payer: Meridian Medicaid |
$486.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,911.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,229.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,229.09
|
| Rate for Payer: UHC Medicaid |
$463.70
|
| Rate for Payer: UHCCP Medicaid |
$463.70
|
|
|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 49654
|
| Min. Negotiated Rate |
$1,162.40 |
| Max. Negotiated Rate |
$2,179.50 |
| Rate for Payer: Aetna Medicare |
$1,453.00
|
| Rate for Payer: BCBS Complete |
$1,162.40
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,179.50
|
|
|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,209.00
|
|
|
Service Code
|
HCPCS 49653
|
| Min. Negotiated Rate |
$1,283.60 |
| Max. Negotiated Rate |
$2,406.75 |
| Rate for Payer: Aetna Medicare |
$1,604.50
|
| Rate for Payer: BCBS Complete |
$1,283.60
|
| Rate for Payer: Cash Price |
$2,567.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,406.75
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$255.46 |
| Max. Negotiated Rate |
$1,304.10 |
| Rate for Payer: Aetna Commercial |
$1,231.65
|
| Rate for Payer: Aetna Medicare |
$376.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.81
|
| Rate for Payer: BCBS Complete |
$268.21
|
| Rate for Payer: BCBS MAPPO |
$362.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.22
|
| Rate for Payer: BCN Commercial |
$1,191.22
|
| Rate for Payer: BCN Medicare Advantage |
$362.25
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$1,246.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.25
|
| Rate for Payer: Healthscope Commercial |
$1,304.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.75
|
| Rate for Payer: Mclaren Medicaid |
$255.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.36
|
| Rate for Payer: Meridian Medicaid |
$268.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$398.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.65
|
| Rate for Payer: Nomi Health Commercial |
$1,188.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PACE Senior Care Partners |
$344.14
|
| Rate for Payer: PACE SWMI |
$362.25
|
| Rate for Payer: PHP Commercial |
$1,231.65
|
| Rate for Payer: PHP Medicare Advantage |
$362.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$255.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,260.63
|
| Rate for Payer: Priority Health Medicare |
$365.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.50
|
| Rate for Payer: Railroad Medicare Medicare |
$362.25
|
| Rate for Payer: UHC Core |
$1,209.91
|
| Rate for Payer: UHC Exchange |
$362.25
|
| Rate for Payer: UHC Medicaid |
$255.46
|
| Rate for Payer: UHC Medicare Advantage |
$362.25
|
| Rate for Payer: UHCCP Medicaid |
$255.46
|
| Rate for Payer: VA VA |
$362.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.75
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,008.50 |
| Max. Negotiated Rate |
$1,304.10 |
| Rate for Payer: Aetna Commercial |
$1,231.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.73
|
| Rate for Payer: BCN Commercial |
$1,196.73
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$1,246.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.20
|
| Rate for Payer: Healthscope Commercial |
$1,304.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.65
|
| Rate for Payer: Nomi Health Commercial |
$1,188.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PHP Commercial |
$1,231.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,260.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.50
|
| Rate for Payer: UHC Core |
$1,209.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.75
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
49320
|
| Min. Negotiated Rate |
$201.71 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$441.92
|
| Rate for Payer: Aetna Medicare |
$724.50
|
| Rate for Payer: BCBS Complete |
$211.80
|
| Rate for Payer: BCN Commercial |
$499.48
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Mclaren Medicaid |
$201.71
|
| Rate for Payer: Meridian Medicaid |
$211.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$608.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.59
|
| Rate for Payer: UHC Medicaid |
$201.71
|
| Rate for Payer: UHCCP Medicaid |
$201.71
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 49320
|
| Min. Negotiated Rate |
$201.71 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$441.92
|
| Rate for Payer: Aetna Medicare |
$724.50
|
| Rate for Payer: BCBS Complete |
$211.80
|
| Rate for Payer: BCN Commercial |
$499.48
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Mclaren Medicaid |
$201.71
|
| Rate for Payer: Meridian Medicaid |
$211.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$608.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.59
|
| Rate for Payer: UHC Medicaid |
$201.71
|
| Rate for Payer: UHCCP Medicaid |
$201.71
|
|
|
PR LAPS ABLTJ RENAL MASS LESION W/INTRAOP US
|
Professional
|
Both
|
$2,178.00
|
|
|
Service Code
|
HCPCS 50542
|
| Min. Negotiated Rate |
$666.26 |
| Max. Negotiated Rate |
$1,892.12 |
| Rate for Payer: Aetna Commercial |
$1,499.49
|
| Rate for Payer: Aetna Medicare |
$1,089.00
|
| Rate for Payer: BCBS Complete |
$699.57
|
| Rate for Payer: BCN Commercial |
$1,736.96
|
| Rate for Payer: Cash Price |
$1,742.40
|
| Rate for Payer: Cash Price |
$1,742.40
|
| Rate for Payer: Mclaren Medicaid |
$666.26
|
| Rate for Payer: Meridian Medicaid |
$699.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,633.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,892.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,892.12
|
| Rate for Payer: UHC Medicaid |
$666.26
|
| Rate for Payer: UHCCP Medicaid |
$666.26
|
|
|
PR LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
HCPCS 38572
|
| Min. Negotiated Rate |
$526.54 |
| Max. Negotiated Rate |
$1,788.36 |
| Rate for Payer: Aetna Commercial |
$1,126.54
|
| Rate for Payer: Aetna Medicare |
$962.50
|
| Rate for Payer: BCBS Complete |
$552.87
|
| Rate for Payer: BCN Commercial |
$1,344.05
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Mclaren Medicaid |
$526.54
|
| Rate for Payer: Meridian Medicaid |
$552.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,443.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,788.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,788.36
|
| Rate for Payer: UHC Medicaid |
$526.54
|
| Rate for Payer: UHCCP Medicaid |
$526.54
|
|
|
PR LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$3,948.00
|
|
|
Service Code
|
HCPCS 44227
|
| Min. Negotiated Rate |
$968.94 |
| Max. Negotiated Rate |
$3,007.09 |
| Rate for Payer: Aetna Commercial |
$2,238.05
|
| Rate for Payer: Aetna Medicare |
$1,974.00
|
| Rate for Payer: BCBS Complete |
$1,017.39
|
| Rate for Payer: BCN Commercial |
$2,468.00
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Mclaren Medicaid |
$968.94
|
| Rate for Payer: Meridian Medicaid |
$1,017.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,961.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$968.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,007.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,007.09
|
| Rate for Payer: UHC Medicaid |
$968.94
|
| Rate for Payer: UHCCP Medicaid |
$968.94
|
|
|
PR LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS
|
Professional
|
Both
|
$6,498.00
|
|
|
Service Code
|
HCPCS 44211
|
| Min. Negotiated Rate |
$1,229.01 |
| Max. Negotiated Rate |
$4,873.50 |
| Rate for Payer: Aetna Commercial |
$2,816.64
|
| Rate for Payer: Aetna Medicare |
$3,249.00
|
| Rate for Payer: BCBS Complete |
$1,290.46
|
| Rate for Payer: BCN Commercial |
$3,131.80
|
| Rate for Payer: Cash Price |
$5,198.40
|
| Rate for Payer: Cash Price |
$5,198.40
|
| Rate for Payer: Mclaren Medicaid |
$1,229.01
|
| Rate for Payer: Meridian Medicaid |
$1,290.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,873.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,229.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,815.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,815.89
|
| Rate for Payer: UHC Medicaid |
$1,229.01
|
| Rate for Payer: UHCCP Medicaid |
$1,229.01
|
|
