|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,690.00
|
|
|
Service Code
|
HCPCS 58661
|
| Min. Negotiated Rate |
$183.85 |
| Max. Negotiated Rate |
$1,883.00 |
| Rate for Payer: Aetna Commercial |
$869.26
|
| Rate for Payer: Aetna Medicare |
$648.70
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS MAPPO |
$648.70
|
| Rate for Payer: BCBS Trust/PPO |
$183.85
|
| Rate for Payer: BCN Commercial |
$955.85
|
| Rate for Payer: BCN Medicare Advantage |
$648.70
|
| Rate for Payer: Cash Price |
$2,152.00
|
| Rate for Payer: Cash Price |
$2,152.00
|
| Rate for Payer: Cofinity Commercial |
$869.26
|
| Rate for Payer: Cofinity Commercial |
$934.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$648.70
|
| Rate for Payer: Healthscope Commercial |
$778.44
|
| Rate for Payer: Healthscope Whirlpool |
$778.44
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$681.14
|
| Rate for Payer: PACE SWMI |
$648.70
|
| Rate for Payer: PHP Medicare Advantage |
$648.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,883.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$926.01
|
| Rate for Payer: Priority Health Medicare |
$648.70
|
| Rate for Payer: Priority Health Narrow Network |
$926.01
|
| Rate for Payer: UHC Medicare Advantage |
$668.16
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Facility
|
OP
|
$2,690.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
58661
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,883.00 |
| Max. Negotiated Rate |
$6,411.01 |
| Rate for Payer: Aetna Commercial |
$2,421.00
|
| Rate for Payer: Aetna Medicare |
$5,128.81
|
| 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: ASR ASR |
$2,609.30
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.56
|
| Rate for Payer: BCN Commercial |
$2,085.56
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$2,152.00
|
| Rate for Payer: Cash Price |
$2,152.00
|
| Rate for Payer: Cofinity Commercial |
$2,528.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,152.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$2,690.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,609.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,128.81
|
| Rate for Payer: Mclaren Commercial |
$2,421.00
|
| 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 |
$2,286.50
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$5,641.69
|
| Rate for Payer: PHP Medicaid |
$2,805.46
|
| 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 |
$1,883.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,447.90
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,909.90
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,367.20
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Facility
|
IP
|
$2,690.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
58661
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,883.00 |
| Max. Negotiated Rate |
$2,690.00 |
| Rate for Payer: Aetna Commercial |
$2,421.00
|
| Rate for Payer: ASR ASR |
$2,609.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,085.56
|
| Rate for Payer: BCN Commercial |
$2,085.56
|
| Rate for Payer: Cash Price |
$2,152.00
|
| Rate for Payer: Cofinity Commercial |
$2,528.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,152.00
|
| Rate for Payer: Healthscope Commercial |
$2,690.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,609.30
|
| Rate for Payer: Mclaren Commercial |
$2,421.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,286.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,883.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,367.20
|
|
|
PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,426.00
|
|
|
Service Code
|
HCPCS 58570
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$1,698.20 |
| Rate for Payer: Aetna Commercial |
$1,073.03
|
| Rate for Payer: Aetna Medicare |
$800.77
|
| Rate for Payer: BCBS Complete |
$544.81
|
| Rate for Payer: BCBS MAPPO |
$800.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$1,184.06
|
| Rate for Payer: BCN Medicare Advantage |
$800.77
|
| Rate for Payer: Cash Price |
$1,940.80
|
| Rate for Payer: Cash Price |
$1,940.80
|
| Rate for Payer: Cofinity Commercial |
$1,073.03
|
| Rate for Payer: Cofinity Commercial |
$1,153.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.77
|
| Rate for Payer: Healthscope Commercial |
$960.92
|
| Rate for Payer: Healthscope Whirlpool |
$960.92
|
| Rate for Payer: Meridian Medicaid |
$544.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$840.81
|
| Rate for Payer: PACE SWMI |
$800.77
|
| Rate for Payer: PHP Medicare Advantage |
$800.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$518.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,698.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.11
|
| Rate for Payer: Priority Health Medicare |
$800.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,147.11
|
| Rate for Payer: UHC Medicare Advantage |
$824.79
|
|
|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,766.00
|
|
|
Service Code
|
HCPCS 49654
|
| Min. Negotiated Rate |
$1,106.40 |
| Max. Negotiated Rate |
$1,936.20 |
| Rate for Payer: BCBS Complete |
$1,106.40
|
| Rate for Payer: Cash Price |
$2,212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.20
|
|
|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,055.00
|
|
|
Service Code
|
HCPCS 49653
|
| Min. Negotiated Rate |
$1,222.00 |
| Max. Negotiated Rate |
$2,138.50 |
| Rate for Payer: BCBS Complete |
$1,222.00
|
| Rate for Payer: Cash Price |
$2,444.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,138.50
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$965.30 |
| Max. Negotiated Rate |
$1,379.00 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: ASR ASR |
$1,337.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.14
|
| Rate for Payer: BCN Commercial |
$1,069.14
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$1,296.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,103.20
|
| Rate for Payer: Healthscope Commercial |
$1,379.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,337.63
|
| Rate for Payer: Mclaren Commercial |
$1,241.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,172.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,213.52
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$965.30 |
| Max. Negotiated Rate |
$6,411.01 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Aetna Medicare |
$5,128.81
|
| 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: ASR ASR |
$1,337.63
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.14
|
| Rate for Payer: BCN Commercial |
$1,069.14
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$1,296.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$1,379.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,337.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,128.81
|
| Rate for Payer: Mclaren Commercial |
$1,241.10
|
| 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 |
$1,172.15
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$5,641.69
|
| Rate for Payer: PHP Medicaid |
$2,805.46
|
| 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 |
$965.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,254.89
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$979.09
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,213.52
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 49320
|
| Min. Negotiated Rate |
$211.72 |
| Max. Negotiated Rate |
$1,309.66 |
| Rate for Payer: Aetna Commercial |
$436.67
|
| Rate for Payer: Aetna Medicare |
$325.87
|
| Rate for Payer: BCBS Complete |
$222.31
|
| Rate for Payer: BCBS MAPPO |
$325.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.66
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: BCN Medicare Advantage |
$325.87
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$469.25
|
| Rate for Payer: Cofinity Commercial |
$436.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.87
|
| Rate for Payer: Healthscope Commercial |
$391.04
|
| Rate for Payer: Healthscope Whirlpool |
$391.04
|
| Rate for Payer: Meridian Medicaid |
$222.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.16
|
| Rate for Payer: PACE SWMI |
$325.87
|
| Rate for Payer: PHP Medicare Advantage |
$325.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$578.57
|
| Rate for Payer: Priority Health Medicare |
$325.87
|
| Rate for Payer: Priority Health Narrow Network |
$578.57
|
| Rate for Payer: UHC Medicare Advantage |
$335.65
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
49320
|
| Min. Negotiated Rate |
$211.72 |
| Max. Negotiated Rate |
$1,309.66 |
| Rate for Payer: Aetna Commercial |
$436.67
|
| Rate for Payer: Aetna Medicare |
$325.87
|
| Rate for Payer: BCBS Complete |
$222.31
|
| Rate for Payer: BCBS MAPPO |
$325.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.66
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: BCN Medicare Advantage |
$325.87
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$469.25
|
| Rate for Payer: Cofinity Commercial |
$436.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.87
|
| Rate for Payer: Healthscope Commercial |
$391.04
|
| Rate for Payer: Healthscope Whirlpool |
$391.04
|
| Rate for Payer: Meridian Medicaid |
$222.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.16
|
| Rate for Payer: PACE SWMI |
$325.87
|
| Rate for Payer: PHP Medicare Advantage |
$325.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$578.57
|
| Rate for Payer: Priority Health Medicare |
$325.87
|
| Rate for Payer: Priority Health Narrow Network |
$578.57
|
| Rate for Payer: UHC Medicare Advantage |
$335.65
|
|
|
PR LAPS ABLTJ RENAL MASS LESION W/INTRAOP US
|
Professional
|
Both
|
$2,074.00
|
|
|
Service Code
|
HCPCS 50542
|
| Min. Negotiated Rate |
$735.28 |
| Max. Negotiated Rate |
$3,188.29 |
| Rate for Payer: Aetna Commercial |
$1,526.85
|
| Rate for Payer: Aetna Medicare |
$1,139.44
|
| Rate for Payer: BCBS Complete |
$772.04
|
| Rate for Payer: BCBS MAPPO |
$1,139.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,188.29
|
| Rate for Payer: BCN Commercial |
$1,678.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,139.44
|
| Rate for Payer: Cash Price |
$1,659.20
|
| Rate for Payer: Cash Price |
$1,659.20
|
| Rate for Payer: Cofinity Commercial |
$1,526.85
|
| Rate for Payer: Cofinity Commercial |
$1,640.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,139.44
|
| Rate for Payer: Healthscope Commercial |
$1,367.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,367.33
|
| Rate for Payer: Meridian Medicaid |
$772.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,196.41
|
| Rate for Payer: PACE SWMI |
$1,139.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,139.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$735.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,856.14
|
| Rate for Payer: Priority Health Medicare |
$1,139.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,856.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,173.62
|
|
|
PR LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1
|
Professional
|
Both
|
$1,832.00
|
|
|
Service Code
|
HCPCS 38572
|
| Min. Negotiated Rate |
$503.47 |
| Max. Negotiated Rate |
$1,950.65 |
| Rate for Payer: Aetna Commercial |
$1,195.43
|
| Rate for Payer: Aetna Medicare |
$892.11
|
| Rate for Payer: BCBS Complete |
$602.07
|
| Rate for Payer: BCBS MAPPO |
$892.11
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$1,316.01
|
| Rate for Payer: BCN Medicare Advantage |
$892.11
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Cofinity Commercial |
$1,195.43
|
| Rate for Payer: Cofinity Commercial |
$1,284.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$892.11
|
| Rate for Payer: Healthscope Commercial |
$1,070.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.53
|
| Rate for Payer: Meridian Medicaid |
$602.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$936.72
|
| Rate for Payer: PACE SWMI |
$892.11
|
| Rate for Payer: PHP Medicare Advantage |
$892.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,282.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,950.65
|
| Rate for Payer: Priority Health Medicare |
$892.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,950.65
|
| Rate for Payer: UHC Medicare Advantage |
$918.87
|
|
|
PR LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$3,758.00
|
|
|
Service Code
|
HCPCS 44227
|
| Min. Negotiated Rate |
$1,051.58 |
| Max. Negotiated Rate |
$2,894.01 |
| Rate for Payer: Aetna Commercial |
$2,197.77
|
| Rate for Payer: Aetna Medicare |
$1,640.13
|
| Rate for Payer: BCBS Complete |
$1,104.16
|
| Rate for Payer: BCBS MAPPO |
$1,640.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,489.81
|
| Rate for Payer: BCN Commercial |
$2,405.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,640.13
|
| Rate for Payer: Cash Price |
$3,006.40
|
| Rate for Payer: Cash Price |
$3,006.40
|
| Rate for Payer: Cofinity Commercial |
$2,361.79
|
| Rate for Payer: Cofinity Commercial |
$2,197.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,640.13
|
| Rate for Payer: Healthscope Commercial |
$1,968.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,968.16
|
| Rate for Payer: Meridian Medicaid |
$1,104.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,722.14
|
| Rate for Payer: PACE SWMI |
$1,640.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,640.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,051.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,630.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,894.01
|
| Rate for Payer: Priority Health Medicare |
$1,640.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,894.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.33
|
|
|
PR LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS
|
Professional
|
Both
|
$6,185.00
|
|
|
Service Code
|
HCPCS 44211
|
| Min. Negotiated Rate |
$1,335.51 |
| Max. Negotiated Rate |
$4,329.50 |
| Rate for Payer: Aetna Commercial |
$2,771.70
|
| Rate for Payer: Aetna Medicare |
$2,068.43
|
| Rate for Payer: BCBS Complete |
$1,402.29
|
| Rate for Payer: BCBS MAPPO |
$2,068.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,775.09
|
| Rate for Payer: BCN Commercial |
$3,053.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,068.43
|
| Rate for Payer: Cash Price |
$4,948.00
|
| Rate for Payer: Cash Price |
$4,948.00
|
| Rate for Payer: Cofinity Commercial |
$2,978.54
|
| Rate for Payer: Cofinity Commercial |
$2,771.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,068.43
|
| Rate for Payer: Healthscope Commercial |
$2,482.12
|
| Rate for Payer: Healthscope Whirlpool |
$2,482.12
|
| Rate for Payer: Meridian Medicaid |
$1,402.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,171.85
|
| Rate for Payer: PACE SWMI |
$2,068.43
|
| Rate for Payer: PHP Medicare Advantage |
$2,068.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,335.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,329.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,674.24
|
| Rate for Payer: Priority Health Medicare |
$2,068.43
|
| Rate for Payer: Priority Health Narrow Network |
$3,674.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,130.48
|
|
|
PR LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 44208
|
| Min. Negotiated Rate |
$1,248.61 |
| Max. Negotiated Rate |
$3,433.76 |
| Rate for Payer: Aetna Commercial |
$2,602.68
|
| Rate for Payer: Aetna Medicare |
$1,942.30
|
| Rate for Payer: BCBS Complete |
$1,311.04
|
| Rate for Payer: BCBS MAPPO |
$1,942.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,882.86
|
| Rate for Payer: BCN Commercial |
$2,853.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,942.30
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cofinity Commercial |
$2,796.91
|
| Rate for Payer: Cofinity Commercial |
$2,602.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,942.30
|
| Rate for Payer: Healthscope Commercial |
$2,330.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,330.76
|
| Rate for Payer: Meridian Medicaid |
$1,311.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,039.42
|
| Rate for Payer: PACE SWMI |
$1,942.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,942.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,248.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,433.76
|
| Rate for Payer: Priority Health Medicare |
$1,942.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,433.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,000.57
|
|
|
PR LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY
|
Professional
|
Both
|
$6,139.00
|
|
|
Service Code
|
HCPCS 44212
|
| Min. Negotiated Rate |
$994.79 |
| Max. Negotiated Rate |
$4,297.30 |
| Rate for Payer: Aetna Commercial |
$2,658.98
|
| Rate for Payer: Aetna Medicare |
$1,984.31
|
| Rate for Payer: BCBS Complete |
$1,344.81
|
| Rate for Payer: BCBS MAPPO |
$1,984.31
|
| Rate for Payer: BCBS Trust/PPO |
$994.79
|
| Rate for Payer: BCN Commercial |
$2,925.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,984.31
|
| Rate for Payer: Cash Price |
$4,911.20
|
| Rate for Payer: Cash Price |
$4,911.20
|
| Rate for Payer: Cofinity Commercial |
$2,857.41
|
| Rate for Payer: Cofinity Commercial |
$2,658.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,984.31
|
| Rate for Payer: Healthscope Commercial |
$2,381.17
|
| Rate for Payer: Healthscope Whirlpool |
$2,381.17
|
| Rate for Payer: Meridian Medicaid |
$1,344.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,083.53
|
| Rate for Payer: PACE SWMI |
$1,984.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,984.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,280.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,297.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,520.20
|
| Rate for Payer: Priority Health Medicare |
$1,984.31
|
| Rate for Payer: Priority Health Narrow Network |
$3,520.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,043.84
|
|
|
PR LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST
|
Professional
|
Both
|
$4,502.00
|
|
|
Service Code
|
HCPCS 44207
|
| Min. Negotiated Rate |
$1,146.79 |
| Max. Negotiated Rate |
$3,154.48 |
| Rate for Payer: Aetna Commercial |
$2,395.05
|
| Rate for Payer: Aetna Medicare |
$1,787.35
|
| Rate for Payer: BCBS Complete |
$1,204.13
|
| Rate for Payer: BCBS MAPPO |
$1,787.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.75
|
| Rate for Payer: BCN Commercial |
$2,621.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,787.35
|
| Rate for Payer: Cash Price |
$3,601.60
|
| Rate for Payer: Cash Price |
$3,601.60
|
| Rate for Payer: Cofinity Commercial |
$2,573.78
|
| Rate for Payer: Cofinity Commercial |
$2,395.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,787.35
|
| Rate for Payer: Healthscope Commercial |
$2,144.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,144.82
|
| Rate for Payer: Meridian Medicaid |
$1,204.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,876.72
|
| Rate for Payer: PACE SWMI |
$1,787.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,787.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,146.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,151.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,154.48
|
| Rate for Payer: Priority Health Medicare |
$1,787.35
|
| Rate for Payer: Priority Health Narrow Network |
$3,154.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,840.97
|
|
|
PR LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM
|
Professional
|
Both
|
$4,643.00
|
|
|
Service Code
|
HCPCS 44206
|
| Min. Negotiated Rate |
$1,105.04 |
| Max. Negotiated Rate |
$3,250.10 |
| Rate for Payer: Aetna Commercial |
$2,305.85
|
| Rate for Payer: Aetna Medicare |
$1,720.78
|
| Rate for Payer: BCBS Complete |
$1,160.29
|
| Rate for Payer: BCBS MAPPO |
$1,720.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,931.99
|
| Rate for Payer: BCN Commercial |
$2,525.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,720.78
|
| Rate for Payer: Cash Price |
$3,714.40
|
| Rate for Payer: Cash Price |
$3,714.40
|
| Rate for Payer: Cofinity Commercial |
$2,477.92
|
| Rate for Payer: Cofinity Commercial |
$2,305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,720.78
|
| Rate for Payer: Healthscope Commercial |
$2,064.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,064.94
|
| Rate for Payer: Meridian Medicaid |
$1,160.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,806.82
|
| Rate for Payer: PACE SWMI |
$1,720.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,720.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,105.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,250.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,038.64
|
| Rate for Payer: Priority Health Medicare |
$1,720.78
|
| Rate for Payer: Priority Health Narrow Network |
$3,038.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,772.40
|
|
|
PR LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM
|
Professional
|
Both
|
$4,117.00
|
|
|
Service Code
|
HCPCS 44205
|
| Min. Negotiated Rate |
$846.89 |
| Max. Negotiated Rate |
$2,881.90 |
| Rate for Payer: Aetna Commercial |
$1,767.02
|
| Rate for Payer: Aetna Medicare |
$1,318.67
|
| Rate for Payer: BCBS Complete |
$889.23
|
| Rate for Payer: BCBS MAPPO |
$1,318.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,868.07
|
| Rate for Payer: BCN Commercial |
$1,936.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,318.67
|
| Rate for Payer: Cash Price |
$3,293.60
|
| Rate for Payer: Cash Price |
$3,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,898.88
|
| Rate for Payer: Cofinity Commercial |
$1,767.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,318.67
|
| Rate for Payer: Healthscope Commercial |
$1,582.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,582.40
|
| Rate for Payer: Meridian Medicaid |
$889.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,384.60
|
| Rate for Payer: PACE SWMI |
$1,318.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,318.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,881.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,329.55
|
| Rate for Payer: Priority Health Medicare |
$1,318.67
|
| Rate for Payer: Priority Health Narrow Network |
$2,329.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,358.23
|
|
|
PR LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$5,178.00
|
|
|
Service Code
|
HCPCS 44210
|
| Min. Negotiated Rate |
$1,121.66 |
| Max. Negotiated Rate |
$3,624.60 |
| Rate for Payer: Aetna Commercial |
$2,332.85
|
| Rate for Payer: Aetna Medicare |
$1,740.93
|
| Rate for Payer: BCBS Complete |
$1,177.74
|
| Rate for Payer: BCBS MAPPO |
$1,740.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,790.41
|
| Rate for Payer: BCN Commercial |
$2,564.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,740.93
|
| Rate for Payer: Cash Price |
$4,142.40
|
| Rate for Payer: Cash Price |
$4,142.40
|
| Rate for Payer: Cofinity Commercial |
$2,506.94
|
| Rate for Payer: Cofinity Commercial |
$2,332.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,740.93
|
| Rate for Payer: Healthscope Commercial |
$2,089.12
|
| Rate for Payer: Healthscope Whirlpool |
$2,089.12
|
| Rate for Payer: Meridian Medicaid |
$1,177.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,827.98
|
| Rate for Payer: PACE SWMI |
$1,740.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,740.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,121.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,624.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,085.09
|
| Rate for Payer: Priority Health Medicare |
$1,740.93
|
| Rate for Payer: Priority Health Narrow Network |
$3,085.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,793.16
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Facility
|
OP
|
$4,561.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
44202
|
| Min. Negotiated Rate |
$1,824.40 |
| Max. Negotiated Rate |
$4,561.00 |
| Rate for Payer: Aetna Commercial |
$4,104.90
|
| Rate for Payer: ASR ASR |
$4,424.17
|
| Rate for Payer: BCBS Complete |
$1,824.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,536.14
|
| Rate for Payer: BCN Commercial |
$3,536.14
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cofinity Commercial |
$4,287.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,648.80
|
| Rate for Payer: Healthscope Commercial |
$4,561.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,424.17
|
| Rate for Payer: Mclaren Commercial |
$4,104.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,876.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,150.51
|
| Rate for Payer: Priority Health Narrow Network |
$3,238.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,013.68
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
HCPCS 44202
|
| Min. Negotiated Rate |
$764.98 |
| Max. Negotiated Rate |
$3,192.70 |
| Rate for Payer: Aetna Commercial |
$1,844.93
|
| Rate for Payer: Aetna Medicare |
$1,376.81
|
| Rate for Payer: BCBS Complete |
$928.15
|
| Rate for Payer: BCBS MAPPO |
$1,376.81
|
| Rate for Payer: BCBS Trust/PPO |
$764.98
|
| Rate for Payer: BCN Commercial |
$2,019.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,376.81
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cofinity Commercial |
$1,844.93
|
| Rate for Payer: Cofinity Commercial |
$1,982.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,376.81
|
| Rate for Payer: Healthscope Commercial |
$1,652.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,652.17
|
| Rate for Payer: Meridian Medicaid |
$928.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,445.65
|
| Rate for Payer: PACE SWMI |
$1,376.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,376.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$883.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,430.10
|
| Rate for Payer: Priority Health Medicare |
$1,376.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,430.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,418.11
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
44202
|
| Min. Negotiated Rate |
$764.98 |
| Max. Negotiated Rate |
$3,192.70 |
| Rate for Payer: Aetna Commercial |
$1,844.93
|
| Rate for Payer: Aetna Medicare |
$1,376.81
|
| Rate for Payer: BCBS Complete |
$928.15
|
| Rate for Payer: BCBS MAPPO |
$1,376.81
|
| Rate for Payer: BCBS Trust/PPO |
$764.98
|
| Rate for Payer: BCN Commercial |
$2,019.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,376.81
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cofinity Commercial |
$1,844.93
|
| Rate for Payer: Cofinity Commercial |
$1,982.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,376.81
|
| Rate for Payer: Healthscope Commercial |
$1,652.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,652.17
|
| Rate for Payer: Meridian Medicaid |
$928.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,445.65
|
| Rate for Payer: PACE SWMI |
$1,376.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,376.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$883.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,430.10
|
| Rate for Payer: Priority Health Medicare |
$1,376.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,430.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,418.11
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Facility
|
IP
|
$4,561.00
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
44202
|
| Min. Negotiated Rate |
$3,192.70 |
| Max. Negotiated Rate |
$4,561.00 |
| Rate for Payer: Aetna Commercial |
$4,104.90
|
| Rate for Payer: ASR ASR |
$4,424.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,536.14
|
| Rate for Payer: BCN Commercial |
$3,536.14
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cofinity Commercial |
$4,287.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,648.80
|
| Rate for Payer: Healthscope Commercial |
$4,561.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,424.17
|
| Rate for Payer: Mclaren Commercial |
$4,104.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,876.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,013.68
|
|
|
PR LAPS ESOPHAGEAL LENGTHENING ADDL
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 43283
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$868.53 |
| Rate for Payer: Aetna Commercial |
$209.67
|
| Rate for Payer: Aetna Medicare |
$156.47
|
| Rate for Payer: BCBS Complete |
$104.44
|
| Rate for Payer: BCBS MAPPO |
$156.47
|
| Rate for Payer: BCBS Trust/PPO |
$868.53
|
| Rate for Payer: BCN Commercial |
$227.24
|
| Rate for Payer: BCN Medicare Advantage |
$156.47
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cofinity Commercial |
$225.32
|
| Rate for Payer: Cofinity Commercial |
$209.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.47
|
| Rate for Payer: Healthscope Commercial |
$187.76
|
| Rate for Payer: Healthscope Whirlpool |
$187.76
|
| Rate for Payer: Meridian Medicaid |
$104.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$164.29
|
| Rate for Payer: PACE SWMI |
$156.47
|
| Rate for Payer: PHP Medicare Advantage |
$156.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.42
|
| Rate for Payer: Priority Health Medicare |
$156.47
|
| Rate for Payer: Priority Health Narrow Network |
$273.42
|
| Rate for Payer: UHC Medicare Advantage |
$161.16
|
|
