|
PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 43279
|
| Min. Negotiated Rate |
$765.10 |
| Max. Negotiated Rate |
$2,338.44 |
| Rate for Payer: Aetna Commercial |
$1,605.67
|
| Rate for Payer: Aetna Medicare |
$1,246.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,725.49
|
| Rate for Payer: BCBS Complete |
$803.36
|
| Rate for Payer: BCBS MAPPO |
$1,198.26
|
| Rate for Payer: BCN Commercial |
$1,919.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,198.26
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,605.67
|
| Rate for Payer: Cofinity Commercial |
$1,725.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,198.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,258.17
|
| Rate for Payer: Meridian Medicaid |
$803.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,318.09
|
| Rate for Payer: Nomi Health Commercial |
$1,437.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,856.25
|
| Rate for Payer: PACE SWMI |
$1,198.26
|
| Rate for Payer: PHP Commercial |
$1,677.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,198.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$765.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,338.44
|
| Rate for Payer: Priority Health Medicare |
$1,198.26
|
| Rate for Payer: Priority Health SBD |
$2,338.44
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,198.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,302.94
|
| Rate for Payer: UHC Core |
$2,302.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,198.26
|
| Rate for Payer: UHC Exchange |
$2,302.94
|
| Rate for Payer: UHC Medicaid |
$765.10
|
| Rate for Payer: UHCCP Medicaid |
$765.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.50
|
|
|
PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$2,295.00
|
|
|
Service Code
|
HCPCS 58662
|
| Min. Negotiated Rate |
$412.37 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Aetna Commercial |
$859.49
|
| Rate for Payer: Aetna Medicare |
$667.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.63
|
| Rate for Payer: BCBS Complete |
$432.99
|
| Rate for Payer: BCBS MAPPO |
$641.41
|
| Rate for Payer: BCN Commercial |
$1,070.66
|
| Rate for Payer: BCN Medicare Advantage |
$641.41
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cofinity Commercial |
$859.49
|
| Rate for Payer: Cofinity Commercial |
$923.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.48
|
| Rate for Payer: Meridian Medicaid |
$432.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$705.55
|
| Rate for Payer: Nomi Health Commercial |
$769.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.25
|
| Rate for Payer: PACE SWMI |
$641.41
|
| Rate for Payer: PHP Commercial |
$897.97
|
| Rate for Payer: PHP Medicare Advantage |
$641.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,084.35
|
| Rate for Payer: Priority Health Medicare |
$641.41
|
| Rate for Payer: Priority Health SBD |
$1,084.35
|
| Rate for Payer: Priority Health Tiered Network |
$1,084.35
|
| Rate for Payer: Railroad Medicare Medicare |
$641.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,260.56
|
| Rate for Payer: UHC Core |
$1,260.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$641.41
|
| Rate for Payer: UHC Exchange |
$1,260.56
|
| Rate for Payer: UHC Medicaid |
$412.37
|
| Rate for Payer: UHCCP Medicaid |
$412.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,055.70
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT
|
Professional
|
Both
|
$1,778.00
|
|
|
Service Code
|
HCPCS 43774
|
| Min. Negotiated Rate |
$578.72 |
| Max. Negotiated Rate |
$1,765.66 |
| Rate for Payer: Aetna Commercial |
$1,209.46
|
| Rate for Payer: Aetna Medicare |
$938.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.72
|
| Rate for Payer: BCBS Complete |
$607.66
|
| Rate for Payer: BCBS MAPPO |
$902.58
|
| Rate for Payer: BCN Commercial |
$1,591.97
|
| Rate for Payer: BCN Medicare Advantage |
$902.58
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cofinity Commercial |
$1,209.46
|
| Rate for Payer: Cofinity Commercial |
$1,299.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.71
|
| Rate for Payer: Meridian Medicaid |
$607.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$992.84
|
| Rate for Payer: Nomi Health Commercial |
$1,083.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,333.50
|
| Rate for Payer: PACE SWMI |
$902.58
|
| Rate for Payer: PHP Commercial |
$1,263.61
|
| Rate for Payer: PHP Medicare Advantage |
$902.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,765.66
|
| Rate for Payer: Priority Health Medicare |
$902.58
|
| Rate for Payer: Priority Health SBD |
$1,765.66
|
| Rate for Payer: Priority Health Tiered Network |
$1,765.66
|
| Rate for Payer: Railroad Medicare Medicare |
$902.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.47
|
| Rate for Payer: UHC Core |
$1,713.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$902.58
|
| Rate for Payer: UHC Exchange |
$1,713.47
|
| Rate for Payer: UHC Medicaid |
$578.72
|
| Rate for Payer: UHCCP Medicaid |
$578.72
|
| Rate for Payer: UMR Bronson Commercial |
$817.88
|
|
|
PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$4,807.00
|
|
|
Service Code
|
HCPCS 43775
|
| Min. Negotiated Rate |
$637.72 |
| Max. Negotiated Rate |
$3,605.25 |
| Rate for Payer: Aetna Commercial |
$1,351.67
|
| Rate for Payer: Aetna Medicare |
$1,049.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,452.54
|
| Rate for Payer: BCBS Complete |
$669.61
|
| Rate for Payer: BCBS MAPPO |
$1,008.71
|
| Rate for Payer: BCN Commercial |
$2,540.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,008.71
|
| Rate for Payer: Cash Price |
$3,845.60
|
| Rate for Payer: Cash Price |
$3,845.60
|
| Rate for Payer: Cofinity Commercial |
$1,351.67
|
| Rate for Payer: Cofinity Commercial |
$1,452.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,008.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,059.15
|
| Rate for Payer: Meridian Medicaid |
$669.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,109.58
|
| Rate for Payer: Nomi Health Commercial |
$1,210.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,605.25
|
| Rate for Payer: PACE SWMI |
$1,008.71
|
| Rate for Payer: PHP Commercial |
$1,412.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,008.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,012.61
|
| Rate for Payer: Priority Health Medicare |
$1,008.71
|
| Rate for Payer: Priority Health SBD |
$2,012.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,012.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,008.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,005.89
|
| Rate for Payer: UHC Core |
$2,005.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,008.71
|
| Rate for Payer: UHC Exchange |
$2,005.89
|
| Rate for Payer: UHC Medicaid |
$637.72
|
| Rate for Payer: UHCCP Medicaid |
$637.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,211.22
|
|
|
PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM
|
Professional
|
Both
|
$3,183.00
|
|
|
Service Code
|
HCPCS 43644
|
| Min. Negotiated Rate |
$1,031.99 |
| Max. Negotiated Rate |
$3,176.38 |
| Rate for Payer: Aetna Commercial |
$2,165.32
|
| Rate for Payer: Aetna Medicare |
$1,680.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,165.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,326.91
|
| Rate for Payer: BCBS Complete |
$1,083.59
|
| Rate for Payer: BCBS MAPPO |
$1,615.91
|
| Rate for Payer: BCN Commercial |
$2,606.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,615.91
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cofinity Commercial |
$2,165.32
|
| Rate for Payer: Cofinity Commercial |
$2,326.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,615.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,696.71
|
| Rate for Payer: Meridian Medicaid |
$1,083.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,777.50
|
| Rate for Payer: Nomi Health Commercial |
$1,939.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.25
|
| Rate for Payer: PACE SWMI |
$1,615.91
|
| Rate for Payer: PHP Commercial |
$2,262.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,615.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,031.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,176.38
|
| Rate for Payer: Priority Health Medicare |
$1,615.91
|
| Rate for Payer: Priority Health SBD |
$3,176.38
|
| Rate for Payer: Priority Health Tiered Network |
$3,176.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,615.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,105.74
|
| Rate for Payer: UHC Core |
$3,105.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,615.91
|
| Rate for Payer: UHC Exchange |
$3,105.74
|
| Rate for Payer: UHC Medicaid |
$1,031.99
|
| Rate for Payer: UHCCP Medicaid |
$1,031.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,464.18
|
|
|
PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ
|
Professional
|
Both
|
$3,436.00
|
|
|
Service Code
|
HCPCS 43645
|
| Min. Negotiated Rate |
$1,095.67 |
| Max. Negotiated Rate |
$3,386.32 |
| Rate for Payer: Aetna Commercial |
$2,300.11
|
| Rate for Payer: Aetna Medicare |
$1,785.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,300.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.76
|
| Rate for Payer: BCBS Complete |
$1,150.45
|
| Rate for Payer: BCBS MAPPO |
$1,716.50
|
| Rate for Payer: BCN Commercial |
$2,779.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.50
|
| Rate for Payer: Cash Price |
$2,748.80
|
| Rate for Payer: Cash Price |
$2,748.80
|
| Rate for Payer: Cofinity Commercial |
$2,300.11
|
| Rate for Payer: Cofinity Commercial |
$2,471.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,802.33
|
| Rate for Payer: Meridian Medicaid |
$1,150.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,888.15
|
| Rate for Payer: Nomi Health Commercial |
$2,059.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,577.00
|
| Rate for Payer: PACE SWMI |
$1,716.50
|
| Rate for Payer: PHP Commercial |
$2,403.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,095.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,386.32
|
| Rate for Payer: Priority Health Medicare |
$1,716.50
|
| Rate for Payer: Priority Health SBD |
$3,386.32
|
| Rate for Payer: Priority Health Tiered Network |
$3,386.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,308.00
|
| Rate for Payer: UHC Core |
$3,308.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,716.50
|
| Rate for Payer: UHC Exchange |
$3,308.00
|
| Rate for Payer: UHC Medicaid |
$1,095.67
|
| Rate for Payer: UHCCP Medicaid |
$1,095.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,580.56
|
|
|
PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$764.00
|
|
|
Service Code
|
HCPCS 49324
|
| Min. Negotiated Rate |
$233.45 |
| Max. Negotiated Rate |
$707.48 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Aetna Medicare |
$378.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.79
|
| Rate for Payer: BCBS Complete |
$245.12
|
| Rate for Payer: BCBS MAPPO |
$363.74
|
| Rate for Payer: BCN Commercial |
$580.64
|
| Rate for Payer: BCN Medicare Advantage |
$363.74
|
| Rate for Payer: Cash Price |
$611.20
|
| Rate for Payer: Cash Price |
$611.20
|
| Rate for Payer: Cofinity Commercial |
$487.41
|
| Rate for Payer: Cofinity Commercial |
$523.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.93
|
| Rate for Payer: Meridian Medicaid |
$245.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$400.11
|
| Rate for Payer: Nomi Health Commercial |
$436.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$573.00
|
| Rate for Payer: PACE SWMI |
$363.74
|
| Rate for Payer: PHP Commercial |
$509.24
|
| Rate for Payer: PHP Medicare Advantage |
$363.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$707.48
|
| Rate for Payer: Priority Health Medicare |
$363.74
|
| Rate for Payer: Priority Health SBD |
$707.48
|
| Rate for Payer: Priority Health Tiered Network |
$707.48
|
| Rate for Payer: Railroad Medicare Medicare |
$363.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.22
|
| Rate for Payer: UHC Core |
$693.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$363.74
|
| Rate for Payer: UHC Exchange |
$693.22
|
| Rate for Payer: UHC Medicaid |
$233.45
|
| Rate for Payer: UHCCP Medicaid |
$233.45
|
| Rate for Payer: UMR Bronson Commercial |
$351.44
|
|
|
PR LAPS LIGATION SPERMATIC VEINS VARICOCELE
|
Professional
|
Both
|
$914.00
|
|
|
Service Code
|
HCPCS 55550
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$753.51 |
| Rate for Payer: Aetna Commercial |
$521.60
|
| Rate for Payer: Aetna Medicare |
$404.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.52
|
| Rate for Payer: BCBS Complete |
$265.69
|
| Rate for Payer: BCBS MAPPO |
$389.25
|
| Rate for Payer: BCN Commercial |
$647.87
|
| Rate for Payer: BCN Medicare Advantage |
$389.25
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cofinity Commercial |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$560.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.71
|
| Rate for Payer: Meridian Medicaid |
$265.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$428.18
|
| Rate for Payer: Nomi Health Commercial |
$467.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$685.50
|
| Rate for Payer: PACE SWMI |
$389.25
|
| Rate for Payer: PHP Commercial |
$544.95
|
| Rate for Payer: PHP Medicare Advantage |
$389.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$705.75
|
| Rate for Payer: Priority Health Medicare |
$389.25
|
| Rate for Payer: Priority Health SBD |
$705.75
|
| Rate for Payer: Priority Health Tiered Network |
$705.75
|
| Rate for Payer: Railroad Medicare Medicare |
$389.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$753.51
|
| Rate for Payer: UHC Core |
$753.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$389.25
|
| Rate for Payer: UHC Exchange |
$753.51
|
| Rate for Payer: UHC Medicaid |
$253.04
|
| Rate for Payer: UHCCP Medicaid |
$253.04
|
| Rate for Payer: UMR Bronson Commercial |
$420.44
|
|
|
PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 44213
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Aetna Commercial |
$221.90
|
| Rate for Payer: Aetna Medicare |
$172.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.46
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS MAPPO |
$165.60
|
| Rate for Payer: BCN Commercial |
$275.88
|
| Rate for Payer: BCN Medicare Advantage |
$165.60
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cofinity Commercial |
$221.90
|
| Rate for Payer: Cofinity Commercial |
$238.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.88
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$182.16
|
| Rate for Payer: Nomi Health Commercial |
$198.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$400.50
|
| Rate for Payer: PACE SWMI |
$165.60
|
| Rate for Payer: PHP Commercial |
$231.84
|
| Rate for Payer: PHP Medicare Advantage |
$165.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.14
|
| Rate for Payer: Priority Health Medicare |
$165.60
|
| Rate for Payer: Priority Health SBD |
$336.14
|
| Rate for Payer: Priority Health Tiered Network |
$336.14
|
| Rate for Payer: Railroad Medicare Medicare |
$165.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.22
|
| Rate for Payer: UHC Core |
$334.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$165.60
|
| Rate for Payer: UHC Exchange |
$334.22
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
| Rate for Payer: UMR Bronson Commercial |
$245.64
|
|
|
PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
HCPCS 58545
|
| Min. Negotiated Rate |
$515.25 |
| Max. Negotiated Rate |
$1,594.01 |
| Rate for Payer: Aetna Commercial |
$1,075.16
|
| Rate for Payer: Aetna Medicare |
$834.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.40
|
| Rate for Payer: BCBS Complete |
$541.01
|
| Rate for Payer: BCBS MAPPO |
$802.36
|
| Rate for Payer: BCN Commercial |
$1,352.02
|
| Rate for Payer: BCN Medicare Advantage |
$802.36
|
| Rate for Payer: Cash Price |
$1,572.00
|
| Rate for Payer: Cash Price |
$1,572.00
|
| Rate for Payer: Cofinity Commercial |
$1,075.16
|
| Rate for Payer: Cofinity Commercial |
$1,155.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$842.48
|
| Rate for Payer: Meridian Medicaid |
$541.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$882.60
|
| Rate for Payer: Nomi Health Commercial |
$962.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.75
|
| Rate for Payer: PACE SWMI |
$802.36
|
| Rate for Payer: PHP Commercial |
$1,123.30
|
| Rate for Payer: PHP Medicare Advantage |
$802.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,369.31
|
| Rate for Payer: Priority Health Medicare |
$802.36
|
| Rate for Payer: Priority Health SBD |
$1,369.31
|
| Rate for Payer: Priority Health Tiered Network |
$1,369.31
|
| Rate for Payer: Railroad Medicare Medicare |
$802.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,594.01
|
| Rate for Payer: UHC Core |
$1,594.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$802.36
|
| Rate for Payer: UHC Exchange |
$1,594.01
|
| Rate for Payer: UHC Medicaid |
$515.25
|
| Rate for Payer: UHCCP Medicaid |
$515.25
|
| Rate for Payer: UMR Bronson Commercial |
$903.90
|
|
|
PR LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS
|
Professional
|
Both
|
$2,474.00
|
|
|
Service Code
|
HCPCS 58546
|
| Min. Negotiated Rate |
$624.73 |
| Max. Negotiated Rate |
$1,990.80 |
| Rate for Payer: Aetna Commercial |
$1,307.09
|
| Rate for Payer: Aetna Medicare |
$1,014.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,307.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.63
|
| Rate for Payer: BCBS Complete |
$655.97
|
| Rate for Payer: BCBS MAPPO |
$975.44
|
| Rate for Payer: BCN Commercial |
$1,666.24
|
| Rate for Payer: BCN Medicare Advantage |
$975.44
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cofinity Commercial |
$1,307.09
|
| Rate for Payer: Cofinity Commercial |
$1,404.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$975.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,024.21
|
| Rate for Payer: Meridian Medicaid |
$655.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,072.98
|
| Rate for Payer: Nomi Health Commercial |
$1,170.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,855.50
|
| Rate for Payer: PACE SWMI |
$975.44
|
| Rate for Payer: PHP Commercial |
$1,365.62
|
| Rate for Payer: PHP Medicare Advantage |
$975.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,687.54
|
| Rate for Payer: Priority Health Medicare |
$975.44
|
| Rate for Payer: Priority Health SBD |
$1,687.54
|
| Rate for Payer: Priority Health Tiered Network |
$1,687.54
|
| Rate for Payer: Railroad Medicare Medicare |
$975.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,990.80
|
| Rate for Payer: UHC Core |
$1,990.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$975.44
|
| Rate for Payer: UHC Exchange |
$1,990.80
|
| Rate for Payer: UHC Medicaid |
$624.73
|
| Rate for Payer: UHCCP Medicaid |
$624.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.04
|
|
|
PR LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY
|
Professional
|
Both
|
$5,800.00
|
|
|
Service Code
|
HCPCS 45395
|
| Min. Negotiated Rate |
$1,147.43 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$2,384.62
|
| Rate for Payer: Aetna Medicare |
$1,850.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,384.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,562.58
|
| Rate for Payer: BCBS Complete |
$1,204.80
|
| Rate for Payer: BCBS MAPPO |
$1,779.57
|
| Rate for Payer: BCN Commercial |
$2,903.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,779.57
|
| Rate for Payer: Cash Price |
$4,640.00
|
| Rate for Payer: Cash Price |
$4,640.00
|
| Rate for Payer: Cofinity Commercial |
$2,384.62
|
| Rate for Payer: Cofinity Commercial |
$2,562.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,779.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,868.55
|
| Rate for Payer: Meridian Medicaid |
$1,204.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,957.53
|
| Rate for Payer: Nomi Health Commercial |
$2,135.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,350.00
|
| Rate for Payer: PACE SWMI |
$1,779.57
|
| Rate for Payer: PHP Commercial |
$2,491.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,779.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,537.39
|
| Rate for Payer: Priority Health Medicare |
$1,779.57
|
| Rate for Payer: Priority Health SBD |
$3,537.39
|
| Rate for Payer: Priority Health Tiered Network |
$3,537.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,779.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,474.17
|
| Rate for Payer: UHC Core |
$3,474.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,779.57
|
| Rate for Payer: UHC Exchange |
$3,474.17
|
| Rate for Payer: UHC Medicaid |
$1,147.43
|
| Rate for Payer: UHCCP Medicaid |
$1,147.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,668.00
|
|
|
PR LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR
|
Professional
|
Both
|
$6,285.00
|
|
|
Service Code
|
HCPCS 45397
|
| Min. Negotiated Rate |
$1,238.38 |
| Max. Negotiated Rate |
$4,713.75 |
| Rate for Payer: Aetna Commercial |
$2,573.93
|
| Rate for Payer: Aetna Medicare |
$1,997.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,573.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,766.01
|
| Rate for Payer: BCBS Complete |
$1,300.30
|
| Rate for Payer: BCBS MAPPO |
$1,920.84
|
| Rate for Payer: BCN Commercial |
$3,147.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,920.84
|
| Rate for Payer: Cash Price |
$5,028.00
|
| Rate for Payer: Cash Price |
$5,028.00
|
| Rate for Payer: Cofinity Commercial |
$2,573.93
|
| Rate for Payer: Cofinity Commercial |
$2,766.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,920.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,016.88
|
| Rate for Payer: Meridian Medicaid |
$1,300.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,112.92
|
| Rate for Payer: Nomi Health Commercial |
$2,305.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,713.75
|
| Rate for Payer: PACE SWMI |
$1,920.84
|
| Rate for Payer: PHP Commercial |
$2,689.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,920.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,238.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,834.71
|
| Rate for Payer: Priority Health Medicare |
$1,920.84
|
| Rate for Payer: Priority Health SBD |
$3,834.71
|
| Rate for Payer: Priority Health Tiered Network |
$3,834.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,920.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,779.94
|
| Rate for Payer: UHC Core |
$3,779.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,920.84
|
| Rate for Payer: UHC Exchange |
$3,779.94
|
| Rate for Payer: UHC Medicaid |
$1,238.38
|
| Rate for Payer: UHCCP Medicaid |
$1,238.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,891.10
|
|
|
PR LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
|
Professional
|
Both
|
$1,247.00
|
|
|
Service Code
|
HCPCS 49652
|
| Min. Negotiated Rate |
$498.80 |
| Max. Negotiated Rate |
$935.25 |
| Rate for Payer: Aetna Medicare |
$623.50
|
| Rate for Payer: BCBS Complete |
$498.80
|
| Rate for Payer: Cash Price |
$997.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$935.25
|
| Rate for Payer: UMR Bronson Commercial |
$573.62
|
|
|
PR LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,547.00
|
|
|
Service Code
|
HCPCS 49655
|
| Min. Negotiated Rate |
$1,418.80 |
| Max. Negotiated Rate |
$2,660.25 |
| Rate for Payer: Aetna Medicare |
$1,773.50
|
| Rate for Payer: BCBS Complete |
$1,418.80
|
| Rate for Payer: Cash Price |
$2,837.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,631.62
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH
|
Professional
|
Both
|
$5,119.00
|
|
|
Service Code
|
HCPCS 43282
|
| Min. Negotiated Rate |
$1,021.55 |
| Max. Negotiated Rate |
$3,839.25 |
| Rate for Payer: Aetna Commercial |
$2,148.53
|
| Rate for Payer: Aetna Medicare |
$1,667.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,148.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,308.87
|
| Rate for Payer: BCBS Complete |
$1,072.63
|
| Rate for Payer: BCBS MAPPO |
$1,603.38
|
| Rate for Payer: BCN Commercial |
$2,587.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,603.38
|
| Rate for Payer: Cash Price |
$4,095.20
|
| Rate for Payer: Cash Price |
$4,095.20
|
| Rate for Payer: Cofinity Commercial |
$2,148.53
|
| Rate for Payer: Cofinity Commercial |
$2,308.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,603.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,683.55
|
| Rate for Payer: Meridian Medicaid |
$1,072.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,763.72
|
| Rate for Payer: Nomi Health Commercial |
$1,924.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,839.25
|
| Rate for Payer: PACE SWMI |
$1,603.38
|
| Rate for Payer: PHP Commercial |
$2,244.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,603.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,021.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,152.70
|
| Rate for Payer: Priority Health Medicare |
$1,603.38
|
| Rate for Payer: Priority Health SBD |
$3,152.70
|
| Rate for Payer: Priority Health Tiered Network |
$3,152.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,603.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,107.07
|
| Rate for Payer: UHC Core |
$3,107.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,603.38
|
| Rate for Payer: UHC Exchange |
$3,107.07
|
| Rate for Payer: UHC Medicaid |
$1,021.55
|
| Rate for Payer: UHCCP Medicaid |
$1,021.55
|
| Rate for Payer: UMR Bronson Commercial |
$2,354.74
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$3,261.00
|
|
|
Service Code
|
HCPCS 43281
|
| Min. Negotiated Rate |
$908.66 |
| Max. Negotiated Rate |
$2,797.14 |
| Rate for Payer: Aetna Commercial |
$1,909.49
|
| Rate for Payer: Aetna Medicare |
$1,481.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,909.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,051.99
|
| Rate for Payer: BCBS Complete |
$954.09
|
| Rate for Payer: BCBS MAPPO |
$1,424.99
|
| Rate for Payer: BCN Commercial |
$2,295.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.99
|
| Rate for Payer: Cash Price |
$2,608.80
|
| Rate for Payer: Cash Price |
$2,608.80
|
| Rate for Payer: Cofinity Commercial |
$1,909.49
|
| Rate for Payer: Cofinity Commercial |
$2,051.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.24
|
| Rate for Payer: Meridian Medicaid |
$954.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.49
|
| Rate for Payer: Nomi Health Commercial |
$1,709.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,445.75
|
| Rate for Payer: PACE SWMI |
$1,424.99
|
| Rate for Payer: PHP Commercial |
$1,994.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$908.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,797.14
|
| Rate for Payer: Priority Health Medicare |
$1,424.99
|
| Rate for Payer: Priority Health SBD |
$2,797.14
|
| Rate for Payer: Priority Health Tiered Network |
$2,797.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,762.20
|
| Rate for Payer: UHC Core |
$2,762.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.99
|
| Rate for Payer: UHC Exchange |
$2,762.20
|
| Rate for Payer: UHC Medicaid |
$908.66
|
| Rate for Payer: UHCCP Medicaid |
$908.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,500.06
|
|
|
PR LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,204.00
|
|
|
Service Code
|
HCPCS 49657
|
| Min. Negotiated Rate |
$1,681.60 |
| Max. Negotiated Rate |
$3,153.00 |
| Rate for Payer: Aetna Medicare |
$2,102.00
|
| Rate for Payer: BCBS Complete |
$1,681.60
|
| Rate for Payer: Cash Price |
$3,363.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,153.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,933.84
|
|
|
PR LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE
|
Professional
|
Both
|
$1,538.00
|
|
|
Service Code
|
HCPCS 49656
|
| Min. Negotiated Rate |
$615.20 |
| Max. Negotiated Rate |
$1,153.50 |
| Rate for Payer: Aetna Medicare |
$769.00
|
| Rate for Payer: BCBS Complete |
$615.20
|
| Rate for Payer: Cash Price |
$1,230.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,153.50
|
| Rate for Payer: UMR Bronson Commercial |
$707.48
|
|
|
PR LAPS SUPRACERVICAL HYSTERECTOMY >250
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
HCPCS 58543
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,743.00 |
| Rate for Payer: Aetna Commercial |
$986.90
|
| Rate for Payer: Aetna Medicare |
$765.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,060.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.90
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS MAPPO |
$736.49
|
| Rate for Payer: BCN Commercial |
$1,262.38
|
| Rate for Payer: BCN Medicare Advantage |
$736.49
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cofinity Commercial |
$1,060.55
|
| Rate for Payer: Cofinity Commercial |
$986.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.31
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.14
|
| Rate for Payer: Nomi Health Commercial |
$883.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,743.00
|
| Rate for Payer: PACE SWMI |
$736.49
|
| Rate for Payer: PHP Commercial |
$1,031.09
|
| Rate for Payer: PHP Medicare Advantage |
$736.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,278.51
|
| Rate for Payer: Priority Health Medicare |
$736.49
|
| Rate for Payer: Priority Health SBD |
$1,278.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,278.51
|
| Rate for Payer: Railroad Medicare Medicare |
$736.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,488.47
|
| Rate for Payer: UHC Core |
$1,488.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.49
|
| Rate for Payer: UHC Exchange |
$1,488.47
|
| Rate for Payer: UHC Medicaid |
$473.50
|
| Rate for Payer: UHCCP Medicaid |
$473.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,069.04
|
|
|
PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY
|
Professional
|
Both
|
$2,532.00
|
|
|
Service Code
|
HCPCS 58544
|
| Min. Negotiated Rate |
$511.41 |
| Max. Negotiated Rate |
$1,899.00 |
| Rate for Payer: Aetna Commercial |
$1,065.78
|
| Rate for Payer: Aetna Medicare |
$827.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,145.32
|
| Rate for Payer: BCBS Complete |
$536.98
|
| Rate for Payer: BCBS MAPPO |
$795.36
|
| Rate for Payer: BCN Commercial |
$1,357.99
|
| Rate for Payer: BCN Medicare Advantage |
$795.36
|
| Rate for Payer: Cash Price |
$2,025.60
|
| Rate for Payer: Cash Price |
$2,025.60
|
| Rate for Payer: Cofinity Commercial |
$1,065.78
|
| Rate for Payer: Cofinity Commercial |
$1,145.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$795.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$835.13
|
| Rate for Payer: Meridian Medicaid |
$536.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$874.90
|
| Rate for Payer: Nomi Health Commercial |
$954.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,899.00
|
| Rate for Payer: PACE SWMI |
$795.36
|
| Rate for Payer: PHP Commercial |
$1,113.50
|
| Rate for Payer: PHP Medicare Advantage |
$795.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$511.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,375.36
|
| Rate for Payer: Priority Health Medicare |
$795.36
|
| Rate for Payer: Priority Health SBD |
$1,375.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,375.36
|
| Rate for Payer: Railroad Medicare Medicare |
$795.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,603.22
|
| Rate for Payer: UHC Core |
$1,603.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$795.36
|
| Rate for Payer: UHC Exchange |
$1,603.22
|
| Rate for Payer: UHC Medicaid |
$511.41
|
| Rate for Payer: UHCCP Medicaid |
$511.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,164.72
|
|
|
PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$2,294.00
|
|
|
Service Code
|
HCPCS 58542
|
| Min. Negotiated Rate |
$467.75 |
| Max. Negotiated Rate |
$1,720.50 |
| Rate for Payer: Aetna Commercial |
$973.95
|
| Rate for Payer: Aetna Medicare |
$755.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,046.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$973.95
|
| Rate for Payer: BCBS Complete |
$491.14
|
| Rate for Payer: BCBS MAPPO |
$726.83
|
| Rate for Payer: BCN Commercial |
$1,243.95
|
| Rate for Payer: BCN Medicare Advantage |
$726.83
|
| Rate for Payer: Cash Price |
$1,835.20
|
| Rate for Payer: Cash Price |
$1,835.20
|
| Rate for Payer: Cofinity Commercial |
$1,046.64
|
| Rate for Payer: Cofinity Commercial |
$973.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$726.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$763.17
|
| Rate for Payer: Meridian Medicaid |
$491.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$799.51
|
| Rate for Payer: Nomi Health Commercial |
$872.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.50
|
| Rate for Payer: PACE SWMI |
$726.83
|
| Rate for Payer: PHP Commercial |
$1,017.56
|
| Rate for Payer: PHP Medicare Advantage |
$726.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,259.87
|
| Rate for Payer: Priority Health Medicare |
$726.83
|
| Rate for Payer: Priority Health SBD |
$1,259.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,259.87
|
| Rate for Payer: Railroad Medicare Medicare |
$726.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,464.30
|
| Rate for Payer: UHC Core |
$1,464.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$726.83
|
| Rate for Payer: UHC Exchange |
$1,464.30
|
| Rate for Payer: UHC Medicaid |
$467.75
|
| Rate for Payer: UHCCP Medicaid |
$467.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,055.24
|
|
|
PR LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY
|
Professional
|
Both
|
$1,601.00
|
|
|
Service Code
|
HCPCS 38571
|
| Min. Negotiated Rate |
$380.42 |
| Max. Negotiated Rate |
$1,317.91 |
| Rate for Payer: Aetna Commercial |
$791.52
|
| Rate for Payer: Aetna Medicare |
$614.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.59
|
| Rate for Payer: BCBS Complete |
$399.44
|
| Rate for Payer: BCBS MAPPO |
$590.69
|
| Rate for Payer: BCN Commercial |
$990.48
|
| Rate for Payer: BCN Medicare Advantage |
$590.69
|
| Rate for Payer: Cash Price |
$1,280.80
|
| Rate for Payer: Cash Price |
$1,280.80
|
| Rate for Payer: Cofinity Commercial |
$791.52
|
| Rate for Payer: Cofinity Commercial |
$850.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.22
|
| Rate for Payer: Meridian Medicaid |
$399.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$649.76
|
| Rate for Payer: Nomi Health Commercial |
$708.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,200.75
|
| Rate for Payer: PACE SWMI |
$590.69
|
| Rate for Payer: PHP Commercial |
$826.97
|
| Rate for Payer: PHP Medicare Advantage |
$590.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,317.91
|
| Rate for Payer: Priority Health Medicare |
$590.69
|
| Rate for Payer: Priority Health SBD |
$1,317.91
|
| Rate for Payer: Priority Health Tiered Network |
$1,317.91
|
| Rate for Payer: Railroad Medicare Medicare |
$590.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,173.23
|
| Rate for Payer: UHC Core |
$1,173.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$590.69
|
| Rate for Payer: UHC Exchange |
$1,173.23
|
| Rate for Payer: UHC Medicaid |
$380.42
|
| Rate for Payer: UHCCP Medicaid |
$380.42
|
| Rate for Payer: UMR Bronson Commercial |
$736.46
|
|
|
PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT
|
Professional
|
Both
|
$3,459.00
|
|
|
Service Code
|
HCPCS 47564
|
| Min. Negotiated Rate |
$676.91 |
| Max. Negotiated Rate |
$2,594.25 |
| Rate for Payer: Aetna Commercial |
$1,411.45
|
| Rate for Payer: Aetna Medicare |
$1,095.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,411.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,516.78
|
| Rate for Payer: BCBS Complete |
$710.76
|
| Rate for Payer: BCBS MAPPO |
$1,053.32
|
| Rate for Payer: BCN Commercial |
$1,686.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,053.32
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cofinity Commercial |
$1,411.45
|
| Rate for Payer: Cofinity Commercial |
$1,516.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,053.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,105.99
|
| Rate for Payer: Meridian Medicaid |
$710.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,158.65
|
| Rate for Payer: Nomi Health Commercial |
$1,263.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,594.25
|
| Rate for Payer: PACE SWMI |
$1,053.32
|
| Rate for Payer: PHP Commercial |
$1,474.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,053.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,055.10
|
| Rate for Payer: Priority Health Medicare |
$1,053.32
|
| Rate for Payer: Priority Health SBD |
$2,055.10
|
| Rate for Payer: Priority Health Tiered Network |
$2,055.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,053.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,984.96
|
| Rate for Payer: UHC Core |
$1,984.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,053.32
|
| Rate for Payer: UHC Exchange |
$1,984.96
|
| Rate for Payer: UHC Medicaid |
$676.91
|
| Rate for Payer: UHCCP Medicaid |
$676.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,591.14
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Facility
|
IP
|
$2,876.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
47563
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,265.44 |
| Max. Negotiated Rate |
$2,588.40 |
| Rate for Payer: Aetna American Axle |
$1,869.40
|
| Rate for Payer: Aetna Commercial |
$2,444.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,869.40
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cofinity Advantage |
$2,013.20
|
| Rate for Payer: Cofinity Commercial |
$2,473.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,300.80
|
| Rate for Payer: Healthscope Commercial |
$2,588.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,013.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,157.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,444.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,157.00
|
| Rate for Payer: PHP Commercial |
$2,444.60
|
| Rate for Payer: Priority Health SBD |
$1,811.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,265.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,157.00
|
|
