|
PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 43279
|
| Min. Negotiated Rate |
$777.66 |
| Max. Negotiated Rate |
$2,245.46 |
| Rate for Payer: Aetna Commercial |
$1,709.45
|
| Rate for Payer: Aetna Medicare |
$1,275.71
|
| Rate for Payer: BCBS Complete |
$858.36
|
| Rate for Payer: BCBS MAPPO |
$1,275.71
|
| Rate for Payer: BCBS Trust/PPO |
$777.66
|
| Rate for Payer: BCN Commercial |
$1,866.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,275.71
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cofinity Commercial |
$1,709.45
|
| Rate for Payer: Cofinity Commercial |
$1,837.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,275.71
|
| Rate for Payer: Healthscope Commercial |
$1,530.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,530.85
|
| Rate for Payer: Meridian Medicaid |
$858.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,339.50
|
| Rate for Payer: PACE SWMI |
$1,275.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,275.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$817.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,245.46
|
| Rate for Payer: Priority Health Medicare |
$1,275.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,245.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,313.98
|
|
|
PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$2,184.00
|
|
|
Service Code
|
HCPCS 58662
|
| Min. Negotiated Rate |
$237.21 |
| Max. Negotiated Rate |
$1,528.80 |
| Rate for Payer: Aetna Commercial |
$947.51
|
| Rate for Payer: Aetna Medicare |
$707.10
|
| Rate for Payer: BCBS Complete |
$481.07
|
| Rate for Payer: BCBS MAPPO |
$707.10
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$1,043.33
|
| Rate for Payer: BCN Medicare Advantage |
$707.10
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cofinity Commercial |
$947.51
|
| Rate for Payer: Cofinity Commercial |
$1,018.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.10
|
| Rate for Payer: Healthscope Commercial |
$848.52
|
| Rate for Payer: Healthscope Whirlpool |
$848.52
|
| Rate for Payer: Meridian Medicaid |
$481.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$742.46
|
| Rate for Payer: PACE SWMI |
$707.10
|
| Rate for Payer: PHP Medicare Advantage |
$707.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,010.76
|
| Rate for Payer: Priority Health Medicare |
$707.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,010.76
|
| Rate for Payer: UHC Medicare Advantage |
$728.31
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
HCPCS 43774
|
| Min. Negotiated Rate |
$530.94 |
| Max. Negotiated Rate |
$1,690.43 |
| Rate for Payer: Aetna Commercial |
$1,282.45
|
| Rate for Payer: Aetna Medicare |
$957.05
|
| Rate for Payer: BCBS Complete |
$646.35
|
| Rate for Payer: BCBS MAPPO |
$957.05
|
| Rate for Payer: BCBS Trust/PPO |
$530.94
|
| Rate for Payer: BCN Commercial |
$1,404.95
|
| Rate for Payer: BCN Medicare Advantage |
$957.05
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cofinity Commercial |
$1,378.15
|
| Rate for Payer: Cofinity Commercial |
$1,282.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$957.05
|
| Rate for Payer: Healthscope Commercial |
$1,148.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,148.46
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,004.90
|
| Rate for Payer: PACE SWMI |
$957.05
|
| Rate for Payer: PHP Medicare Advantage |
$957.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,184.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,690.43
|
| Rate for Payer: Priority Health Medicare |
$957.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,690.43
|
| Rate for Payer: UHC Medicare Advantage |
$985.76
|
|
|
PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 43775
|
| Min. Negotiated Rate |
$703.54 |
| Max. Negotiated Rate |
$3,202.50 |
| Rate for Payer: Aetna Commercial |
$1,484.72
|
| Rate for Payer: Aetna Medicare |
$1,108.00
|
| Rate for Payer: BCBS Complete |
$738.72
|
| Rate for Payer: BCBS MAPPO |
$1,108.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,269.50
|
| Rate for Payer: BCN Commercial |
$1,611.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,108.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$1,595.52
|
| Rate for Payer: Cofinity Commercial |
$1,484.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,108.00
|
| Rate for Payer: Healthscope Commercial |
$1,329.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,329.60
|
| Rate for Payer: Meridian Medicaid |
$738.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,163.40
|
| Rate for Payer: PACE SWMI |
$1,108.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,108.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,202.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,939.13
|
| Rate for Payer: Priority Health Medicare |
$1,108.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,939.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,141.24
|
|
|
PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM
|
Professional
|
Both
|
$3,029.00
|
|
|
Service Code
|
HCPCS 43644
|
| Min. Negotiated Rate |
$916.07 |
| Max. Negotiated Rate |
$3,047.46 |
| Rate for Payer: Aetna Commercial |
$2,317.81
|
| Rate for Payer: Aetna Medicare |
$1,729.71
|
| Rate for Payer: BCBS Complete |
$1,165.00
|
| Rate for Payer: BCBS MAPPO |
$1,729.71
|
| Rate for Payer: BCBS Trust/PPO |
$916.07
|
| Rate for Payer: BCN Commercial |
$2,532.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,729.71
|
| Rate for Payer: Cash Price |
$2,423.20
|
| Rate for Payer: Cash Price |
$2,423.20
|
| Rate for Payer: Cofinity Commercial |
$2,317.81
|
| Rate for Payer: Cofinity Commercial |
$2,490.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,729.71
|
| Rate for Payer: Healthscope Commercial |
$2,075.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,075.65
|
| Rate for Payer: Meridian Medicaid |
$1,165.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,816.20
|
| Rate for Payer: PACE SWMI |
$1,729.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,729.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,109.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,120.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,047.46
|
| Rate for Payer: Priority Health Medicare |
$1,729.71
|
| Rate for Payer: Priority Health Narrow Network |
$3,047.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,781.60
|
|
|
PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ
|
Professional
|
Both
|
$3,271.00
|
|
|
Service Code
|
HCPCS 43645
|
| Min. Negotiated Rate |
$1,018.03 |
| Max. Negotiated Rate |
$3,237.38 |
| Rate for Payer: Aetna Commercial |
$2,462.96
|
| Rate for Payer: Aetna Medicare |
$1,838.03
|
| Rate for Payer: BCBS Complete |
$1,237.68
|
| Rate for Payer: BCBS MAPPO |
$1,838.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,018.03
|
| Rate for Payer: BCN Commercial |
$2,690.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,838.03
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Cofinity Commercial |
$2,462.96
|
| Rate for Payer: Cofinity Commercial |
$2,646.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,838.03
|
| Rate for Payer: Healthscope Commercial |
$2,205.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,205.64
|
| Rate for Payer: Meridian Medicaid |
$1,237.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,929.93
|
| Rate for Payer: PACE SWMI |
$1,838.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,838.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,178.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,289.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,237.38
|
| Rate for Payer: Priority Health Medicare |
$1,838.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,237.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,893.17
|
|
|
PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 49324
|
| Min. Negotiated Rate |
$247.72 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna Commercial |
$516.26
|
| Rate for Payer: Aetna Medicare |
$385.27
|
| Rate for Payer: BCBS Complete |
$260.11
|
| Rate for Payer: BCBS MAPPO |
$385.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,137.50
|
| Rate for Payer: BCN Commercial |
$565.89
|
| Rate for Payer: BCN Medicare Advantage |
$385.27
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$554.79
|
| Rate for Payer: Cofinity Commercial |
$516.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$385.27
|
| Rate for Payer: Healthscope Commercial |
$462.32
|
| Rate for Payer: Healthscope Whirlpool |
$462.32
|
| Rate for Payer: Meridian Medicaid |
$260.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$404.53
|
| Rate for Payer: PACE SWMI |
$385.27
|
| Rate for Payer: PHP Medicare Advantage |
$385.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$680.87
|
| Rate for Payer: Priority Health Medicare |
$385.27
|
| Rate for Payer: Priority Health Narrow Network |
$680.87
|
| Rate for Payer: UHC Medicare Advantage |
$396.83
|
|
|
PR LAPS LIGATION SPERMATIC VEINS VARICOCELE
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 55550
|
| Min. Negotiated Rate |
$275.41 |
| Max. Negotiated Rate |
$2,149.12 |
| Rate for Payer: Aetna Commercial |
$562.08
|
| Rate for Payer: Aetna Medicare |
$419.46
|
| Rate for Payer: BCBS Complete |
$289.18
|
| Rate for Payer: BCBS MAPPO |
$419.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.12
|
| Rate for Payer: BCN Commercial |
$622.09
|
| Rate for Payer: BCN Medicare Advantage |
$419.46
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cofinity Commercial |
$562.08
|
| Rate for Payer: Cofinity Commercial |
$604.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.46
|
| Rate for Payer: Healthscope Commercial |
$503.35
|
| Rate for Payer: Healthscope Whirlpool |
$503.35
|
| Rate for Payer: Meridian Medicaid |
$289.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$440.43
|
| Rate for Payer: PACE SWMI |
$419.46
|
| Rate for Payer: PHP Medicare Advantage |
$419.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$687.87
|
| Rate for Payer: Priority Health Medicare |
$419.46
|
| Rate for Payer: Priority Health Narrow Network |
$687.87
|
| Rate for Payer: UHC Medicare Advantage |
$432.04
|
|
|
PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 44213
|
| Min. Negotiated Rate |
$117.36 |
| Max. Negotiated Rate |
$1,274.26 |
| Rate for Payer: Aetna Commercial |
$246.43
|
| Rate for Payer: Aetna Medicare |
$183.90
|
| Rate for Payer: BCBS Complete |
$123.23
|
| Rate for Payer: BCBS MAPPO |
$183.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,274.26
|
| Rate for Payer: BCN Commercial |
$268.29
|
| Rate for Payer: BCN Medicare Advantage |
$183.90
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cofinity Commercial |
$264.82
|
| Rate for Payer: Cofinity Commercial |
$246.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.90
|
| Rate for Payer: Healthscope Commercial |
$220.68
|
| Rate for Payer: Healthscope Whirlpool |
$220.68
|
| Rate for Payer: Meridian Medicaid |
$123.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$193.10
|
| Rate for Payer: PACE SWMI |
$183.90
|
| Rate for Payer: PHP Medicare Advantage |
$183.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.80
|
| Rate for Payer: Priority Health Medicare |
$183.90
|
| Rate for Payer: Priority Health Narrow Network |
$322.80
|
| Rate for Payer: UHC Medicare Advantage |
$189.42
|
|
|
PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Professional
|
Both
|
$1,871.00
|
|
|
Service Code
|
HCPCS 58545
|
| Min. Negotiated Rate |
$459.62 |
| Max. Negotiated Rate |
$1,320.41 |
| Rate for Payer: Aetna Commercial |
$1,200.29
|
| Rate for Payer: Aetna Medicare |
$895.74
|
| Rate for Payer: BCBS Complete |
$608.11
|
| Rate for Payer: BCBS MAPPO |
$895.74
|
| Rate for Payer: BCBS Trust/PPO |
$459.62
|
| Rate for Payer: BCN Commercial |
$1,320.41
|
| Rate for Payer: BCN Medicare Advantage |
$895.74
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cofinity Commercial |
$1,289.87
|
| Rate for Payer: Cofinity Commercial |
$1,200.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$895.74
|
| Rate for Payer: Healthscope Commercial |
$1,074.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,074.89
|
| Rate for Payer: Meridian Medicaid |
$608.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$940.53
|
| Rate for Payer: PACE SWMI |
$895.74
|
| Rate for Payer: PHP Medicare Advantage |
$895.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,309.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,279.19
|
| Rate for Payer: Priority Health Medicare |
$895.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,279.19
|
| Rate for Payer: UHC Medicare Advantage |
$922.61
|
|
|
PR LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS
|
Professional
|
Both
|
$2,355.00
|
|
|
Service Code
|
HCPCS 58546
|
| Min. Negotiated Rate |
$74.49 |
| Max. Negotiated Rate |
$1,648.50 |
| Rate for Payer: Aetna Commercial |
$1,486.09
|
| Rate for Payer: Aetna Medicare |
$1,109.02
|
| Rate for Payer: BCBS Complete |
$749.23
|
| Rate for Payer: BCBS MAPPO |
$1,109.02
|
| Rate for Payer: BCBS Trust/PPO |
$74.49
|
| Rate for Payer: BCN Commercial |
$1,631.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,109.02
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cofinity Commercial |
$1,486.09
|
| Rate for Payer: Cofinity Commercial |
$1,596.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,109.02
|
| Rate for Payer: Healthscope Commercial |
$1,330.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,330.82
|
| Rate for Payer: Meridian Medicaid |
$749.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,164.47
|
| Rate for Payer: PACE SWMI |
$1,109.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,109.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,648.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,580.28
|
| Rate for Payer: Priority Health Medicare |
$1,109.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.29
|
|
|
PR LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY
|
Professional
|
Both
|
$5,521.00
|
|
|
Service Code
|
HCPCS 45395
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$3,864.70 |
| Rate for Payer: Aetna Commercial |
$2,576.55
|
| Rate for Payer: Aetna Medicare |
$1,922.80
|
| Rate for Payer: BCBS Complete |
$1,301.64
|
| Rate for Payer: BCBS MAPPO |
$1,922.80
|
| Rate for Payer: BCBS Trust/PPO |
$75.55
|
| Rate for Payer: BCN Commercial |
$2,834.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,922.80
|
| Rate for Payer: Cash Price |
$4,416.80
|
| Rate for Payer: Cash Price |
$4,416.80
|
| Rate for Payer: Cofinity Commercial |
$2,768.83
|
| Rate for Payer: Cofinity Commercial |
$2,576.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,922.80
|
| Rate for Payer: Healthscope Commercial |
$2,307.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,307.36
|
| Rate for Payer: Meridian Medicaid |
$1,301.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,018.94
|
| Rate for Payer: PACE SWMI |
$1,922.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,922.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,239.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,864.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,410.84
|
| Rate for Payer: Priority Health Medicare |
$1,922.80
|
| Rate for Payer: Priority Health Narrow Network |
$3,410.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,980.48
|
|
|
PR LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR
|
Professional
|
Both
|
$5,982.00
|
|
|
Service Code
|
HCPCS 45397
|
| Min. Negotiated Rate |
$121.51 |
| Max. Negotiated Rate |
$4,187.40 |
| Rate for Payer: Aetna Commercial |
$2,793.77
|
| Rate for Payer: Aetna Medicare |
$2,084.90
|
| Rate for Payer: BCBS Complete |
$1,408.32
|
| Rate for Payer: BCBS MAPPO |
$2,084.90
|
| Rate for Payer: BCBS Trust/PPO |
$121.51
|
| Rate for Payer: BCN Commercial |
$3,073.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,084.90
|
| Rate for Payer: Cash Price |
$4,785.60
|
| Rate for Payer: Cash Price |
$4,785.60
|
| Rate for Payer: Cofinity Commercial |
$3,002.26
|
| Rate for Payer: Cofinity Commercial |
$2,793.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,084.90
|
| Rate for Payer: Healthscope Commercial |
$2,501.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,501.88
|
| Rate for Payer: Meridian Medicaid |
$1,408.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,189.14
|
| Rate for Payer: PACE SWMI |
$2,084.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,084.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,341.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,187.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,697.77
|
| Rate for Payer: Priority Health Medicare |
$2,084.90
|
| Rate for Payer: Priority Health Narrow Network |
$3,697.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,147.45
|
|
|
PR LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
|
Professional
|
Both
|
$1,187.00
|
|
|
Service Code
|
HCPCS 49652
|
| Min. Negotiated Rate |
$474.80 |
| Max. Negotiated Rate |
$830.90 |
| Rate for Payer: BCBS Complete |
$474.80
|
| Rate for Payer: Cash Price |
$949.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.90
|
|
|
PR LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,376.00
|
|
|
Service Code
|
HCPCS 49655
|
| Min. Negotiated Rate |
$1,350.40 |
| Max. Negotiated Rate |
$2,363.20 |
| Rate for Payer: BCBS Complete |
$1,350.40
|
| Rate for Payer: Cash Price |
$2,700.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,363.20
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH
|
Professional
|
Both
|
$4,873.00
|
|
|
Service Code
|
HCPCS 43282
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$3,411.10 |
| Rate for Payer: Aetna Commercial |
$2,308.00
|
| Rate for Payer: Aetna Medicare |
$1,722.39
|
| Rate for Payer: BCBS Complete |
$1,157.16
|
| Rate for Payer: BCBS MAPPO |
$1,722.39
|
| Rate for Payer: BCBS Trust/PPO |
$835.24
|
| Rate for Payer: BCN Commercial |
$2,517.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,722.39
|
| Rate for Payer: Cash Price |
$3,898.40
|
| Rate for Payer: Cash Price |
$3,898.40
|
| Rate for Payer: Cofinity Commercial |
$2,308.00
|
| Rate for Payer: Cofinity Commercial |
$2,480.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,722.39
|
| Rate for Payer: Healthscope Commercial |
$2,066.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,066.87
|
| Rate for Payer: Meridian Medicaid |
$1,157.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,808.51
|
| Rate for Payer: PACE SWMI |
$1,722.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,722.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,102.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,028.65
|
| Rate for Payer: Priority Health Medicare |
$1,722.39
|
| Rate for Payer: Priority Health Narrow Network |
$3,028.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,774.06
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$3,104.00
|
|
|
Service Code
|
HCPCS 43281
|
| Min. Negotiated Rate |
$936.15 |
| Max. Negotiated Rate |
$2,692.91 |
| Rate for Payer: Aetna Commercial |
$2,051.29
|
| Rate for Payer: Aetna Medicare |
$1,530.81
|
| Rate for Payer: BCBS Complete |
$1,027.45
|
| Rate for Payer: BCBS MAPPO |
$1,530.81
|
| Rate for Payer: BCBS Trust/PPO |
$936.15
|
| Rate for Payer: BCN Commercial |
$2,238.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,530.81
|
| Rate for Payer: Cash Price |
$2,483.20
|
| Rate for Payer: Cash Price |
$2,483.20
|
| Rate for Payer: Cofinity Commercial |
$2,204.37
|
| Rate for Payer: Cofinity Commercial |
$2,051.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,530.81
|
| Rate for Payer: Healthscope Commercial |
$1,836.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,836.97
|
| Rate for Payer: Meridian Medicaid |
$1,027.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,607.35
|
| Rate for Payer: PACE SWMI |
$1,530.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,530.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$978.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,692.91
|
| Rate for Payer: Priority Health Medicare |
$1,530.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,692.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,576.73
|
|
|
PR LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS 49657
|
| Min. Negotiated Rate |
$1,600.80 |
| Max. Negotiated Rate |
$2,801.40 |
| Rate for Payer: BCBS Complete |
$1,600.80
|
| Rate for Payer: Cash Price |
$3,201.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,801.40
|
|
|
PR LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE
|
Professional
|
Both
|
$1,464.00
|
|
|
Service Code
|
HCPCS 49656
|
| Min. Negotiated Rate |
$585.60 |
| Max. Negotiated Rate |
$1,024.80 |
| Rate for Payer: BCBS Complete |
$585.60
|
| Rate for Payer: Cash Price |
$1,171.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.80
|
|
|
PR LAPS SUPRACERVICAL HYSTERECTOMY >250
|
Professional
|
Both
|
$2,212.00
|
|
|
Service Code
|
HCPCS 58543
|
| Min. Negotiated Rate |
$362.94 |
| Max. Negotiated Rate |
$1,548.40 |
| Rate for Payer: Aetna Commercial |
$1,123.42
|
| Rate for Payer: Aetna Medicare |
$838.37
|
| Rate for Payer: BCBS Complete |
$568.29
|
| Rate for Payer: BCBS MAPPO |
$838.37
|
| Rate for Payer: BCBS Trust/PPO |
$362.94
|
| Rate for Payer: BCN Commercial |
$1,237.34
|
| Rate for Payer: BCN Medicare Advantage |
$838.37
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Cash Price |
$1,769.60
|
| Rate for Payer: Cofinity Commercial |
$1,207.25
|
| Rate for Payer: Cofinity Commercial |
$1,123.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.37
|
| Rate for Payer: Healthscope Commercial |
$1,006.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.04
|
| Rate for Payer: Meridian Medicaid |
$568.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$880.29
|
| Rate for Payer: PACE SWMI |
$838.37
|
| Rate for Payer: PHP Medicare Advantage |
$838.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,548.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,198.70
|
| Rate for Payer: Priority Health Medicare |
$838.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,198.70
|
| Rate for Payer: UHC Medicare Advantage |
$863.52
|
|
|
PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY
|
Professional
|
Both
|
$2,410.00
|
|
|
Service Code
|
HCPCS 58544
|
| Min. Negotiated Rate |
$387.24 |
| Max. Negotiated Rate |
$1,687.00 |
| Rate for Payer: Aetna Commercial |
$1,209.00
|
| Rate for Payer: Aetna Medicare |
$902.24
|
| Rate for Payer: BCBS Complete |
$610.56
|
| Rate for Payer: BCBS MAPPO |
$902.24
|
| Rate for Payer: BCBS Trust/PPO |
$387.24
|
| Rate for Payer: BCN Commercial |
$1,331.16
|
| Rate for Payer: BCN Medicare Advantage |
$902.24
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Cofinity Commercial |
$1,209.00
|
| Rate for Payer: Cofinity Commercial |
$1,299.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.24
|
| Rate for Payer: Healthscope Commercial |
$1,082.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,082.69
|
| Rate for Payer: Meridian Medicaid |
$610.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$947.35
|
| Rate for Payer: PACE SWMI |
$902.24
|
| Rate for Payer: PHP Medicare Advantage |
$902.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$581.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,687.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,289.61
|
| Rate for Payer: Priority Health Medicare |
$902.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.61
|
| Rate for Payer: UHC Medicare Advantage |
$929.31
|
|
|
PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$2,183.00
|
|
|
Service Code
|
HCPCS 58542
|
| Min. Negotiated Rate |
$383.55 |
| Max. Negotiated Rate |
$1,528.10 |
| Rate for Payer: Aetna Commercial |
$1,105.59
|
| Rate for Payer: Aetna Medicare |
$825.07
|
| Rate for Payer: BCBS Complete |
$559.58
|
| Rate for Payer: BCBS MAPPO |
$825.07
|
| Rate for Payer: BCBS Trust/PPO |
$383.55
|
| Rate for Payer: BCN Commercial |
$1,218.27
|
| Rate for Payer: BCN Medicare Advantage |
$825.07
|
| Rate for Payer: Cash Price |
$1,746.40
|
| Rate for Payer: Cash Price |
$1,746.40
|
| Rate for Payer: Cofinity Commercial |
$1,188.10
|
| Rate for Payer: Cofinity Commercial |
$1,105.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$825.07
|
| Rate for Payer: Healthscope Commercial |
$990.08
|
| Rate for Payer: Healthscope Whirlpool |
$990.08
|
| Rate for Payer: Meridian Medicaid |
$559.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$866.32
|
| Rate for Payer: PACE SWMI |
$825.07
|
| Rate for Payer: PHP Medicare Advantage |
$825.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,180.25
|
| Rate for Payer: Priority Health Medicare |
$825.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,180.25
|
| Rate for Payer: UHC Medicare Advantage |
$849.82
|
|
|
PR LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 38571
|
| Min. Negotiated Rate |
$421.10 |
| Max. Negotiated Rate |
$1,418.26 |
| Rate for Payer: Aetna Commercial |
$870.01
|
| Rate for Payer: Aetna Medicare |
$649.26
|
| Rate for Payer: BCBS Complete |
$442.16
|
| Rate for Payer: BCBS MAPPO |
$649.26
|
| Rate for Payer: BCBS Trust/PPO |
$459.62
|
| Rate for Payer: BCN Commercial |
$956.83
|
| Rate for Payer: BCN Medicare Advantage |
$649.26
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$870.01
|
| Rate for Payer: Cofinity Commercial |
$934.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.26
|
| Rate for Payer: Healthscope Commercial |
$779.11
|
| Rate for Payer: Healthscope Whirlpool |
$779.11
|
| Rate for Payer: Meridian Medicaid |
$442.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$681.72
|
| Rate for Payer: PACE SWMI |
$649.26
|
| Rate for Payer: PHP Medicare Advantage |
$649.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,418.26
|
| Rate for Payer: Priority Health Medicare |
$649.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.26
|
| Rate for Payer: UHC Medicare Advantage |
$668.74
|
|
|
PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 47564
|
| Min. Negotiated Rate |
$716.75 |
| Max. Negotiated Rate |
$2,304.40 |
| Rate for Payer: Aetna Commercial |
$1,488.85
|
| Rate for Payer: Aetna Medicare |
$1,111.08
|
| Rate for Payer: BCBS Complete |
$752.59
|
| Rate for Payer: BCBS MAPPO |
$1,111.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,228.90
|
| Rate for Payer: BCN Commercial |
$1,633.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,111.08
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cofinity Commercial |
$1,488.85
|
| Rate for Payer: Cofinity Commercial |
$1,599.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,111.08
|
| Rate for Payer: Healthscope Commercial |
$1,333.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,333.30
|
| Rate for Payer: Meridian Medicaid |
$752.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,166.63
|
| Rate for Payer: PACE SWMI |
$1,111.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,111.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$716.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,965.59
|
| Rate for Payer: Priority Health Medicare |
$1,111.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,965.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.41
|
|
|
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 |
$958.61
|
| Rate for Payer: Aetna Medicare |
$715.38
|
| Rate for Payer: BCBS Complete |
$484.21
|
| Rate for Payer: BCBS MAPPO |
$715.38
|
| Rate for Payer: BCBS Trust/PPO |
$584.28
|
| Rate for Payer: BCN Commercial |
$1,052.61
|
| Rate for Payer: BCN Medicare Advantage |
$715.38
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cofinity Commercial |
$958.61
|
| Rate for Payer: Cofinity Commercial |
$1,030.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.38
|
| Rate for Payer: Healthscope Commercial |
$858.46
|
| Rate for Payer: Healthscope Whirlpool |
$858.46
|
| Rate for Payer: Meridian Medicaid |
$484.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$751.15
|
| Rate for Payer: PACE SWMI |
$715.38
|
| Rate for Payer: PHP Medicare Advantage |
$715.38
|
| 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 Medicare |
$715.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,266.49
|
| Rate for Payer: UHC Medicare Advantage |
$736.84
|
|
