|
PR LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL
|
Professional
|
Both
|
$6,724.00
|
|
|
Service Code
|
HCPCS 63173
|
| Min. Negotiated Rate |
$1,122.72 |
| Max. Negotiated Rate |
$4,706.80 |
| Rate for Payer: Aetna Commercial |
$2,229.76
|
| Rate for Payer: BCBS Complete |
$1,178.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,763.08
|
| Rate for Payer: Cash Price |
$5,379.20
|
| Rate for Payer: Cash Price |
$5,379.20
|
| Rate for Payer: Meridian Medicaid |
$1,178.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,122.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,706.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,954.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,954.55
|
| Rate for Payer: Priority Health SBD |
$2,954.55
|
| Rate for Payer: UMR Bronson Commercial |
$3,093.04
|
|
|
PR LAM W/O FACETEC FORAMOT/DSC 1/2 VRT SGM CRV
|
Professional
|
Both
|
$4,992.00
|
|
|
Service Code
|
HCPCS 63001
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$3,494.40 |
| Rate for Payer: Aetna Commercial |
$1,593.74
|
| Rate for Payer: BCBS Complete |
$837.34
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Meridian Medicaid |
$837.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$797.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,494.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,106.91
|
| Rate for Payer: Priority Health Narrow Network |
$2,106.91
|
| Rate for Payer: Priority Health SBD |
$2,106.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,296.32
|
|
|
PR LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
44970
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$869.00 |
| Max. Negotiated Rate |
$1,777.50 |
| Rate for Payer: Aetna American Axle |
$1,283.75
|
| Rate for Payer: Aetna Commercial |
$1,678.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,283.75
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cofinity Commercial |
$1,382.50
|
| Rate for Payer: Cofinity Commercial |
$1,698.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.00
|
| Rate for Payer: Healthscope Commercial |
$1,777.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,382.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,678.75
|
| Rate for Payer: PHP Commercial |
$1,678.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.50
|
| Rate for Payer: Priority Health SBD |
$1,244.25
|
| Rate for Payer: UMR Bronson Commercial |
$869.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.25
|
|
|
PR LAPAROSCOPIC APPENDECTOMY
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
44970
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$595.29 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$1,283.75
|
| Rate for Payer: Aetna Commercial |
$1,678.75
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,283.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,819.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cofinity Commercial |
$1,382.50
|
| Rate for Payer: Cofinity Commercial |
$1,698.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$1,777.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,382.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.25
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,678.75
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$1,678.75
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Priority Health SBD |
$1,244.25
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$595.29
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$730.75
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.25
|
|
|
PR LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
44970
|
| Min. Negotiated Rate |
$387.23 |
| Max. Negotiated Rate |
$2,450.78 |
| Rate for Payer: Aetna Commercial |
$811.51
|
| Rate for Payer: BCBS Complete |
$406.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,450.78
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Meridian Medicaid |
$406.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,061.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.87
|
| Rate for Payer: Priority Health SBD |
$1,061.87
|
| Rate for Payer: UMR Bronson Commercial |
$908.50
|
|
|
PR LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 44970
|
| Min. Negotiated Rate |
$387.23 |
| Max. Negotiated Rate |
$2,450.78 |
| Rate for Payer: Aetna Commercial |
$811.51
|
| Rate for Payer: BCBS Complete |
$406.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,450.78
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Meridian Medicaid |
$406.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,061.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.87
|
| Rate for Payer: Priority Health SBD |
$1,061.87
|
| Rate for Payer: UMR Bronson Commercial |
$908.50
|
|
|
PR LAPAROSCOPIC SURGICAL SPLENECTOMY
|
Professional
|
Both
|
$3,947.00
|
|
|
Service Code
|
HCPCS 38120
|
| Min. Negotiated Rate |
$410.49 |
| Max. Negotiated Rate |
$2,762.90 |
| Rate for Payer: Aetna Commercial |
$1,317.62
|
| Rate for Payer: BCBS Complete |
$712.10
|
| Rate for Payer: BCBS Trust/PPO |
$410.49
|
| Rate for Payer: Cash Price |
$3,157.60
|
| Rate for Payer: Cash Price |
$3,157.60
|
| Rate for Payer: Meridian Medicaid |
$712.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$678.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,762.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,290.36
|
| Rate for Payer: Priority Health Narrow Network |
$2,290.36
|
| Rate for Payer: Priority Health SBD |
$2,290.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,815.62
|
|
|
PR LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL
|
Professional
|
Both
|
$2,172.00
|
|
|
Service Code
|
HCPCS 60650
|
| Min. Negotiated Rate |
$533.05 |
| Max. Negotiated Rate |
$1,674.45 |
| Rate for Payer: Aetna Commercial |
$1,544.16
|
| Rate for Payer: BCBS Complete |
$797.98
|
| Rate for Payer: BCBS Trust/PPO |
$533.05
|
| Rate for Payer: Cash Price |
$1,737.60
|
| Rate for Payer: Cash Price |
$1,737.60
|
| Rate for Payer: Meridian Medicaid |
$797.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$759.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,520.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,674.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,674.45
|
| Rate for Payer: Priority Health SBD |
$1,674.45
|
| Rate for Payer: UMR Bronson Commercial |
$999.12
|
|
|
PR LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$3,555.00
|
|
|
Service Code
|
HCPCS 44204
|
| Min. Negotiated Rate |
$975.54 |
| Max. Negotiated Rate |
$2,682.33 |
| Rate for Payer: Aetna Commercial |
$2,065.92
|
| Rate for Payer: BCBS Complete |
$1,024.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.45
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Meridian Medicaid |
$1,024.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$975.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,488.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,682.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,682.33
|
| Rate for Payer: Priority Health SBD |
$2,682.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,635.30
|
|
|
PR LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 57425
|
| Min. Negotiated Rate |
$540.98 |
| Max. Negotiated Rate |
$1,389.50 |
| Rate for Payer: Aetna Commercial |
$1,163.50
|
| Rate for Payer: BCBS Complete |
$654.40
|
| Rate for Payer: BCBS Trust/PPO |
$540.98
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Meridian Medicaid |
$654.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,377.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,377.67
|
| Rate for Payer: Priority Health SBD |
$1,377.67
|
| Rate for Payer: UMR Bronson Commercial |
$913.10
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
44180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$843.23 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$1,481.35
|
| Rate for Payer: Aetna Commercial |
$1,937.15
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,481.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,543.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cofinity Commercial |
$1,595.30
|
| Rate for Payer: Cofinity Commercial |
$1,959.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,823.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$2,051.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,595.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,709.25
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,937.15
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$1,937.15
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,595.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Priority Health SBD |
$1,435.77
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$994.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$904.39
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$843.23
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,709.25
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
44180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,002.76 |
| Max. Negotiated Rate |
$2,051.10 |
| Rate for Payer: Aetna American Axle |
$1,481.35
|
| Rate for Payer: Aetna Commercial |
$1,937.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,481.35
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cofinity Commercial |
$1,595.30
|
| Rate for Payer: Cofinity Commercial |
$1,959.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,823.20
|
| Rate for Payer: Healthscope Commercial |
$2,051.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,595.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,709.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,937.15
|
| Rate for Payer: PHP Commercial |
$1,937.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,595.30
|
| Rate for Payer: Priority Health SBD |
$1,435.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,002.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,709.25
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,279.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
44180
|
| Min. Negotiated Rate |
$588.31 |
| Max. Negotiated Rate |
$1,614.57 |
| Rate for Payer: Aetna Commercial |
$1,241.34
|
| Rate for Payer: BCBS Complete |
$617.73
|
| Rate for Payer: BCBS Trust/PPO |
$952.00
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Meridian Medicaid |
$617.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$588.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,595.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,614.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,614.57
|
| Rate for Payer: Priority Health SBD |
$1,614.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,048.34
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,279.00
|
|
|
Service Code
|
HCPCS 44180
|
| Min. Negotiated Rate |
$588.31 |
| Max. Negotiated Rate |
$1,614.57 |
| Rate for Payer: Aetna Commercial |
$1,241.34
|
| Rate for Payer: BCBS Complete |
$617.73
|
| Rate for Payer: BCBS Trust/PPO |
$952.00
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Meridian Medicaid |
$617.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$588.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,595.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,614.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,614.57
|
| Rate for Payer: Priority Health SBD |
$1,614.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,048.34
|
|
|
PR LAPAROSCOPY FULGURATION OVIDUCTS
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
HCPCS 58670
|
| Min. Negotiated Rate |
$239.63 |
| Max. Negotiated Rate |
$1,015.70 |
| Rate for Payer: Aetna Commercial |
$442.77
|
| Rate for Payer: BCBS Complete |
$251.61
|
| Rate for Payer: BCBS Trust/PPO |
$373.07
|
| Rate for Payer: Cash Price |
$1,160.80
|
| Rate for Payer: Cash Price |
$1,160.80
|
| Rate for Payer: Meridian Medicaid |
$251.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.29
|
| Rate for Payer: Priority Health Narrow Network |
$529.29
|
| Rate for Payer: Priority Health SBD |
$529.29
|
| Rate for Payer: UMR Bronson Commercial |
$667.46
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT
|
Professional
|
Both
|
$2,949.00
|
|
|
Service Code
|
HCPCS 50546
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$2,064.30 |
| Rate for Payer: Aetna Commercial |
$1,546.92
|
| Rate for Payer: BCBS Complete |
$800.89
|
| Rate for Payer: BCBS Trust/PPO |
$267.32
|
| Rate for Payer: Cash Price |
$2,359.20
|
| Rate for Payer: Cash Price |
$2,359.20
|
| Rate for Payer: Meridian Medicaid |
$800.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,064.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,915.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,915.02
|
| Rate for Payer: Priority Health SBD |
$1,915.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,356.54
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY
|
Professional
|
Both
|
$2,541.00
|
|
|
Service Code
|
HCPCS 50548
|
| Min. Negotiated Rate |
$848.17 |
| Max. Negotiated Rate |
$2,995.46 |
| Rate for Payer: Aetna Commercial |
$1,729.50
|
| Rate for Payer: BCBS Complete |
$890.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,995.46
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Meridian Medicaid |
$890.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$848.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,778.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,129.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,129.02
|
| Rate for Payer: Priority Health SBD |
$2,129.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,168.86
|
|
|
PR LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$2,249.00
|
|
|
Service Code
|
HCPCS 54692
|
| Min. Negotiated Rate |
$480.10 |
| Max. Negotiated Rate |
$1,686.86 |
| Rate for Payer: Aetna Commercial |
$972.39
|
| Rate for Payer: BCBS Complete |
$504.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,686.86
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Meridian Medicaid |
$504.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,574.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,203.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.92
|
| Rate for Payer: Priority Health SBD |
$1,203.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,034.54
|
|
|
PR LAPAROSCOPY PROCTOPEXY PROLAPSE
|
Professional
|
Both
|
$3,279.00
|
|
|
Service Code
|
HCPCS 45400
|
| Min. Negotiated Rate |
$719.30 |
| Max. Negotiated Rate |
$2,758.78 |
| Rate for Payer: Aetna Commercial |
$1,512.32
|
| Rate for Payer: BCBS Complete |
$755.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,758.78
|
| Rate for Payer: Cash Price |
$2,623.20
|
| Rate for Payer: Cash Price |
$2,623.20
|
| Rate for Payer: Meridian Medicaid |
$755.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$719.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,295.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,974.41
|
| Rate for Payer: Priority Health SBD |
$1,974.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,508.34
|
|
|
PR LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ
|
Professional
|
Both
|
$4,572.00
|
|
|
Service Code
|
HCPCS 45402
|
| Min. Negotiated Rate |
$961.70 |
| Max. Negotiated Rate |
$3,200.40 |
| Rate for Payer: Aetna Commercial |
$2,023.67
|
| Rate for Payer: BCBS Complete |
$1,009.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,142.26
|
| Rate for Payer: Cash Price |
$3,657.60
|
| Rate for Payer: Cash Price |
$3,657.60
|
| Rate for Payer: Meridian Medicaid |
$1,009.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$961.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,200.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,644.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,644.12
|
| Rate for Payer: Priority Health SBD |
$2,644.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,103.12
|
|
|
PR LAPAROSCOPY RADICAL NEPHRECTOMY
|
Professional
|
Both
|
$4,009.00
|
|
|
Service Code
|
HCPCS 50545
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$2,806.30 |
| Rate for Payer: Aetna Commercial |
$1,716.91
|
| Rate for Payer: BCBS Complete |
$885.87
|
| Rate for Payer: BCBS Trust/PPO |
$24.83
|
| Rate for Payer: Cash Price |
$3,207.20
|
| Rate for Payer: Cash Price |
$3,207.20
|
| Rate for Payer: Meridian Medicaid |
$885.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,806.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,117.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,117.66
|
| Rate for Payer: Priority Health SBD |
$2,117.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,844.14
|
|
|
PR LAPAROSCOPY SALPINGOSTOMY
|
Professional
|
Both
|
$3,056.00
|
|
|
Service Code
|
HCPCS 58673
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$2,139.20 |
| Rate for Payer: Aetna Commercial |
$953.91
|
| Rate for Payer: BCBS Complete |
$533.85
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Meridian Medicaid |
$533.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,126.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.28
|
| Rate for Payer: Priority Health SBD |
$1,126.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,405.76
|
|
|
PR LAPAROSCOPY SLING OPERATION STRESS INCONT
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 51992
|
| Min. Negotiated Rate |
$533.78 |
| Max. Negotiated Rate |
$1,505.66 |
| Rate for Payer: Aetna Commercial |
$1,079.36
|
| Rate for Payer: BCBS Complete |
$560.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.66
|
| Rate for Payer: Cash Price |
$1,352.00
|
| Rate for Payer: Cash Price |
$1,352.00
|
| Rate for Payer: Meridian Medicaid |
$560.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$533.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,339.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,339.00
|
| Rate for Payer: Priority Health SBD |
$1,339.00
|
| Rate for Payer: UMR Bronson Commercial |
$777.40
|
|
|
PR LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$1,045.00
|
|
|
Service Code
|
HCPCS 44203
|
| Min. Negotiated Rate |
$151.66 |
| Max. Negotiated Rate |
$1,325.50 |
| Rate for Payer: Aetna Commercial |
$324.29
|
| Rate for Payer: BCBS Complete |
$159.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,325.50
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Meridian Medicaid |
$159.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$420.98
|
| Rate for Payer: Priority Health Narrow Network |
$420.98
|
| Rate for Payer: Priority Health SBD |
$420.98
|
| Rate for Payer: UMR Bronson Commercial |
$480.70
|
|
|
PR LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 58541
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$1,389.50 |
| Rate for Payer: Aetna Commercial |
$871.92
|
| Rate for Payer: BCBS Complete |
$492.92
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Meridian Medicaid |
$492.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$469.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,037.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,037.27
|
| Rate for Payer: Priority Health SBD |
$1,037.27
|
| Rate for Payer: UMR Bronson Commercial |
$913.10
|
|
