|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 38570
|
| Hospital Charge Code |
38570
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$637.65 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Aetna Commercial |
$833.85
|
| Rate for Payer: BCBS Trust/PPO |
$800.79
|
| Rate for Payer: BCN Commercial |
$758.12
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cofinity Commercial |
$843.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$784.80
|
| Rate for Payer: Healthscope Commercial |
$882.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$833.85
|
| Rate for Payer: Nomi Health Commercial |
$804.42
|
| Rate for Payer: PHP Commercial |
$833.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.65
|
| Rate for Payer: Priority Health HMO/PPO |
$853.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$657.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.28
|
| Rate for Payer: UHC Core |
$819.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.75
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
38570
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$714.67 |
| Rate for Payer: Aetna Commercial |
$665.04
|
| Rate for Payer: Aetna Medicare |
$516.15
|
| Rate for Payer: BCBS Complete |
$392.40
|
| Rate for Payer: BCBS MAPPO |
$496.30
|
| Rate for Payer: BCN Medicare Advantage |
$496.30
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cofinity Commercial |
$714.67
|
| Rate for Payer: Cofinity Commercial |
$665.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.12
|
| Rate for Payer: Nomi Health Commercial |
$595.56
|
| Rate for Payer: PACE SWMI |
$496.30
|
| Rate for Payer: PHP Medicare Advantage |
$496.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.65
|
| Rate for Payer: Priority Health Medicare |
$501.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.30
|
| Rate for Payer: UHC Exchange |
$496.30
|
| Rate for Payer: UHC Medicare Advantage |
$496.30
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT 38570
|
| Hospital Charge Code |
38570
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$232.99 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: Aetna Commercial |
$833.85
|
| Rate for Payer: Aetna Medicare |
$255.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$306.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$306.56
|
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: BCBS MAPPO |
$245.25
|
| Rate for Payer: BCBS Trust/PPO |
$806.48
|
| Rate for Payer: BCN Commercial |
$762.73
|
| Rate for Payer: BCN Medicare Advantage |
$245.25
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cofinity Commercial |
$843.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$784.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.25
|
| Rate for Payer: Healthscope Commercial |
$882.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.75
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.51
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$833.85
|
| Rate for Payer: Nomi Health Commercial |
$804.42
|
| Rate for Payer: PACE Senior Care Partners |
$232.99
|
| Rate for Payer: PACE SWMI |
$245.25
|
| Rate for Payer: PHP Commercial |
$833.85
|
| Rate for Payer: PHP Medicare Advantage |
$245.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.65
|
| Rate for Payer: Priority Health HMO/PPO |
$853.47
|
| Rate for Payer: Priority Health Medicare |
$247.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$657.27
|
| Rate for Payer: Railroad Medicare Medicare |
$245.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.28
|
| Rate for Payer: UHC Core |
$819.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$245.25
|
| Rate for Payer: UHC Exchange |
$245.25
|
| Rate for Payer: UHC Medicare Advantage |
$245.25
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
| Rate for Payer: VA VA |
$245.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.75
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
HCPCS 38570
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$714.67 |
| Rate for Payer: Aetna Commercial |
$665.04
|
| Rate for Payer: Aetna Medicare |
$516.15
|
| Rate for Payer: BCBS Complete |
$392.40
|
| Rate for Payer: BCBS MAPPO |
$496.30
|
| Rate for Payer: BCN Medicare Advantage |
$496.30
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cofinity Commercial |
$714.67
|
| Rate for Payer: Cofinity Commercial |
$665.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.12
|
| Rate for Payer: Nomi Health Commercial |
$595.56
|
| Rate for Payer: PACE SWMI |
$496.30
|
| Rate for Payer: PHP Medicare Advantage |
$496.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.65
|
| Rate for Payer: Priority Health Medicare |
$501.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.30
|
| Rate for Payer: UHC Exchange |
$496.30
|
| Rate for Payer: UHC Medicare Advantage |
$496.30
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$2,071.00
|
|
|
Service Code
|
HCPCS 49651
|
| Min. Negotiated Rate |
$550.11 |
| Max. Negotiated Rate |
$1,346.15 |
| Rate for Payer: Aetna Commercial |
$737.15
|
| Rate for Payer: Aetna Medicare |
$572.11
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS MAPPO |
$550.11
|
| Rate for Payer: BCN Medicare Advantage |
$550.11
|
| Rate for Payer: Cash Price |
$1,656.80
|
| Rate for Payer: Cash Price |
$1,656.80
|
| Rate for Payer: Cofinity Commercial |
$792.16
|
| Rate for Payer: Cofinity Commercial |
$737.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.62
|
| Rate for Payer: Nomi Health Commercial |
$660.13
|
| Rate for Payer: PACE SWMI |
$550.11
|
| Rate for Payer: PHP Medicare Advantage |
$550.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.15
|
| Rate for Payer: Priority Health Medicare |
$555.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$550.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.11
|
| Rate for Payer: UHC Exchange |
$550.11
|
| Rate for Payer: UHC Medicare Advantage |
$550.11
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
49651
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$491.86 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: Aetna Medicare |
$538.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$647.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$647.19
|
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: BCBS MAPPO |
$517.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,702.57
|
| Rate for Payer: BCN Commercial |
$1,610.20
|
| Rate for Payer: BCN Medicare Advantage |
$517.75
|
| Rate for Payer: Cash Price |
$1,656.80
|
| Rate for Payer: Cash Price |
$1,656.80
|
| Rate for Payer: Cofinity Commercial |
$1,781.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,656.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.75
|
| Rate for Payer: Healthscope Commercial |
$1,863.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,553.25
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.64
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,760.35
|
| Rate for Payer: Nomi Health Commercial |
$1,698.22
|
| Rate for Payer: PACE Senior Care Partners |
$491.86
|
| Rate for Payer: PACE SWMI |
$517.75
|
| Rate for Payer: PHP Commercial |
$1,760.35
|
| Rate for Payer: PHP Medicare Advantage |
$517.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,801.77
|
| Rate for Payer: Priority Health Medicare |
$522.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,387.57
|
| Rate for Payer: Railroad Medicare Medicare |
$517.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,822.48
|
| Rate for Payer: UHC Core |
$1,729.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.75
|
| Rate for Payer: UHC Exchange |
$517.75
|
| Rate for Payer: UHC Medicare Advantage |
$517.75
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
| Rate for Payer: VA VA |
$517.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,553.25
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
49651
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,346.15 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,690.56
|
| Rate for Payer: BCN Commercial |
$1,600.47
|
| Rate for Payer: Cash Price |
$1,656.80
|
| Rate for Payer: Cofinity Commercial |
$1,781.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,656.80
|
| Rate for Payer: Healthscope Commercial |
$1,863.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,553.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,760.35
|
| Rate for Payer: Nomi Health Commercial |
$1,698.22
|
| Rate for Payer: PHP Commercial |
$1,760.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,801.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,387.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,822.48
|
| Rate for Payer: UHC Core |
$1,729.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,553.25
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$2,071.00
|
|
|
Service Code
|
HCPCS 49651
|
| Hospital Charge Code |
49651
|
| Min. Negotiated Rate |
$550.11 |
| Max. Negotiated Rate |
$1,346.15 |
| Rate for Payer: Aetna Commercial |
$737.15
|
| Rate for Payer: Aetna Medicare |
$572.11
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS MAPPO |
$550.11
|
| Rate for Payer: BCN Medicare Advantage |
$550.11
|
| Rate for Payer: Cash Price |
$1,656.80
|
| Rate for Payer: Cash Price |
$1,656.80
|
| Rate for Payer: Cofinity Commercial |
$792.16
|
| Rate for Payer: Cofinity Commercial |
$737.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.62
|
| Rate for Payer: Nomi Health Commercial |
$660.13
|
| Rate for Payer: PACE SWMI |
$550.11
|
| Rate for Payer: PHP Medicare Advantage |
$550.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.15
|
| Rate for Payer: Priority Health Medicare |
$555.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$550.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.11
|
| Rate for Payer: UHC Exchange |
$550.11
|
| Rate for Payer: UHC Medicare Advantage |
$550.11
|
|
|
PR LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
HCPCS 43652
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$1,074.57 |
| Rate for Payer: Aetna Commercial |
$999.95
|
| Rate for Payer: Aetna Medicare |
$776.08
|
| Rate for Payer: BCBS Complete |
$638.00
|
| Rate for Payer: BCBS MAPPO |
$746.23
|
| Rate for Payer: BCN Medicare Advantage |
$746.23
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cofinity Commercial |
$999.95
|
| Rate for Payer: Cofinity Commercial |
$1,074.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.54
|
| Rate for Payer: Nomi Health Commercial |
$895.48
|
| Rate for Payer: PACE SWMI |
$746.23
|
| Rate for Payer: PHP Medicare Advantage |
$746.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,036.75
|
| Rate for Payer: Priority Health Medicare |
$753.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.23
|
| Rate for Payer: UHC Exchange |
$746.23
|
| Rate for Payer: UHC Medicare Advantage |
$746.23
|
|
|
PR LAPS SURG TRNSXJ VAGUS NRV TRUNCAL
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 43651
|
| Min. Negotiated Rate |
$640.47 |
| Max. Negotiated Rate |
$1,681.55 |
| Rate for Payer: Aetna Commercial |
$858.23
|
| Rate for Payer: Aetna Medicare |
$666.09
|
| Rate for Payer: BCBS Complete |
$1,034.80
|
| Rate for Payer: BCBS MAPPO |
$640.47
|
| Rate for Payer: BCN Medicare Advantage |
$640.47
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cofinity Commercial |
$922.28
|
| Rate for Payer: Cofinity Commercial |
$858.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.49
|
| Rate for Payer: Nomi Health Commercial |
$768.56
|
| Rate for Payer: PACE SWMI |
$640.47
|
| Rate for Payer: PHP Medicare Advantage |
$640.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health Medicare |
$646.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.47
|
| Rate for Payer: UHC Exchange |
$640.47
|
| Rate for Payer: UHC Medicare Advantage |
$640.47
|
|
|
PR LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 49322
|
| Min. Negotiated Rate |
$363.45 |
| Max. Negotiated Rate |
$1,014.65 |
| Rate for Payer: Aetna Commercial |
$487.02
|
| Rate for Payer: Aetna Medicare |
$377.99
|
| Rate for Payer: BCBS Complete |
$624.40
|
| Rate for Payer: BCBS MAPPO |
$363.45
|
| Rate for Payer: BCN Medicare Advantage |
$363.45
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cofinity Commercial |
$523.37
|
| Rate for Payer: Cofinity Commercial |
$487.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.62
|
| Rate for Payer: Nomi Health Commercial |
$436.14
|
| Rate for Payer: PACE SWMI |
$363.45
|
| Rate for Payer: PHP Medicare Advantage |
$363.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.65
|
| Rate for Payer: Priority Health Medicare |
$367.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.45
|
| Rate for Payer: UHC Exchange |
$363.45
|
| Rate for Payer: UHC Medicare Advantage |
$363.45
|
|
|
PR LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY
|
Professional
|
Both
|
$1,945.00
|
|
|
Service Code
|
HCPCS 49323
|
| Min. Negotiated Rate |
$620.87 |
| Max. Negotiated Rate |
$1,264.25 |
| Rate for Payer: Aetna Commercial |
$831.97
|
| Rate for Payer: Aetna Medicare |
$645.70
|
| Rate for Payer: BCBS Complete |
$778.00
|
| Rate for Payer: BCBS MAPPO |
$620.87
|
| Rate for Payer: BCN Medicare Advantage |
$620.87
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cofinity Commercial |
$894.05
|
| Rate for Payer: Cofinity Commercial |
$831.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.91
|
| Rate for Payer: Nomi Health Commercial |
$745.04
|
| Rate for Payer: PACE SWMI |
$620.87
|
| Rate for Payer: PHP Medicare Advantage |
$620.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,264.25
|
| Rate for Payer: Priority Health Medicare |
$627.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$620.87
|
| Rate for Payer: UHC Exchange |
$620.87
|
| Rate for Payer: UHC Medicare Advantage |
$620.87
|
|
|
PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Professional
|
Both
|
$2,772.00
|
|
|
Service Code
|
HCPCS 58571
|
| Min. Negotiated Rate |
$871.11 |
| Max. Negotiated Rate |
$1,801.80 |
| Rate for Payer: Aetna Commercial |
$1,167.29
|
| Rate for Payer: Aetna Medicare |
$905.95
|
| Rate for Payer: BCBS Complete |
$1,108.80
|
| Rate for Payer: BCBS MAPPO |
$871.11
|
| Rate for Payer: BCN Medicare Advantage |
$871.11
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cofinity Commercial |
$1,254.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$871.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.67
|
| Rate for Payer: Nomi Health Commercial |
$1,045.33
|
| Rate for Payer: PACE SWMI |
$871.11
|
| Rate for Payer: PHP Medicare Advantage |
$871.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.80
|
| Rate for Payer: Priority Health Medicare |
$879.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$871.11
|
| Rate for Payer: UHC Exchange |
$871.11
|
| Rate for Payer: UHC Medicare Advantage |
$871.11
|
|
|
PR LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 59150
|
| Min. Negotiated Rate |
$590.00 |
| Max. Negotiated Rate |
$1,112.75 |
| Rate for Payer: Aetna Commercial |
$1,035.47
|
| Rate for Payer: Aetna Medicare |
$803.65
|
| Rate for Payer: BCBS Complete |
$590.00
|
| Rate for Payer: BCBS MAPPO |
$772.74
|
| Rate for Payer: BCN Medicare Advantage |
$772.74
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,112.75
|
| Rate for Payer: Cofinity Commercial |
$1,035.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.38
|
| Rate for Payer: Nomi Health Commercial |
$927.29
|
| Rate for Payer: PACE SWMI |
$772.74
|
| Rate for Payer: PHP Medicare Advantage |
$772.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.75
|
| Rate for Payer: Priority Health Medicare |
$780.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.74
|
| Rate for Payer: UHC Exchange |
$772.74
|
| Rate for Payer: UHC Medicare Advantage |
$772.74
|
|
|
PR LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 59151
|
| Min. Negotiated Rate |
$556.00 |
| Max. Negotiated Rate |
$1,088.35 |
| Rate for Payer: Aetna Commercial |
$1,012.77
|
| Rate for Payer: Aetna Medicare |
$786.03
|
| Rate for Payer: BCBS Complete |
$556.00
|
| Rate for Payer: BCBS MAPPO |
$755.80
|
| Rate for Payer: BCN Medicare Advantage |
$755.80
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cofinity Commercial |
$1,088.35
|
| Rate for Payer: Cofinity Commercial |
$1,012.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$755.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$793.59
|
| Rate for Payer: Nomi Health Commercial |
$906.96
|
| Rate for Payer: PACE SWMI |
$755.80
|
| Rate for Payer: PHP Medicare Advantage |
$755.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.50
|
| Rate for Payer: Priority Health Medicare |
$763.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$755.80
|
| Rate for Payer: UHC Exchange |
$755.80
|
| Rate for Payer: UHC Medicare Advantage |
$755.80
|
|
|
PR LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$2,890.00
|
|
|
Service Code
|
HCPCS 50947
|
| Min. Negotiated Rate |
$1,156.00 |
| Max. Negotiated Rate |
$1,896.84 |
| Rate for Payer: Aetna Commercial |
$1,765.12
|
| Rate for Payer: Aetna Medicare |
$1,369.94
|
| Rate for Payer: BCBS Complete |
$1,156.00
|
| Rate for Payer: BCBS MAPPO |
$1,317.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,317.25
|
| Rate for Payer: Cash Price |
$2,312.00
|
| Rate for Payer: Cash Price |
$2,312.00
|
| Rate for Payer: Cofinity Commercial |
$1,896.84
|
| Rate for Payer: Cofinity Commercial |
$1,765.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,317.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,383.11
|
| Rate for Payer: Nomi Health Commercial |
$1,580.70
|
| Rate for Payer: PACE SWMI |
$1,317.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,317.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,878.50
|
| Rate for Payer: Priority Health Medicare |
$1,330.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,317.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,317.25
|
| Rate for Payer: UHC Exchange |
$1,317.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,317.25
|
|
|
PR LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 50948
|
| Min. Negotiated Rate |
$1,046.80 |
| Max. Negotiated Rate |
$1,754.44 |
| Rate for Payer: Aetna Commercial |
$1,632.60
|
| Rate for Payer: Aetna Medicare |
$1,267.09
|
| Rate for Payer: BCBS Complete |
$1,046.80
|
| Rate for Payer: BCBS MAPPO |
$1,218.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.36
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,754.44
|
| Rate for Payer: Cofinity Commercial |
$1,632.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.28
|
| Rate for Payer: Nomi Health Commercial |
$1,462.03
|
| Rate for Payer: PACE SWMI |
$1,218.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health Medicare |
$1,230.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.36
|
| Rate for Payer: UHC Exchange |
$1,218.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.36
|
|
|
PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR
|
Professional
|
Both
|
$3,230.00
|
|
|
Service Code
|
HCPCS 58554
|
| Min. Negotiated Rate |
$1,253.66 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Aetna Commercial |
$1,679.90
|
| Rate for Payer: Aetna Medicare |
$1,303.81
|
| Rate for Payer: BCBS Complete |
$1,292.00
|
| Rate for Payer: BCBS MAPPO |
$1,253.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,253.66
|
| Rate for Payer: Cash Price |
$2,584.00
|
| Rate for Payer: Cash Price |
$2,584.00
|
| Rate for Payer: Cofinity Commercial |
$1,805.27
|
| Rate for Payer: Cofinity Commercial |
$1,679.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,253.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,316.34
|
| Rate for Payer: Nomi Health Commercial |
$1,504.39
|
| Rate for Payer: PACE SWMI |
$1,253.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,253.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,099.50
|
| Rate for Payer: Priority Health Medicare |
$1,266.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,253.66
|
| Rate for Payer: UHC Exchange |
$1,253.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,253.66
|
|
|
PR LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,517.00
|
|
|
Service Code
|
HCPCS 58550
|
| Min. Negotiated Rate |
$848.50 |
| Max. Negotiated Rate |
$1,636.05 |
| Rate for Payer: Aetna Commercial |
$1,136.99
|
| Rate for Payer: Aetna Medicare |
$882.44
|
| Rate for Payer: BCBS Complete |
$1,006.80
|
| Rate for Payer: BCBS MAPPO |
$848.50
|
| Rate for Payer: BCN Medicare Advantage |
$848.50
|
| Rate for Payer: Cash Price |
$2,013.60
|
| Rate for Payer: Cash Price |
$2,013.60
|
| Rate for Payer: Cofinity Commercial |
$1,221.84
|
| Rate for Payer: Cofinity Commercial |
$1,136.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$848.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$890.92
|
| Rate for Payer: Nomi Health Commercial |
$1,018.20
|
| Rate for Payer: PACE SWMI |
$848.50
|
| Rate for Payer: PHP Medicare Advantage |
$848.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,636.05
|
| Rate for Payer: Priority Health Medicare |
$856.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$848.50
|
| Rate for Payer: UHC Exchange |
$848.50
|
| Rate for Payer: UHC Medicare Advantage |
$848.50
|
|
|
PR LAPS W/REVISION INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 49325
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$622.05 |
| Rate for Payer: Aetna Commercial |
$537.34
|
| Rate for Payer: Aetna Medicare |
$417.04
|
| Rate for Payer: BCBS Complete |
$382.80
|
| Rate for Payer: BCBS MAPPO |
$401.00
|
| Rate for Payer: BCN Medicare Advantage |
$401.00
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cofinity Commercial |
$577.44
|
| Rate for Payer: Cofinity Commercial |
$537.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$401.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$421.05
|
| Rate for Payer: Nomi Health Commercial |
$481.20
|
| Rate for Payer: PACE SWMI |
$401.00
|
| Rate for Payer: PHP Medicare Advantage |
$401.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.05
|
| Rate for Payer: Priority Health Medicare |
$405.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$401.00
|
| Rate for Payer: UHC Exchange |
$401.00
|
| Rate for Payer: UHC Medicare Advantage |
$401.00
|
|
|
PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 58552
|
| Min. Negotiated Rate |
$943.77 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$1,264.65
|
| Rate for Payer: Aetna Medicare |
$981.52
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$943.77
|
| Rate for Payer: BCN Medicare Advantage |
$943.77
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$1,359.03
|
| Rate for Payer: Cofinity Commercial |
$1,264.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$990.96
|
| Rate for Payer: Nomi Health Commercial |
$1,132.52
|
| Rate for Payer: PACE SWMI |
$943.77
|
| Rate for Payer: PHP Medicare Advantage |
$943.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$953.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$943.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$943.77
|
| Rate for Payer: UHC Exchange |
$943.77
|
| Rate for Payer: UHC Medicare Advantage |
$943.77
|
|
|
PR LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS
|
Professional
|
Both
|
$3,016.00
|
|
|
Service Code
|
HCPCS 58553
|
| Min. Negotiated Rate |
$1,077.81 |
| Max. Negotiated Rate |
$1,960.40 |
| Rate for Payer: Aetna Commercial |
$1,444.27
|
| Rate for Payer: Aetna Medicare |
$1,120.92
|
| Rate for Payer: BCBS Complete |
$1,206.40
|
| Rate for Payer: BCBS MAPPO |
$1,077.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.81
|
| Rate for Payer: Cash Price |
$2,412.80
|
| Rate for Payer: Cash Price |
$2,412.80
|
| Rate for Payer: Cofinity Commercial |
$1,552.05
|
| Rate for Payer: Cofinity Commercial |
$1,444.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.70
|
| Rate for Payer: Nomi Health Commercial |
$1,293.37
|
| Rate for Payer: PACE SWMI |
$1,077.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.40
|
| Rate for Payer: Priority Health Medicare |
$1,088.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.81
|
| Rate for Payer: UHC Exchange |
$1,077.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.81
|
|
|
PR LAPT RPR PARAESOPH HIATAL HERNIA W/MESH
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
HCPCS 43333
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,760.90 |
| Rate for Payer: Aetna Commercial |
$1,638.62
|
| Rate for Payer: Aetna Medicare |
$1,271.76
|
| Rate for Payer: BCBS Complete |
$1,050.00
|
| Rate for Payer: BCBS MAPPO |
$1,222.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,222.85
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cofinity Commercial |
$1,760.90
|
| Rate for Payer: Cofinity Commercial |
$1,638.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,222.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,283.99
|
| Rate for Payer: Nomi Health Commercial |
$1,467.42
|
| Rate for Payer: PACE SWMI |
$1,222.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,222.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.25
|
| Rate for Payer: Priority Health Medicare |
$1,235.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,222.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,222.85
|
| Rate for Payer: UHC Exchange |
$1,222.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,222.85
|
|
|
PR LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 58960
|
| Min. Negotiated Rate |
$860.00 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$1,281.54
|
| Rate for Payer: Aetna Medicare |
$994.62
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$956.37
|
| Rate for Payer: BCN Medicare Advantage |
$956.37
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$1,377.17
|
| Rate for Payer: Cofinity Commercial |
$1,281.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.19
|
| Rate for Payer: Nomi Health Commercial |
$1,147.64
|
| Rate for Payer: PACE SWMI |
$956.37
|
| Rate for Payer: PHP Medicare Advantage |
$956.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$965.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$956.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.37
|
| Rate for Payer: UHC Exchange |
$956.37
|
| Rate for Payer: UHC Medicare Advantage |
$956.37
|
|
|
PR LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS
|
Professional
|
Both
|
$2,415.00
|
|
|
Service Code
|
HCPCS 47015
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$1,628.19 |
| Rate for Payer: Aetna Commercial |
$1,515.12
|
| Rate for Payer: Aetna Medicare |
$1,175.92
|
| Rate for Payer: BCBS Complete |
$966.00
|
| Rate for Payer: BCBS MAPPO |
$1,130.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,130.69
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cofinity Commercial |
$1,628.19
|
| Rate for Payer: Cofinity Commercial |
$1,515.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,130.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,187.22
|
| Rate for Payer: Nomi Health Commercial |
$1,356.83
|
| Rate for Payer: PACE SWMI |
$1,130.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,130.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.75
|
| Rate for Payer: Priority Health Medicare |
$1,142.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,130.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,130.69
|
| Rate for Payer: UHC Exchange |
$1,130.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,130.69
|
|
