|
PR LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
44970
|
| Min. Negotiated Rate |
$585.75 |
| Max. Negotiated Rate |
$1,309.75 |
| Rate for Payer: Aetna Commercial |
$784.90
|
| Rate for Payer: Aetna Medicare |
$585.75
|
| Rate for Payer: BCBS Complete |
$806.00
|
| Rate for Payer: BCBS MAPPO |
$585.75
|
| Rate for Payer: BCN Medicare Advantage |
$585.75
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cofinity Commercial |
$843.48
|
| Rate for Payer: Cofinity Commercial |
$784.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.75
|
| Rate for Payer: Healthscope Commercial |
$702.90
|
| Rate for Payer: Healthscope Whirlpool |
$702.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.04
|
| Rate for Payer: Nomi Health Commercial |
$702.90
|
| Rate for Payer: PACE SWMI |
$585.75
|
| Rate for Payer: PHP Medicare Advantage |
$585.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,309.75
|
| Rate for Payer: Priority Health Medicare |
$585.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$585.75
|
| Rate for Payer: UHC Medicare Advantage |
$585.75
|
| Rate for Payer: UHCCP DNSP |
$585.75
|
|
|
PR LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
44970
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,309.75 |
| Max. Negotiated Rate |
$2,015.00 |
| Rate for Payer: Aetna Commercial |
$1,813.50
|
| Rate for Payer: ASR ASR |
$1,954.55
|
| Rate for Payer: ASR Commercial |
$1,954.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,642.02
|
| Rate for Payer: BCN Commercial |
$1,562.23
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cofinity Commercial |
$1,894.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.00
|
| Rate for Payer: Healthscope Commercial |
$2,015.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,954.55
|
| Rate for Payer: Mclaren Commercial |
$1,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.75
|
| Rate for Payer: Nomi Health Commercial |
$1,652.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,309.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,773.20
|
|
|
PR LAPAROSCOPIC SURGICAL SPLENECTOMY
|
Professional
|
Both
|
$4,026.00
|
|
|
Service Code
|
HCPCS 38120
|
| Min. Negotiated Rate |
$1,028.92 |
| Max. Negotiated Rate |
$2,616.90 |
| Rate for Payer: Aetna Commercial |
$1,378.75
|
| Rate for Payer: Aetna Medicare |
$1,028.92
|
| Rate for Payer: BCBS Complete |
$1,610.40
|
| Rate for Payer: BCBS MAPPO |
$1,028.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,028.92
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cash Price |
$3,220.80
|
| Rate for Payer: Cofinity Commercial |
$1,481.64
|
| Rate for Payer: Cofinity Commercial |
$1,378.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,028.92
|
| Rate for Payer: Healthscope Commercial |
$1,234.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,234.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,080.37
|
| Rate for Payer: Nomi Health Commercial |
$1,234.70
|
| Rate for Payer: PACE SWMI |
$1,028.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,028.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,616.90
|
| Rate for Payer: Priority Health Medicare |
$1,028.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,028.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,028.92
|
| Rate for Payer: UHCCP DNSP |
$1,028.92
|
|
|
PR LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 60650
|
| Min. Negotiated Rate |
$886.00 |
| Max. Negotiated Rate |
$1,666.40 |
| Rate for Payer: Aetna Commercial |
$1,550.67
|
| Rate for Payer: Aetna Medicare |
$1,157.22
|
| Rate for Payer: BCBS Complete |
$886.00
|
| Rate for Payer: BCBS MAPPO |
$1,157.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,157.22
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,666.40
|
| Rate for Payer: Cofinity Commercial |
$1,550.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,157.22
|
| Rate for Payer: Healthscope Commercial |
$1,388.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,388.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,215.08
|
| Rate for Payer: Nomi Health Commercial |
$1,388.66
|
| Rate for Payer: PACE SWMI |
$1,157.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,157.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.75
|
| Rate for Payer: Priority Health Medicare |
$1,157.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,157.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,157.22
|
| Rate for Payer: UHCCP DNSP |
$1,157.22
|
|
|
PR LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$3,626.00
|
|
|
Service Code
|
HCPCS 44204
|
| Min. Negotiated Rate |
$1,450.40 |
| Max. Negotiated Rate |
$2,356.90 |
| Rate for Payer: Aetna Commercial |
$1,982.46
|
| Rate for Payer: Aetna Medicare |
$1,479.45
|
| Rate for Payer: BCBS Complete |
$1,450.40
|
| Rate for Payer: BCBS MAPPO |
$1,479.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,479.45
|
| Rate for Payer: Cash Price |
$2,900.80
|
| Rate for Payer: Cash Price |
$2,900.80
|
| Rate for Payer: Cofinity Commercial |
$2,130.41
|
| Rate for Payer: Cofinity Commercial |
$1,982.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,479.45
|
| Rate for Payer: Healthscope Commercial |
$1,775.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,775.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,553.42
|
| Rate for Payer: Nomi Health Commercial |
$1,775.34
|
| Rate for Payer: PACE SWMI |
$1,479.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,479.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,356.90
|
| Rate for Payer: Priority Health Medicare |
$1,479.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,479.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,479.45
|
| Rate for Payer: UHCCP DNSP |
$1,479.45
|
|
|
PR LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 57425
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,250.66
|
| Rate for Payer: Aetna Medicare |
$933.33
|
| Rate for Payer: BCBS Complete |
$810.00
|
| Rate for Payer: BCBS MAPPO |
$933.33
|
| Rate for Payer: BCN Medicare Advantage |
$933.33
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$1,250.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.33
|
| Rate for Payer: Healthscope Commercial |
$1,120.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,120.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.00
|
| Rate for Payer: Nomi Health Commercial |
$1,120.00
|
| Rate for Payer: PACE SWMI |
$933.33
|
| Rate for Payer: PHP Medicare Advantage |
$933.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.25
|
| Rate for Payer: Priority Health Medicare |
$933.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.33
|
| Rate for Payer: UHC Medicare Advantage |
$933.33
|
| Rate for Payer: UHCCP DNSP |
$933.33
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 44180
|
| Hospital Charge Code |
44180
|
| Min. Negotiated Rate |
$894.60 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,198.76
|
| Rate for Payer: Aetna Medicare |
$894.60
|
| Rate for Payer: BCBS Complete |
$930.00
|
| Rate for Payer: BCBS MAPPO |
$894.60
|
| Rate for Payer: BCN Medicare Advantage |
$894.60
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cofinity Commercial |
$1,288.22
|
| Rate for Payer: Cofinity Commercial |
$1,198.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$894.60
|
| Rate for Payer: Healthscope Commercial |
$1,073.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$939.33
|
| Rate for Payer: Nomi Health Commercial |
$1,073.52
|
| Rate for Payer: PACE SWMI |
$894.60
|
| Rate for Payer: PHP Medicare Advantage |
$894.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.25
|
| Rate for Payer: Priority Health Medicare |
$894.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$894.60
|
| Rate for Payer: UHC Medicare Advantage |
$894.60
|
| Rate for Payer: UHCCP DNSP |
$894.60
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 44180
|
| Min. Negotiated Rate |
$894.60 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,198.76
|
| Rate for Payer: Aetna Medicare |
$894.60
|
| Rate for Payer: BCBS Complete |
$930.00
|
| Rate for Payer: BCBS MAPPO |
$894.60
|
| Rate for Payer: BCN Medicare Advantage |
$894.60
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cofinity Commercial |
$1,288.22
|
| Rate for Payer: Cofinity Commercial |
$1,198.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$894.60
|
| Rate for Payer: Healthscope Commercial |
$1,073.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$939.33
|
| Rate for Payer: Nomi Health Commercial |
$1,073.52
|
| Rate for Payer: PACE SWMI |
$894.60
|
| Rate for Payer: PHP Medicare Advantage |
$894.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.25
|
| Rate for Payer: Priority Health Medicare |
$894.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$894.60
|
| Rate for Payer: UHC Medicare Advantage |
$894.60
|
| Rate for Payer: UHCCP DNSP |
$894.60
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
44180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: ASR ASR |
$2,255.25
|
| Rate for Payer: ASR Commercial |
$2,255.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,894.64
|
| Rate for Payer: BCN Commercial |
$1,802.57
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cofinity Commercial |
$2,185.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,860.00
|
| Rate for Payer: Healthscope Commercial |
$2,325.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,255.25
|
| Rate for Payer: Mclaren Commercial |
$2,092.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,976.25
|
| Rate for Payer: Nomi Health Commercial |
$1,906.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,046.00
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
44180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$8,819.70 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Aetna Medicare |
$5,690.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: ASR ASR |
$2,255.25
|
| Rate for Payer: ASR Commercial |
$2,255.25
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,903.94
|
| Rate for Payer: BCN Commercial |
$1,802.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cash Price |
$1,860.00
|
| Rate for Payer: Cofinity Commercial |
$2,185.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,860.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$2,325.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,255.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,690.13
|
| Rate for Payer: Mclaren Commercial |
$2,092.50
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,976.25
|
| Rate for Payer: Nomi Health Commercial |
$1,906.50
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$6,259.14
|
| Rate for Payer: PHP Medicaid |
$3,049.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,037.16
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,629.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,046.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$8,819.70
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP DNSP |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
PR LAPAROSCOPY FULGURATION OVIDUCTS
|
Professional
|
Both
|
$1,480.00
|
|
|
Service Code
|
HCPCS 58670
|
| Min. Negotiated Rate |
$356.12 |
| Max. Negotiated Rate |
$962.00 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: Aetna Medicare |
$356.12
|
| Rate for Payer: BCBS Complete |
$592.00
|
| Rate for Payer: BCBS MAPPO |
$356.12
|
| Rate for Payer: BCN Medicare Advantage |
$356.12
|
| Rate for Payer: Cash Price |
$1,184.00
|
| Rate for Payer: Cash Price |
$1,184.00
|
| Rate for Payer: Cofinity Commercial |
$512.81
|
| Rate for Payer: Cofinity Commercial |
$477.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.12
|
| Rate for Payer: Healthscope Commercial |
$427.34
|
| Rate for Payer: Healthscope Whirlpool |
$427.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.93
|
| Rate for Payer: Nomi Health Commercial |
$427.34
|
| Rate for Payer: PACE SWMI |
$356.12
|
| Rate for Payer: PHP Medicare Advantage |
$356.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.00
|
| Rate for Payer: Priority Health Medicare |
$356.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$356.12
|
| Rate for Payer: UHC Medicare Advantage |
$356.12
|
| Rate for Payer: UHCCP DNSP |
$356.12
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT
|
Professional
|
Both
|
$3,008.00
|
|
|
Service Code
|
HCPCS 50546
|
| Min. Negotiated Rate |
$1,149.47 |
| Max. Negotiated Rate |
$1,955.20 |
| Rate for Payer: Aetna Commercial |
$1,540.29
|
| Rate for Payer: Aetna Medicare |
$1,149.47
|
| Rate for Payer: BCBS Complete |
$1,203.20
|
| Rate for Payer: BCBS MAPPO |
$1,149.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.47
|
| Rate for Payer: Cash Price |
$2,406.40
|
| Rate for Payer: Cash Price |
$2,406.40
|
| Rate for Payer: Cofinity Commercial |
$1,655.24
|
| Rate for Payer: Cofinity Commercial |
$1,540.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.47
|
| Rate for Payer: Healthscope Commercial |
$1,379.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,379.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,206.94
|
| Rate for Payer: Nomi Health Commercial |
$1,379.36
|
| Rate for Payer: PACE SWMI |
$1,149.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,955.20
|
| Rate for Payer: Priority Health Medicare |
$1,149.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.47
|
| Rate for Payer: UHCCP DNSP |
$1,149.47
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY
|
Professional
|
Both
|
$2,592.00
|
|
|
Service Code
|
HCPCS 50548
|
| Min. Negotiated Rate |
$1,036.80 |
| Max. Negotiated Rate |
$1,842.12 |
| Rate for Payer: Aetna Commercial |
$1,714.19
|
| Rate for Payer: Aetna Medicare |
$1,279.25
|
| Rate for Payer: BCBS Complete |
$1,036.80
|
| Rate for Payer: BCBS MAPPO |
$1,279.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.25
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cofinity Commercial |
$1,842.12
|
| Rate for Payer: Cofinity Commercial |
$1,714.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.25
|
| Rate for Payer: Healthscope Commercial |
$1,535.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,535.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.21
|
| Rate for Payer: Nomi Health Commercial |
$1,535.10
|
| Rate for Payer: PACE SWMI |
$1,279.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,684.80
|
| Rate for Payer: Priority Health Medicare |
$1,279.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.25
|
| Rate for Payer: UHCCP DNSP |
$1,279.25
|
|
|
PR LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$2,294.00
|
|
|
Service Code
|
HCPCS 54692
|
| Min. Negotiated Rate |
$722.62 |
| Max. Negotiated Rate |
$1,491.10 |
| Rate for Payer: Aetna Commercial |
$968.31
|
| Rate for Payer: Aetna Medicare |
$722.62
|
| Rate for Payer: BCBS Complete |
$917.60
|
| Rate for Payer: BCBS MAPPO |
$722.62
|
| Rate for Payer: BCN Medicare Advantage |
$722.62
|
| Rate for Payer: Cash Price |
$1,835.20
|
| Rate for Payer: Cash Price |
$1,835.20
|
| Rate for Payer: Cofinity Commercial |
$968.31
|
| Rate for Payer: Cofinity Commercial |
$1,040.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.62
|
| Rate for Payer: Healthscope Commercial |
$867.14
|
| Rate for Payer: Healthscope Whirlpool |
$867.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.75
|
| Rate for Payer: Nomi Health Commercial |
$867.14
|
| Rate for Payer: PACE SWMI |
$722.62
|
| Rate for Payer: PHP Medicare Advantage |
$722.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,491.10
|
| Rate for Payer: Priority Health Medicare |
$722.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.62
|
| Rate for Payer: UHC Medicare Advantage |
$722.62
|
| Rate for Payer: UHCCP DNSP |
$722.62
|
|
|
PR LAPAROSCOPY PROCTOPEXY PROLAPSE
|
Professional
|
Both
|
$3,345.00
|
|
|
Service Code
|
HCPCS 45400
|
| Min. Negotiated Rate |
$1,082.00 |
| Max. Negotiated Rate |
$2,174.25 |
| Rate for Payer: Aetna Commercial |
$1,449.88
|
| Rate for Payer: Aetna Medicare |
$1,082.00
|
| Rate for Payer: BCBS Complete |
$1,338.00
|
| Rate for Payer: BCBS MAPPO |
$1,082.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,082.00
|
| Rate for Payer: Cash Price |
$2,676.00
|
| Rate for Payer: Cash Price |
$2,676.00
|
| Rate for Payer: Cofinity Commercial |
$1,558.08
|
| Rate for Payer: Cofinity Commercial |
$1,449.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,082.00
|
| Rate for Payer: Healthscope Commercial |
$1,298.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,298.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,136.10
|
| Rate for Payer: Nomi Health Commercial |
$1,298.40
|
| Rate for Payer: PACE SWMI |
$1,082.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,082.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,174.25
|
| Rate for Payer: Priority Health Medicare |
$1,082.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,082.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,082.00
|
| Rate for Payer: UHCCP DNSP |
$1,082.00
|
|
|
PR LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ
|
Professional
|
Both
|
$4,663.00
|
|
|
Service Code
|
HCPCS 45402
|
| Min. Negotiated Rate |
$1,451.59 |
| Max. Negotiated Rate |
$3,030.95 |
| Rate for Payer: Aetna Commercial |
$1,945.13
|
| Rate for Payer: Aetna Medicare |
$1,451.59
|
| Rate for Payer: BCBS Complete |
$1,865.20
|
| Rate for Payer: BCBS MAPPO |
$1,451.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.59
|
| Rate for Payer: Cash Price |
$3,730.40
|
| Rate for Payer: Cash Price |
$3,730.40
|
| Rate for Payer: Cofinity Commercial |
$2,090.29
|
| Rate for Payer: Cofinity Commercial |
$1,945.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.59
|
| Rate for Payer: Healthscope Commercial |
$1,741.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,741.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.17
|
| Rate for Payer: Nomi Health Commercial |
$1,741.91
|
| Rate for Payer: PACE SWMI |
$1,451.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,030.95
|
| Rate for Payer: Priority Health Medicare |
$1,451.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.59
|
| Rate for Payer: UHCCP DNSP |
$1,451.59
|
|
|
PR LAPAROSCOPY RADICAL NEPHRECTOMY
|
Professional
|
Both
|
$4,089.00
|
|
|
Service Code
|
HCPCS 50545
|
| Min. Negotiated Rate |
$1,272.53 |
| Max. Negotiated Rate |
$2,657.85 |
| Rate for Payer: Aetna Commercial |
$1,705.19
|
| Rate for Payer: Aetna Medicare |
$1,272.53
|
| Rate for Payer: BCBS Complete |
$1,635.60
|
| Rate for Payer: BCBS MAPPO |
$1,272.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,272.53
|
| Rate for Payer: Cash Price |
$3,271.20
|
| Rate for Payer: Cash Price |
$3,271.20
|
| Rate for Payer: Cofinity Commercial |
$1,832.44
|
| Rate for Payer: Cofinity Commercial |
$1,705.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,272.53
|
| Rate for Payer: Healthscope Commercial |
$1,527.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,527.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.16
|
| Rate for Payer: Nomi Health Commercial |
$1,527.04
|
| Rate for Payer: PACE SWMI |
$1,272.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,272.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,657.85
|
| Rate for Payer: Priority Health Medicare |
$1,272.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,272.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,272.53
|
| Rate for Payer: UHCCP DNSP |
$1,272.53
|
|
|
PR LAPAROSCOPY SALPINGOSTOMY
|
Professional
|
Both
|
$3,117.00
|
|
|
Service Code
|
HCPCS 58673
|
| Min. Negotiated Rate |
$762.46 |
| Max. Negotiated Rate |
$2,026.05 |
| Rate for Payer: Aetna Commercial |
$1,021.70
|
| Rate for Payer: Aetna Medicare |
$762.46
|
| Rate for Payer: BCBS Complete |
$1,246.80
|
| Rate for Payer: BCBS MAPPO |
$762.46
|
| Rate for Payer: BCN Medicare Advantage |
$762.46
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cofinity Commercial |
$1,097.94
|
| Rate for Payer: Cofinity Commercial |
$1,021.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.46
|
| Rate for Payer: Healthscope Commercial |
$914.95
|
| Rate for Payer: Healthscope Whirlpool |
$914.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$800.58
|
| Rate for Payer: Nomi Health Commercial |
$914.95
|
| Rate for Payer: PACE SWMI |
$762.46
|
| Rate for Payer: PHP Medicare Advantage |
$762.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.05
|
| Rate for Payer: Priority Health Medicare |
$762.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.46
|
| Rate for Payer: UHC Medicare Advantage |
$762.46
|
| Rate for Payer: UHCCP DNSP |
$762.46
|
|
|
PR LAPAROSCOPY SLING OPERATION STRESS INCONT
|
Professional
|
Both
|
$1,724.00
|
|
|
Service Code
|
HCPCS 51992
|
| Min. Negotiated Rate |
$689.60 |
| Max. Negotiated Rate |
$1,154.49 |
| Rate for Payer: Aetna Commercial |
$1,074.32
|
| Rate for Payer: Aetna Medicare |
$801.73
|
| Rate for Payer: BCBS Complete |
$689.60
|
| Rate for Payer: BCBS MAPPO |
$801.73
|
| Rate for Payer: BCN Medicare Advantage |
$801.73
|
| Rate for Payer: Cash Price |
$1,379.20
|
| Rate for Payer: Cash Price |
$1,379.20
|
| Rate for Payer: Cofinity Commercial |
$1,154.49
|
| Rate for Payer: Cofinity Commercial |
$1,074.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.73
|
| Rate for Payer: Healthscope Commercial |
$962.08
|
| Rate for Payer: Healthscope Whirlpool |
$962.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.82
|
| Rate for Payer: Nomi Health Commercial |
$962.08
|
| Rate for Payer: PACE SWMI |
$801.73
|
| Rate for Payer: PHP Medicare Advantage |
$801.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.60
|
| Rate for Payer: Priority Health Medicare |
$801.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$801.73
|
| Rate for Payer: UHC Medicare Advantage |
$801.73
|
| Rate for Payer: UHCCP DNSP |
$801.73
|
|
|
PR LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 44203
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$692.90 |
| Rate for Payer: Aetna Commercial |
$311.15
|
| Rate for Payer: Aetna Medicare |
$232.20
|
| Rate for Payer: BCBS Complete |
$426.40
|
| Rate for Payer: BCBS MAPPO |
$232.20
|
| Rate for Payer: BCN Medicare Advantage |
$232.20
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cofinity Commercial |
$334.37
|
| Rate for Payer: Cofinity Commercial |
$311.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.20
|
| Rate for Payer: Healthscope Commercial |
$278.64
|
| Rate for Payer: Healthscope Whirlpool |
$278.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.81
|
| Rate for Payer: Nomi Health Commercial |
$278.64
|
| Rate for Payer: PACE SWMI |
$232.20
|
| Rate for Payer: PHP Medicare Advantage |
$232.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.90
|
| Rate for Payer: Priority Health Medicare |
$232.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.20
|
| Rate for Payer: UHC Medicare Advantage |
$232.20
|
| Rate for Payer: UHCCP DNSP |
$232.20
|
|
|
PR LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 58541
|
| Min. Negotiated Rate |
$700.91 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$939.22
|
| Rate for Payer: Aetna Medicare |
$700.91
|
| Rate for Payer: BCBS Complete |
$810.00
|
| Rate for Payer: BCBS MAPPO |
$700.91
|
| Rate for Payer: BCN Medicare Advantage |
$700.91
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cofinity Commercial |
$939.22
|
| Rate for Payer: Cofinity Commercial |
$1,009.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.91
|
| Rate for Payer: Healthscope Commercial |
$841.09
|
| Rate for Payer: Healthscope Whirlpool |
$841.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$735.96
|
| Rate for Payer: Nomi Health Commercial |
$841.09
|
| Rate for Payer: PACE SWMI |
$700.91
|
| Rate for Payer: PHP Medicare Advantage |
$700.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.25
|
| Rate for Payer: Priority Health Medicare |
$700.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.91
|
| Rate for Payer: UHC Medicare Advantage |
$700.91
|
| Rate for Payer: UHCCP DNSP |
$700.91
|
|
|
PR LAPAROSCOPY SURG ABLATION RENAL CYSTS
|
Professional
|
Both
|
$1,762.00
|
|
|
Service Code
|
HCPCS 50541
|
| Min. Negotiated Rate |
$704.80 |
| Max. Negotiated Rate |
$1,261.17 |
| Rate for Payer: Aetna Commercial |
$1,173.59
|
| Rate for Payer: Aetna Medicare |
$875.81
|
| Rate for Payer: BCBS Complete |
$704.80
|
| Rate for Payer: BCBS MAPPO |
$875.81
|
| Rate for Payer: BCN Medicare Advantage |
$875.81
|
| Rate for Payer: Cash Price |
$1,409.60
|
| Rate for Payer: Cash Price |
$1,409.60
|
| Rate for Payer: Cofinity Commercial |
$1,261.17
|
| Rate for Payer: Cofinity Commercial |
$1,173.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.81
|
| Rate for Payer: Healthscope Commercial |
$1,050.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,050.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$919.60
|
| Rate for Payer: Nomi Health Commercial |
$1,050.97
|
| Rate for Payer: PACE SWMI |
$875.81
|
| Rate for Payer: PHP Medicare Advantage |
$875.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,145.30
|
| Rate for Payer: Priority Health Medicare |
$875.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$875.81
|
| Rate for Payer: UHC Medicare Advantage |
$875.81
|
| Rate for Payer: UHCCP DNSP |
$875.81
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Facility
|
OP
|
$3,011.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
47562
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,957.15 |
| Max. Negotiated Rate |
$8,819.70 |
| Rate for Payer: Aetna Commercial |
$2,709.90
|
| Rate for Payer: Aetna Medicare |
$5,690.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: ASR ASR |
$2,920.67
|
| Rate for Payer: ASR Commercial |
$2,920.67
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,465.71
|
| Rate for Payer: BCN Commercial |
$2,334.43
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cofinity Commercial |
$2,830.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,408.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$3,011.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,920.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,690.13
|
| Rate for Payer: Mclaren Commercial |
$2,709.90
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,559.35
|
| Rate for Payer: Nomi Health Commercial |
$2,469.02
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$6,259.14
|
| Rate for Payer: PHP Medicaid |
$3,049.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,638.24
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,110.71
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,649.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$8,819.70
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP DNSP |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Professional
|
Both
|
$3,011.00
|
|
|
Service Code
|
HCPCS 47562
|
| Min. Negotiated Rate |
$643.47 |
| Max. Negotiated Rate |
$1,957.15 |
| Rate for Payer: Aetna Commercial |
$862.25
|
| Rate for Payer: Aetna Medicare |
$643.47
|
| Rate for Payer: BCBS Complete |
$1,204.40
|
| Rate for Payer: BCBS MAPPO |
$643.47
|
| Rate for Payer: BCN Medicare Advantage |
$643.47
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cofinity Commercial |
$926.60
|
| Rate for Payer: Cofinity Commercial |
$862.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.47
|
| Rate for Payer: Healthscope Commercial |
$772.16
|
| Rate for Payer: Healthscope Whirlpool |
$772.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$675.64
|
| Rate for Payer: Nomi Health Commercial |
$772.16
|
| Rate for Payer: PACE SWMI |
$643.47
|
| Rate for Payer: PHP Medicare Advantage |
$643.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.15
|
| Rate for Payer: Priority Health Medicare |
$643.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.47
|
| Rate for Payer: UHC Medicare Advantage |
$643.47
|
| Rate for Payer: UHCCP DNSP |
$643.47
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Professional
|
Both
|
$3,011.00
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
47562
|
| Min. Negotiated Rate |
$643.47 |
| Max. Negotiated Rate |
$1,957.15 |
| Rate for Payer: Aetna Commercial |
$862.25
|
| Rate for Payer: Aetna Medicare |
$643.47
|
| Rate for Payer: BCBS Complete |
$1,204.40
|
| Rate for Payer: BCBS MAPPO |
$643.47
|
| Rate for Payer: BCN Medicare Advantage |
$643.47
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cofinity Commercial |
$926.60
|
| Rate for Payer: Cofinity Commercial |
$862.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.47
|
| Rate for Payer: Healthscope Commercial |
$772.16
|
| Rate for Payer: Healthscope Whirlpool |
$772.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$675.64
|
| Rate for Payer: Nomi Health Commercial |
$772.16
|
| Rate for Payer: PACE SWMI |
$643.47
|
| Rate for Payer: PHP Medicare Advantage |
$643.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.15
|
| Rate for Payer: Priority Health Medicare |
$643.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.47
|
| Rate for Payer: UHC Medicare Advantage |
$643.47
|
| Rate for Payer: UHCCP DNSP |
$643.47
|
|
