|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Facility
|
IP
|
$2,737.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
47563
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,204.28 |
| Max. Negotiated Rate |
$2,463.30 |
| Rate for Payer: Aetna American Axle |
$1,779.05
|
| Rate for Payer: Aetna Commercial |
$2,326.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,779.05
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cofinity Commercial |
$1,915.90
|
| Rate for Payer: Cofinity Commercial |
$2,353.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,189.60
|
| Rate for Payer: Healthscope Commercial |
$2,463.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,915.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,052.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,326.45
|
| Rate for Payer: PHP Commercial |
$2,326.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,915.90
|
| Rate for Payer: Priority Health SBD |
$1,724.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,204.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,052.75
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Facility
|
OP
|
$2,737.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
47563
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$708.91 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$1,779.05
|
| Rate for Payer: Aetna Commercial |
$2,326.45
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,779.05
|
| 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 |
$5,235.40
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cofinity Commercial |
$1,915.90
|
| Rate for Payer: Cofinity Commercial |
$2,353.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,189.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$2,463.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,915.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,052.75
|
| 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 |
$2,326.45
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$2,326.45
|
| 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 |
$1,915.90
|
| 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 |
$1,724.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$708.91
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,012.69
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,052.75
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$2,737.00
|
|
|
Service Code
|
HCPCS 47563
|
| Min. Negotiated Rate |
$461.15 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Aetna Commercial |
$969.23
|
| Rate for Payer: BCBS Complete |
$484.21
|
| Rate for Payer: BCBS Trust/PPO |
$584.28
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Meridian Medicaid |
$484.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,915.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,266.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,266.49
|
| Rate for Payer: Priority Health SBD |
$1,266.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,259.02
|
|
|
PR LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$4,068.00
|
|
|
Service Code
|
HCPCS 43280
|
| Min. Negotiated Rate |
$688.42 |
| Max. Negotiated Rate |
$2,847.60 |
| Rate for Payer: Aetna Commercial |
$1,458.26
|
| Rate for Payer: BCBS Complete |
$722.84
|
| Rate for Payer: BCBS Trust/PPO |
$798.79
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Meridian Medicaid |
$722.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$688.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,890.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,890.92
|
| Rate for Payer: Priority Health SBD |
$1,890.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,871.28
|
|
|
PR LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX
|
Professional
|
Both
|
$2,249.00
|
|
|
Service Code
|
HCPCS 43653
|
| Min. Negotiated Rate |
$372.32 |
| Max. Negotiated Rate |
$1,574.30 |
| Rate for Payer: Aetna Commercial |
$777.16
|
| Rate for Payer: BCBS Complete |
$390.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.13
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Meridian Medicaid |
$390.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,574.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.13
|
| Rate for Payer: Priority Health SBD |
$1,020.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,034.54
|
|
|
PR LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT
|
Professional
|
Both
|
$3,274.00
|
|
|
Service Code
|
HCPCS 55866
|
| Min. Negotiated Rate |
$756.79 |
| Max. Negotiated Rate |
$2,291.80 |
| Rate for Payer: Aetna Commercial |
$1,851.29
|
| Rate for Payer: BCBS Complete |
$794.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,132.22
|
| Rate for Payer: Cash Price |
$2,619.20
|
| Rate for Payer: Cash Price |
$2,619.20
|
| Rate for Payer: Meridian Medicaid |
$794.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$756.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,291.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,900.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,900.98
|
| Rate for Payer: Priority Health SBD |
$1,900.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,506.04
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 38570
|
| Hospital Charge Code |
38570
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$355.94 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$625.30
|
| Rate for Payer: Aetna Commercial |
$817.70
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.30
|
| 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 |
$3,233.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cofinity Commercial |
$673.40
|
| Rate for Payer: Cofinity Commercial |
$827.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$769.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$865.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$673.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$721.50
|
| 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 |
$817.70
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$817.70
|
| 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 |
$673.40
|
| 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 |
$606.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$508.52
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$355.94
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$721.50
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 38570
|
| Hospital Charge Code |
38570
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$423.28 |
| Max. Negotiated Rate |
$865.80 |
| Rate for Payer: Aetna American Axle |
$625.30
|
| Rate for Payer: Aetna Commercial |
$817.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.30
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cofinity Commercial |
$673.40
|
| Rate for Payer: Cofinity Commercial |
$827.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$769.60
|
| Rate for Payer: Healthscope Commercial |
$865.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$673.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$817.70
|
| Rate for Payer: PHP Commercial |
$817.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health SBD |
$606.06
|
| Rate for Payer: UMR Bronson Commercial |
$423.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$721.50
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 38570
|
| Hospital Charge Code |
38570
|
| Min. Negotiated Rate |
$330.79 |
| Max. Negotiated Rate |
$1,111.87 |
| Rate for Payer: Aetna Commercial |
$637.62
|
| Rate for Payer: BCBS Complete |
$347.33
|
| Rate for Payer: BCBS Trust/PPO |
$453.28
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Meridian Medicaid |
$347.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,111.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,111.87
|
| Rate for Payer: Priority Health SBD |
$1,111.87
|
| Rate for Payer: UMR Bronson Commercial |
$442.52
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 38570
|
| Min. Negotiated Rate |
$330.79 |
| Max. Negotiated Rate |
$1,111.87 |
| Rate for Payer: Aetna Commercial |
$637.62
|
| Rate for Payer: BCBS Complete |
$347.33
|
| Rate for Payer: BCBS Trust/PPO |
$453.28
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Meridian Medicaid |
$347.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$673.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,111.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,111.87
|
| Rate for Payer: Priority Health SBD |
$1,111.87
|
| Rate for Payer: UMR Bronson Commercial |
$442.52
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
49651
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$560.58 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$1,319.50
|
| Rate for Payer: Aetna Commercial |
$1,725.50
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.50
|
| 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 |
$5,617.73
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cofinity Commercial |
$1,745.80
|
| Rate for Payer: Cofinity Commercial |
$1,421.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,624.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$1,827.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,421.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,522.50
|
| 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 |
$1,725.50
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$1,725.50
|
| 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 |
$1,421.00
|
| 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 |
$1,278.90
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$560.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$751.10
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,522.50
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
49651
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$893.20 |
| Max. Negotiated Rate |
$1,827.00 |
| Rate for Payer: Aetna American Axle |
$1,319.50
|
| Rate for Payer: Aetna Commercial |
$1,725.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.50
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cofinity Commercial |
$1,421.00
|
| Rate for Payer: Cofinity Commercial |
$1,745.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,624.00
|
| Rate for Payer: Healthscope Commercial |
$1,827.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,421.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,522.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,725.50
|
| Rate for Payer: PHP Commercial |
$1,725.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,421.00
|
| Rate for Payer: Priority Health SBD |
$1,278.90
|
| Rate for Payer: UMR Bronson Commercial |
$893.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,522.50
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 49651
|
| Hospital Charge Code |
49651
|
| Min. Negotiated Rate |
$364.66 |
| Max. Negotiated Rate |
$3,934.25 |
| Rate for Payer: Aetna Commercial |
$756.01
|
| Rate for Payer: BCBS Complete |
$382.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.25
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Meridian Medicaid |
$382.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,421.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$998.37
|
| Rate for Payer: Priority Health Narrow Network |
$998.37
|
| Rate for Payer: Priority Health SBD |
$998.37
|
| Rate for Payer: UMR Bronson Commercial |
$933.80
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 49651
|
| Min. Negotiated Rate |
$364.66 |
| Max. Negotiated Rate |
$3,934.25 |
| Rate for Payer: Aetna Commercial |
$756.01
|
| Rate for Payer: BCBS Complete |
$382.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.25
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Meridian Medicaid |
$382.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,421.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$998.37
|
| Rate for Payer: Priority Health Narrow Network |
$998.37
|
| Rate for Payer: Priority Health SBD |
$998.37
|
| Rate for Payer: UMR Bronson Commercial |
$933.80
|
|
|
PR LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 43652
|
| Min. Negotiated Rate |
$492.24 |
| Max. Negotiated Rate |
$1,349.40 |
| Rate for Payer: Aetna Commercial |
$1,033.64
|
| Rate for Payer: BCBS Complete |
$516.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,018.56
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Meridian Medicaid |
$516.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,349.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.40
|
| Rate for Payer: Priority Health SBD |
$1,349.40
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR LAPS SURG TRNSXJ VAGUS NRV TRUNCAL
|
Professional
|
Both
|
$2,536.00
|
|
|
Service Code
|
HCPCS 43651
|
| Min. Negotiated Rate |
$423.02 |
| Max. Negotiated Rate |
$1,775.20 |
| Rate for Payer: Aetna Commercial |
$884.62
|
| Rate for Payer: BCBS Complete |
$444.17
|
| Rate for Payer: BCBS Trust/PPO |
$806.71
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Meridian Medicaid |
$444.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,157.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,157.72
|
| Rate for Payer: Priority Health SBD |
$1,157.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,166.56
|
|
|
PR LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 49322
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$504.97
|
| Rate for Payer: BCBS Complete |
$252.72
|
| Rate for Payer: BCBS Trust/PPO |
$572.15
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Meridian Medicaid |
$252.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$660.29
|
| Rate for Payer: Priority Health Narrow Network |
$660.29
|
| Rate for Payer: Priority Health SBD |
$660.29
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
|
PR LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY
|
Professional
|
Both
|
$1,907.00
|
|
|
Service Code
|
HCPCS 49323
|
| Min. Negotiated Rate |
$336.53 |
| Max. Negotiated Rate |
$1,334.90 |
| Rate for Payer: Aetna Commercial |
$853.34
|
| Rate for Payer: BCBS Complete |
$430.53
|
| Rate for Payer: BCBS Trust/PPO |
$336.53
|
| Rate for Payer: Cash Price |
$1,525.60
|
| Rate for Payer: Cash Price |
$1,525.60
|
| Rate for Payer: Meridian Medicaid |
$430.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,120.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,120.09
|
| Rate for Payer: Priority Health SBD |
$1,120.09
|
| Rate for Payer: UMR Bronson Commercial |
$877.22
|
|
|
PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Professional
|
Both
|
$2,718.00
|
|
|
Service Code
|
HCPCS 58571
|
| Min. Negotiated Rate |
$74.49 |
| Max. Negotiated Rate |
$1,902.60 |
| Rate for Payer: Aetna Commercial |
$1,077.28
|
| Rate for Payer: BCBS Complete |
$613.47
|
| Rate for Payer: BCBS Trust/PPO |
$74.49
|
| Rate for Payer: Cash Price |
$2,174.40
|
| Rate for Payer: Cash Price |
$2,174.40
|
| Rate for Payer: Meridian Medicaid |
$613.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,287.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,287.71
|
| Rate for Payer: Priority Health SBD |
$1,287.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,250.28
|
|
|
PR LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,446.00
|
|
|
Service Code
|
HCPCS 59150
|
| Min. Negotiated Rate |
$284.23 |
| Max. Negotiated Rate |
$1,128.03 |
| Rate for Payer: Aetna Commercial |
$865.98
|
| Rate for Payer: BCBS Complete |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Meridian Medicaid |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$511.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,128.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,128.03
|
| Rate for Payer: Priority Health SBD |
$1,128.03
|
| Rate for Payer: UMR Bronson Commercial |
$665.16
|
|
|
PR LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 59151
|
| Min. Negotiated Rate |
$447.47 |
| Max. Negotiated Rate |
$1,103.46 |
| Rate for Payer: Aetna Commercial |
$844.79
|
| Rate for Payer: BCBS Complete |
$525.58
|
| Rate for Payer: BCBS Trust/PPO |
$447.47
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Meridian Medicaid |
$525.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,103.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,103.46
|
| Rate for Payer: Priority Health SBD |
$1,103.46
|
| Rate for Payer: UMR Bronson Commercial |
$626.98
|
|
|
PR LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$2,833.00
|
|
|
Service Code
|
HCPCS 50947
|
| Min. Negotiated Rate |
$875.43 |
| Max. Negotiated Rate |
$5,304.13 |
| Rate for Payer: Aetna Commercial |
$1,780.49
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS Trust/PPO |
$5,304.13
|
| Rate for Payer: Cash Price |
$2,266.40
|
| Rate for Payer: Cash Price |
$2,266.40
|
| Rate for Payer: Meridian Medicaid |
$919.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$875.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,983.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,196.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,196.02
|
| Rate for Payer: Priority Health SBD |
$2,196.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,303.18
|
|
|
PR LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$2,566.00
|
|
|
Service Code
|
HCPCS 50948
|
| Min. Negotiated Rate |
$802.80 |
| Max. Negotiated Rate |
$2,539.54 |
| Rate for Payer: Aetna Commercial |
$1,642.77
|
| Rate for Payer: BCBS Complete |
$842.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: Cash Price |
$2,052.80
|
| Rate for Payer: Cash Price |
$2,052.80
|
| Rate for Payer: Meridian Medicaid |
$842.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$802.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,796.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,021.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,021.48
|
| Rate for Payer: Priority Health SBD |
$2,021.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,180.36
|
|
|
PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR
|
Professional
|
Both
|
$3,167.00
|
|
|
Service Code
|
HCPCS 58554
|
| Min. Negotiated Rate |
$639.24 |
| Max. Negotiated Rate |
$2,216.90 |
| Rate for Payer: Aetna Commercial |
$1,567.07
|
| Rate for Payer: BCBS Complete |
$878.05
|
| Rate for Payer: BCBS Trust/PPO |
$639.24
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Meridian Medicaid |
$878.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,216.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,847.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,847.30
|
| Rate for Payer: Priority Health SBD |
$1,847.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,456.82
|
|
|
PR LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,468.00
|
|
|
Service Code
|
HCPCS 58550
|
| Min. Negotiated Rate |
$395.17 |
| Max. Negotiated Rate |
$1,727.60 |
| Rate for Payer: Aetna Commercial |
$1,055.17
|
| Rate for Payer: BCBS Complete |
$594.91
|
| Rate for Payer: BCBS Trust/PPO |
$395.17
|
| Rate for Payer: Cash Price |
$1,974.40
|
| Rate for Payer: Cash Price |
$1,974.40
|
| Rate for Payer: Meridian Medicaid |
$594.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$566.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,727.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,252.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,252.21
|
| Rate for Payer: Priority Health SBD |
$1,252.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,135.28
|
|
