|
PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 49324
|
| Min. Negotiated Rate |
$296.80 |
| Max. Negotiated Rate |
$540.13 |
| Rate for Payer: Aetna Commercial |
$502.62
|
| Rate for Payer: Aetna Medicare |
$390.09
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.84
|
| 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 |
$378.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.09
|
| Rate for Payer: UHC Exchange |
$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 |
$592.40 |
| Rate for Payer: Aetna Commercial |
$551.26
|
| Rate for Payer: Aetna Medicare |
$427.85
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.96
|
| 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 |
$415.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.39
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.31
|
| 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 |
$181.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.34
|
| Rate for Payer: UHC Exchange |
$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 |
$1,248.87 |
| Rate for Payer: Aetna Commercial |
$1,162.14
|
| Rate for Payer: Aetna Medicare |
$901.96
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.63
|
| 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 |
$875.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.27
|
| Rate for Payer: UHC Exchange |
$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 |
$1,561.30 |
| Rate for Payer: Aetna Commercial |
$1,435.96
|
| Rate for Payer: Aetna Medicare |
$1,114.47
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.19
|
| 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 |
$1,082.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,071.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.61
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,955.76
|
| 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 |
$1,881.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,862.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,862.63
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,119.73
|
| 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 |
$2,038.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,018.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,018.79
|
| Rate for Payer: UHC Exchange |
$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: 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: 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.69
|
| 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 |
$1,698.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,681.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.61
|
| Rate for Payer: UHC Exchange |
$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 |
$2,147.49 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Medicare |
$1,550.96
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,565.88
|
| 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 |
$1,506.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,491.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,491.31
|
| Rate for Payer: UHC Exchange |
$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: 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: 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 |
$1,466.40 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna Medicare |
$841.12
|
| 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 |
$1,083.75
|
| Rate for Payer: Cofinity Commercial |
$1,164.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$808.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.21
|
| 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 |
$816.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$808.77
|
| Rate for Payer: UHC Exchange |
$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 |
$1,597.70 |
| Rate for Payer: Aetna Commercial |
$1,166.51
|
| Rate for Payer: Aetna Medicare |
$905.35
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.06
|
| 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 |
$879.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.53
|
| Rate for Payer: UHC Exchange |
$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 |
$1,447.55 |
| Rate for Payer: Aetna Commercial |
$1,067.12
|
| Rate for Payer: Aetna Medicare |
$828.21
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.18
|
| 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 |
$804.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.36
|
| Rate for Payer: UHC Exchange |
$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 |
$1,010.10 |
| Rate for Payer: Aetna Commercial |
$849.40
|
| Rate for Payer: Aetna Medicare |
$659.24
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$665.57
|
| 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 |
$640.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$633.88
|
| Rate for Payer: UHC Exchange |
$633.88
|
| Rate for Payer: UHC Medicare Advantage |
$633.88
|
|
|
PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT
|
Professional
|
Both
|
$3,358.00
|
|
|
Service Code
|
HCPCS 47564
|
| Min. Negotiated Rate |
$1,088.19 |
| Max. Negotiated Rate |
$2,182.70 |
| Rate for Payer: Aetna Commercial |
$1,458.17
|
| Rate for Payer: Aetna Medicare |
$1,131.72
|
| Rate for Payer: BCBS Complete |
$1,343.20
|
| Rate for Payer: BCBS MAPPO |
$1,088.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,088.19
|
| Rate for Payer: Cash Price |
$2,686.40
|
| Rate for Payer: Cash Price |
$2,686.40
|
| Rate for Payer: Cofinity Commercial |
$1,566.99
|
| Rate for Payer: Cofinity Commercial |
$1,458.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,088.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,142.60
|
| Rate for Payer: Nomi Health Commercial |
$1,305.83
|
| Rate for Payer: PACE SWMI |
$1,088.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,088.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,182.70
|
| Rate for Payer: Priority Health Medicare |
$1,099.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,088.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,088.19
|
| Rate for Payer: UHC Exchange |
$1,088.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,088.19
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$2,792.00
|
|
|
Service Code
|
HCPCS 47563
|
| Min. Negotiated Rate |
$700.20 |
| Max. Negotiated Rate |
$1,814.80 |
| Rate for Payer: Aetna Commercial |
$938.27
|
| Rate for Payer: Aetna Medicare |
$728.21
|
| Rate for Payer: BCBS Complete |
$1,116.80
|
| Rate for Payer: BCBS MAPPO |
$700.20
|
| Rate for Payer: BCN Medicare Advantage |
$700.20
|
| Rate for Payer: Cash Price |
$2,233.60
|
| Rate for Payer: Cash Price |
$2,233.60
|
| Rate for Payer: Cofinity Commercial |
$938.27
|
| Rate for Payer: Cofinity Commercial |
$1,008.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.21
|
| Rate for Payer: Nomi Health Commercial |
$840.24
|
| Rate for Payer: PACE SWMI |
$700.20
|
| Rate for Payer: PHP Medicare Advantage |
$700.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,814.80
|
| Rate for Payer: Priority Health Medicare |
$707.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.20
|
| Rate for Payer: UHC Exchange |
$700.20
|
| Rate for Payer: UHC Medicare Advantage |
$700.20
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$2,792.00
|
|
|
Service Code
|
HCPCS 47563
|
| Hospital Charge Code |
47563
|
| Min. Negotiated Rate |
$700.20 |
| Max. Negotiated Rate |
$1,814.80 |
| Rate for Payer: Aetna Commercial |
$938.27
|
| Rate for Payer: Aetna Medicare |
$728.21
|
| Rate for Payer: BCBS Complete |
$1,116.80
|
| Rate for Payer: BCBS MAPPO |
$700.20
|
| Rate for Payer: BCN Medicare Advantage |
$700.20
|
| Rate for Payer: Cash Price |
$2,233.60
|
| Rate for Payer: Cash Price |
$2,233.60
|
| Rate for Payer: Cofinity Commercial |
$938.27
|
| Rate for Payer: Cofinity Commercial |
$1,008.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.21
|
| Rate for Payer: Nomi Health Commercial |
$840.24
|
| Rate for Payer: PACE SWMI |
$700.20
|
| Rate for Payer: PHP Medicare Advantage |
$700.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,814.80
|
| Rate for Payer: Priority Health Medicare |
$707.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.20
|
| Rate for Payer: UHC Exchange |
$700.20
|
| Rate for Payer: UHC Medicare Advantage |
$700.20
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Facility
|
IP
|
$2,792.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
47563
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,814.80 |
| Max. Negotiated Rate |
$2,512.80 |
| Rate for Payer: Aetna Commercial |
$2,373.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,279.11
|
| Rate for Payer: BCN Commercial |
$2,157.66
|
| Rate for Payer: Cash Price |
$2,233.60
|
| Rate for Payer: Cofinity Commercial |
$2,401.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,233.60
|
| Rate for Payer: Healthscope Commercial |
$2,512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,094.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,373.20
|
| Rate for Payer: Nomi Health Commercial |
$2,289.44
|
| Rate for Payer: PHP Commercial |
$2,373.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,814.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,429.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,870.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,456.96
|
| Rate for Payer: UHC Core |
$2,331.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,094.00
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Facility
|
OP
|
$2,792.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
47563
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$663.10 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: Aetna Commercial |
$2,373.20
|
| Rate for Payer: Aetna Medicare |
$725.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$872.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$872.50
|
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: BCBS MAPPO |
$698.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,295.30
|
| Rate for Payer: BCN Commercial |
$2,170.78
|
| Rate for Payer: BCN Medicare Advantage |
$698.00
|
| Rate for Payer: Cash Price |
$2,233.60
|
| Rate for Payer: Cash Price |
$2,233.60
|
| Rate for Payer: Cofinity Commercial |
$2,401.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,233.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$698.00
|
| Rate for Payer: Healthscope Commercial |
$2,512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,094.00
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.90
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$802.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,373.20
|
| Rate for Payer: Nomi Health Commercial |
$2,289.44
|
| Rate for Payer: PACE Senior Care Partners |
$663.10
|
| Rate for Payer: PACE SWMI |
$698.00
|
| Rate for Payer: PHP Commercial |
$2,373.20
|
| Rate for Payer: PHP Medicare Advantage |
$698.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,814.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,429.04
|
| Rate for Payer: Priority Health Medicare |
$704.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,870.64
|
| Rate for Payer: Railroad Medicare Medicare |
$698.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,456.96
|
| Rate for Payer: UHC Core |
$2,331.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$698.00
|
| Rate for Payer: UHC Exchange |
$698.00
|
| Rate for Payer: UHC Medicare Advantage |
$698.00
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
| Rate for Payer: VA VA |
$698.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,094.00
|
|
|
PR LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$4,149.00
|
|
|
Service Code
|
HCPCS 43280
|
| Min. Negotiated Rate |
$1,047.65 |
| Max. Negotiated Rate |
$2,696.85 |
| Rate for Payer: Aetna Commercial |
$1,403.85
|
| Rate for Payer: Aetna Medicare |
$1,089.56
|
| Rate for Payer: BCBS Complete |
$1,659.60
|
| Rate for Payer: BCBS MAPPO |
$1,047.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.65
|
| Rate for Payer: Cash Price |
$3,319.20
|
| Rate for Payer: Cash Price |
$3,319.20
|
| Rate for Payer: Cofinity Commercial |
$1,508.62
|
| Rate for Payer: Cofinity Commercial |
$1,403.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.03
|
| Rate for Payer: Nomi Health Commercial |
$1,257.18
|
| Rate for Payer: PACE SWMI |
$1,047.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,696.85
|
| Rate for Payer: Priority Health Medicare |
$1,058.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,047.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.65
|
| Rate for Payer: UHC Exchange |
$1,047.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.65
|
|
|
PR LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX
|
Professional
|
Both
|
$2,294.00
|
|
|
Service Code
|
HCPCS 43653
|
| Min. Negotiated Rate |
$561.09 |
| Max. Negotiated Rate |
$1,491.10 |
| Rate for Payer: Aetna Commercial |
$751.86
|
| Rate for Payer: Aetna Medicare |
$583.53
|
| Rate for Payer: BCBS Complete |
$917.60
|
| Rate for Payer: BCBS MAPPO |
$561.09
|
| Rate for Payer: BCN Medicare Advantage |
$561.09
|
| Rate for Payer: Cash Price |
$1,835.20
|
| Rate for Payer: Cash Price |
$1,835.20
|
| Rate for Payer: Cofinity Commercial |
$807.97
|
| Rate for Payer: Cofinity Commercial |
$751.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.14
|
| Rate for Payer: Nomi Health Commercial |
$673.31
|
| Rate for Payer: PACE SWMI |
$561.09
|
| Rate for Payer: PHP Medicare Advantage |
$561.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,491.10
|
| Rate for Payer: Priority Health Medicare |
$566.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$561.09
|
| Rate for Payer: UHC Exchange |
$561.09
|
| Rate for Payer: UHC Medicare Advantage |
$561.09
|
|
|
PR LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT
|
Professional
|
Both
|
$3,339.00
|
|
|
Service Code
|
HCPCS 55866
|
| Min. Negotiated Rate |
$1,141.64 |
| Max. Negotiated Rate |
$2,170.35 |
| Rate for Payer: Aetna Commercial |
$1,529.80
|
| Rate for Payer: Aetna Medicare |
$1,187.31
|
| Rate for Payer: BCBS Complete |
$1,335.60
|
| Rate for Payer: BCBS MAPPO |
$1,141.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.64
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cofinity Commercial |
$1,643.96
|
| Rate for Payer: Cofinity Commercial |
$1,529.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,198.72
|
| Rate for Payer: Nomi Health Commercial |
$1,369.97
|
| Rate for Payer: PACE SWMI |
$1,141.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.35
|
| Rate for Payer: Priority Health Medicare |
$1,153.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,141.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,141.64
|
| Rate for Payer: UHC Exchange |
$1,141.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,141.64
|
|
