|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Facility
|
IP
|
$3,011.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
47562
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,957.15 |
| Max. Negotiated Rate |
$3,011.00 |
| Rate for Payer: Aetna Commercial |
$2,709.90
|
| Rate for Payer: ASR ASR |
$2,920.67
|
| Rate for Payer: ASR Commercial |
$2,920.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,453.66
|
| Rate for Payer: BCN Commercial |
$2,334.43
|
| 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: Healthscope Commercial |
$3,011.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,920.67
|
| Rate for Payer: Mclaren Commercial |
$2,709.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,559.35
|
| Rate for Payer: Nomi Health Commercial |
$2,469.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,649.68
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Facility
|
IP
|
$2,762.00
|
|
|
Service Code
|
CPT 44188
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$1,795.30 |
| Max. Negotiated Rate |
$2,762.00 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: ASR ASR |
$2,679.14
|
| Rate for Payer: ASR Commercial |
$2,679.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.75
|
| Rate for Payer: BCN Commercial |
$2,141.38
|
| Rate for Payer: Cash Price |
$2,209.60
|
| Rate for Payer: Cofinity Commercial |
$2,596.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,209.60
|
| Rate for Payer: Healthscope Commercial |
$2,762.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,679.14
|
| Rate for Payer: Mclaren Commercial |
$2,485.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,347.70
|
| Rate for Payer: Nomi Health Commercial |
$2,264.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,795.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,430.56
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$2,762.00
|
|
|
Service Code
|
HCPCS 44188
|
| Min. Negotiated Rate |
$1,104.80 |
| Max. Negotiated Rate |
$1,795.30 |
| Rate for Payer: Aetna Commercial |
$1,558.69
|
| Rate for Payer: Aetna Medicare |
$1,163.20
|
| Rate for Payer: BCBS Complete |
$1,104.80
|
| Rate for Payer: BCBS MAPPO |
$1,163.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,163.20
|
| Rate for Payer: Cash Price |
$2,209.60
|
| Rate for Payer: Cash Price |
$2,209.60
|
| Rate for Payer: Cofinity Commercial |
$1,675.01
|
| Rate for Payer: Cofinity Commercial |
$1,558.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,163.20
|
| Rate for Payer: Healthscope Commercial |
$1,395.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,395.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,221.36
|
| Rate for Payer: Nomi Health Commercial |
$1,395.84
|
| Rate for Payer: PACE SWMI |
$1,163.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,795.30
|
| Rate for Payer: Priority Health Medicare |
$1,163.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,163.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,163.20
|
| Rate for Payer: UHCCP DNSP |
$1,163.20
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Facility
|
OP
|
$2,762.00
|
|
|
Service Code
|
CPT 44188
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$1,104.80 |
| Max. Negotiated Rate |
$2,762.00 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: Aetna Medicare |
$1,381.00
|
| Rate for Payer: ASR ASR |
$2,679.14
|
| Rate for Payer: ASR Commercial |
$2,679.14
|
| Rate for Payer: BCBS Complete |
$1,104.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,261.80
|
| Rate for Payer: BCN Commercial |
$2,141.38
|
| Rate for Payer: Cash Price |
$2,209.60
|
| Rate for Payer: Cofinity Commercial |
$2,596.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,209.60
|
| Rate for Payer: Healthscope Commercial |
$2,762.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,679.14
|
| Rate for Payer: Mclaren Commercial |
$2,485.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,347.70
|
| Rate for Payer: Nomi Health Commercial |
$2,264.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,795.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,420.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,936.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,430.56
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$2,762.00
|
|
|
Service Code
|
HCPCS 44188
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$1,104.80 |
| Max. Negotiated Rate |
$1,795.30 |
| Rate for Payer: Aetna Commercial |
$1,558.69
|
| Rate for Payer: Aetna Medicare |
$1,163.20
|
| Rate for Payer: BCBS Complete |
$1,104.80
|
| Rate for Payer: BCBS MAPPO |
$1,163.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,163.20
|
| Rate for Payer: Cash Price |
$2,209.60
|
| Rate for Payer: Cash Price |
$2,209.60
|
| Rate for Payer: Cofinity Commercial |
$1,675.01
|
| Rate for Payer: Cofinity Commercial |
$1,558.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,163.20
|
| Rate for Payer: Healthscope Commercial |
$1,395.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,395.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,221.36
|
| Rate for Payer: Nomi Health Commercial |
$1,395.84
|
| Rate for Payer: PACE SWMI |
$1,163.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,795.30
|
| Rate for Payer: Priority Health Medicare |
$1,163.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,163.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,163.20
|
| Rate for Payer: UHCCP DNSP |
$1,163.20
|
|
|
PR LAPAROSCOPY SURGICAL JEJUNOSTOMY
|
Professional
|
Both
|
$1,998.00
|
|
|
Service Code
|
HCPCS 44186
|
| Min. Negotiated Rate |
$632.39 |
| Max. Negotiated Rate |
$1,298.70 |
| Rate for Payer: Aetna Commercial |
$847.40
|
| Rate for Payer: Aetna Medicare |
$632.39
|
| Rate for Payer: BCBS Complete |
$799.20
|
| Rate for Payer: BCBS MAPPO |
$632.39
|
| Rate for Payer: BCN Medicare Advantage |
$632.39
|
| Rate for Payer: Cash Price |
$1,598.40
|
| Rate for Payer: Cash Price |
$1,598.40
|
| Rate for Payer: Cofinity Commercial |
$910.64
|
| Rate for Payer: Cofinity Commercial |
$847.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.39
|
| Rate for Payer: Healthscope Commercial |
$758.87
|
| Rate for Payer: Healthscope Whirlpool |
$758.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.01
|
| Rate for Payer: Nomi Health Commercial |
$758.87
|
| Rate for Payer: PACE SWMI |
$632.39
|
| Rate for Payer: PHP Medicare Advantage |
$632.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,298.70
|
| Rate for Payer: Priority Health Medicare |
$632.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.39
|
| Rate for Payer: UHC Medicare Advantage |
$632.39
|
| Rate for Payer: UHCCP DNSP |
$632.39
|
|
|
PR LAPAROSCOPY SURGICAL ORCHIECTOMY
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 54690
|
| Min. Negotiated Rate |
$530.80 |
| Max. Negotiated Rate |
$903.04 |
| Rate for Payer: Aetna Commercial |
$840.33
|
| Rate for Payer: Aetna Medicare |
$627.11
|
| Rate for Payer: BCBS Complete |
$530.80
|
| Rate for Payer: BCBS MAPPO |
$627.11
|
| Rate for Payer: BCN Medicare Advantage |
$627.11
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$903.04
|
| Rate for Payer: Cofinity Commercial |
$840.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.11
|
| Rate for Payer: Healthscope Commercial |
$752.53
|
| Rate for Payer: Healthscope Whirlpool |
$752.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.47
|
| Rate for Payer: Nomi Health Commercial |
$752.53
|
| Rate for Payer: PACE SWMI |
$627.11
|
| Rate for Payer: PHP Medicare Advantage |
$627.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health Medicare |
$627.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$627.11
|
| Rate for Payer: UHC Medicare Advantage |
$627.11
|
| Rate for Payer: UHCCP DNSP |
$627.11
|
|
|
PR LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$3,023.00
|
|
|
Service Code
|
HCPCS 44187
|
| Min. Negotiated Rate |
$1,041.32 |
| Max. Negotiated Rate |
$1,964.95 |
| Rate for Payer: Aetna Commercial |
$1,395.37
|
| Rate for Payer: Aetna Medicare |
$1,041.32
|
| Rate for Payer: BCBS Complete |
$1,209.20
|
| Rate for Payer: BCBS MAPPO |
$1,041.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.32
|
| Rate for Payer: Cash Price |
$2,418.40
|
| Rate for Payer: Cash Price |
$2,418.40
|
| Rate for Payer: Cofinity Commercial |
$1,499.50
|
| Rate for Payer: Cofinity Commercial |
$1,395.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.32
|
| Rate for Payer: Healthscope Commercial |
$1,249.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,093.39
|
| Rate for Payer: Nomi Health Commercial |
$1,249.58
|
| Rate for Payer: PACE SWMI |
$1,041.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,964.95
|
| Rate for Payer: Priority Health Medicare |
$1,041.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,041.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.32
|
| Rate for Payer: UHCCP DNSP |
$1,041.32
|
|
|
PR LAPAROSCOPY SURG PARTIAL NEPHRECTOMY
|
Professional
|
Both
|
$2,852.00
|
|
|
Service Code
|
HCPCS 50543
|
| Min. Negotiated Rate |
$1,140.80 |
| Max. Negotiated Rate |
$2,043.29 |
| Rate for Payer: Aetna Commercial |
$1,901.39
|
| Rate for Payer: Aetna Medicare |
$1,418.95
|
| Rate for Payer: BCBS Complete |
$1,140.80
|
| Rate for Payer: BCBS MAPPO |
$1,418.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,418.95
|
| Rate for Payer: Cash Price |
$2,281.60
|
| Rate for Payer: Cash Price |
$2,281.60
|
| Rate for Payer: Cofinity Commercial |
$2,043.29
|
| Rate for Payer: Cofinity Commercial |
$1,901.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,418.95
|
| Rate for Payer: Healthscope Commercial |
$1,702.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,702.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,489.90
|
| Rate for Payer: Nomi Health Commercial |
$1,702.74
|
| Rate for Payer: PACE SWMI |
$1,418.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,418.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.80
|
| Rate for Payer: Priority Health Medicare |
$1,418.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,418.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,418.95
|
| Rate for Payer: UHCCP DNSP |
$1,418.95
|
|
|
PR LAPAROSCOPY SURG PYELOPLASTY
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
HCPCS 50544
|
| Min. Negotiated Rate |
$958.80 |
| Max. Negotiated Rate |
$1,702.60 |
| Rate for Payer: Aetna Commercial |
$1,584.36
|
| Rate for Payer: Aetna Medicare |
$1,182.36
|
| Rate for Payer: BCBS Complete |
$958.80
|
| Rate for Payer: BCBS MAPPO |
$1,182.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.36
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$1,702.60
|
| Rate for Payer: Cofinity Commercial |
$1,584.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.36
|
| Rate for Payer: Healthscope Commercial |
$1,418.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,418.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,241.48
|
| Rate for Payer: Nomi Health Commercial |
$1,418.83
|
| Rate for Payer: PACE SWMI |
$1,182.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: Priority Health Medicare |
$1,182.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.36
|
| Rate for Payer: UHCCP DNSP |
$1,182.36
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$1,014.65 |
| Rate for Payer: Aetna Commercial |
$564.61
|
| Rate for Payer: Aetna Medicare |
$421.35
|
| Rate for Payer: BCBS Complete |
$624.40
|
| Rate for Payer: BCBS MAPPO |
$421.35
|
| Rate for Payer: BCN Medicare Advantage |
$421.35
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cofinity Commercial |
$606.74
|
| Rate for Payer: Cofinity Commercial |
$564.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.35
|
| Rate for Payer: Healthscope Commercial |
$505.62
|
| Rate for Payer: Healthscope Whirlpool |
$505.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.42
|
| Rate for Payer: Nomi Health Commercial |
$505.62
|
| Rate for Payer: PACE SWMI |
$421.35
|
| Rate for Payer: PHP Medicare Advantage |
$421.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.65
|
| Rate for Payer: Priority Health Medicare |
$421.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.35
|
| Rate for Payer: UHC Medicare Advantage |
$421.35
|
| Rate for Payer: UHCCP DNSP |
$421.35
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
49650
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,014.65 |
| Max. Negotiated Rate |
$1,561.00 |
| Rate for Payer: Aetna Commercial |
$1,404.90
|
| Rate for Payer: ASR ASR |
$1,514.17
|
| Rate for Payer: ASR Commercial |
$1,514.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,272.06
|
| Rate for Payer: BCN Commercial |
$1,210.24
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cofinity Commercial |
$1,467.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.80
|
| Rate for Payer: Healthscope Commercial |
$1,561.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,514.17
|
| Rate for Payer: Mclaren Commercial |
$1,404.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.85
|
| Rate for Payer: Nomi Health Commercial |
$1,280.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.68
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
49650
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,014.65 |
| Max. Negotiated Rate |
$8,819.70 |
| Rate for Payer: Aetna Commercial |
$1,404.90
|
| 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 |
$1,514.17
|
| Rate for Payer: ASR Commercial |
$1,514.17
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.30
|
| Rate for Payer: BCN Commercial |
$1,210.24
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cofinity Commercial |
$1,467.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$1,561.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,514.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,690.13
|
| Rate for Payer: Mclaren Commercial |
$1,404.90
|
| 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 |
$1,326.85
|
| Rate for Payer: Nomi Health Commercial |
$1,280.02
|
| 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 |
$1,014.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,367.75
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,094.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.68
|
| 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 RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 49650
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$1,014.65 |
| Rate for Payer: Aetna Commercial |
$564.61
|
| Rate for Payer: Aetna Medicare |
$421.35
|
| Rate for Payer: BCBS Complete |
$624.40
|
| Rate for Payer: BCBS MAPPO |
$421.35
|
| Rate for Payer: BCN Medicare Advantage |
$421.35
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cofinity Commercial |
$606.74
|
| Rate for Payer: Cofinity Commercial |
$564.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.35
|
| Rate for Payer: Healthscope Commercial |
$505.62
|
| Rate for Payer: Healthscope Whirlpool |
$505.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.42
|
| Rate for Payer: Nomi Health Commercial |
$505.62
|
| Rate for Payer: PACE SWMI |
$421.35
|
| Rate for Payer: PHP Medicare Advantage |
$421.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.65
|
| Rate for Payer: Priority Health Medicare |
$421.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.35
|
| Rate for Payer: UHC Medicare Advantage |
$421.35
|
| Rate for Payer: UHCCP DNSP |
$421.35
|
|
|
PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 49321
|
| Min. Negotiated Rate |
$333.85 |
| Max. Negotiated Rate |
$1,020.50 |
| Rate for Payer: Aetna Commercial |
$447.36
|
| Rate for Payer: Aetna Medicare |
$333.85
|
| Rate for Payer: BCBS Complete |
$628.00
|
| Rate for Payer: BCBS MAPPO |
$333.85
|
| Rate for Payer: BCN Medicare Advantage |
$333.85
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cofinity Commercial |
$480.74
|
| Rate for Payer: Cofinity Commercial |
$447.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.85
|
| Rate for Payer: Healthscope Commercial |
$400.62
|
| Rate for Payer: Healthscope Whirlpool |
$400.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.54
|
| Rate for Payer: Nomi Health Commercial |
$400.62
|
| Rate for Payer: PACE SWMI |
$333.85
|
| Rate for Payer: PHP Medicare Advantage |
$333.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.50
|
| Rate for Payer: Priority Health Medicare |
$333.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.85
|
| Rate for Payer: UHC Medicare Advantage |
$333.85
|
| Rate for Payer: UHCCP DNSP |
$333.85
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM
|
Professional
|
Both
|
$2,970.00
|
|
|
Service Code
|
HCPCS 58572
|
| Min. Negotiated Rate |
$1,000.55 |
| Max. Negotiated Rate |
$1,930.50 |
| Rate for Payer: Aetna Commercial |
$1,340.74
|
| Rate for Payer: Aetna Medicare |
$1,000.55
|
| Rate for Payer: BCBS Complete |
$1,188.00
|
| Rate for Payer: BCBS MAPPO |
$1,000.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.55
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Cofinity Commercial |
$1,440.79
|
| Rate for Payer: Cofinity Commercial |
$1,340.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.55
|
| Rate for Payer: Healthscope Commercial |
$1,200.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,050.58
|
| Rate for Payer: Nomi Health Commercial |
$1,200.66
|
| Rate for Payer: PACE SWMI |
$1,000.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,930.50
|
| Rate for Payer: Priority Health Medicare |
$1,000.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,000.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,000.55
|
| Rate for Payer: UHCCP DNSP |
$1,000.55
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$3,465.00
|
|
|
Service Code
|
HCPCS 58573
|
| Min. Negotiated Rate |
$1,170.22 |
| Max. Negotiated Rate |
$2,252.25 |
| Rate for Payer: Aetna Commercial |
$1,568.09
|
| Rate for Payer: Aetna Medicare |
$1,170.22
|
| Rate for Payer: BCBS Complete |
$1,386.00
|
| Rate for Payer: BCBS MAPPO |
$1,170.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,170.22
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,685.12
|
| Rate for Payer: Cofinity Commercial |
$1,568.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,170.22
|
| Rate for Payer: Healthscope Commercial |
$1,404.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,228.73
|
| Rate for Payer: Nomi Health Commercial |
$1,404.26
|
| Rate for Payer: PACE SWMI |
$1,170.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,170.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.25
|
| Rate for Payer: Priority Health Medicare |
$1,170.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,170.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,170.22
|
| Rate for Payer: UHCCP DNSP |
$1,170.22
|
|
|
PR LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$2,687.00
|
|
|
Service Code
|
HCPCS 58660
|
| Min. Negotiated Rate |
$662.41 |
| Max. Negotiated Rate |
$1,746.55 |
| Rate for Payer: Aetna Commercial |
$887.63
|
| Rate for Payer: Aetna Medicare |
$662.41
|
| Rate for Payer: BCBS Complete |
$1,074.80
|
| Rate for Payer: BCBS MAPPO |
$662.41
|
| Rate for Payer: BCN Medicare Advantage |
$662.41
|
| Rate for Payer: Cash Price |
$2,149.60
|
| Rate for Payer: Cash Price |
$2,149.60
|
| Rate for Payer: Cofinity Commercial |
$953.87
|
| Rate for Payer: Cofinity Commercial |
$887.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.41
|
| Rate for Payer: Healthscope Commercial |
$794.89
|
| Rate for Payer: Healthscope Whirlpool |
$794.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.53
|
| Rate for Payer: Nomi Health Commercial |
$794.89
|
| Rate for Payer: PACE SWMI |
$662.41
|
| Rate for Payer: PHP Medicare Advantage |
$662.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,746.55
|
| Rate for Payer: Priority Health Medicare |
$662.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.41
|
| Rate for Payer: UHC Medicare Advantage |
$662.41
|
| Rate for Payer: UHCCP DNSP |
$662.41
|
|
|
PR LAPAROSCOPY W/OMENTOPEXY
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 49326
|
| Min. Negotiated Rate |
$137.60 |
| Max. Negotiated Rate |
$263.17 |
| Rate for Payer: Aetna Commercial |
$244.90
|
| Rate for Payer: Aetna Medicare |
$182.76
|
| Rate for Payer: BCBS Complete |
$137.60
|
| Rate for Payer: BCBS MAPPO |
$182.76
|
| Rate for Payer: BCN Medicare Advantage |
$182.76
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$263.17
|
| Rate for Payer: Cofinity Commercial |
$244.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.76
|
| Rate for Payer: Healthscope Commercial |
$219.31
|
| Rate for Payer: Healthscope Whirlpool |
$219.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.90
|
| Rate for Payer: Nomi Health Commercial |
$219.31
|
| Rate for Payer: PACE SWMI |
$182.76
|
| Rate for Payer: PHP Medicare Advantage |
$182.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.60
|
| Rate for Payer: Priority Health Medicare |
$182.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.76
|
| Rate for Payer: UHC Medicare Advantage |
$182.76
|
| Rate for Payer: UHCCP DNSP |
$182.76
|
|
|
PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 58671
|
| Min. Negotiated Rate |
$356.12 |
| Max. Negotiated Rate |
$991.90 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: Aetna Medicare |
$356.12
|
| Rate for Payer: BCBS Complete |
$610.40
|
| Rate for Payer: BCBS MAPPO |
$356.12
|
| Rate for Payer: BCN Medicare Advantage |
$356.12
|
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Cash Price |
$1,220.80
|
| 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 |
$991.90
|
| 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 W/RMVL ADNEXAL STRUCTURES
|
Facility
|
IP
|
$2,744.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
58661
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,783.60 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Aetna Commercial |
$2,469.60
|
| Rate for Payer: ASR ASR |
$2,661.68
|
| Rate for Payer: ASR Commercial |
$2,661.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,236.09
|
| Rate for Payer: BCN Commercial |
$2,127.42
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cofinity Commercial |
$2,579.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,195.20
|
| Rate for Payer: Healthscope Commercial |
$2,744.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,661.68
|
| Rate for Payer: Mclaren Commercial |
$2,469.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,332.40
|
| Rate for Payer: Nomi Health Commercial |
$2,250.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,783.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,414.72
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,744.00
|
|
|
Service Code
|
HCPCS 58661
|
| Min. Negotiated Rate |
$627.90 |
| Max. Negotiated Rate |
$1,783.60 |
| Rate for Payer: Aetna Commercial |
$841.39
|
| Rate for Payer: Aetna Medicare |
$627.90
|
| Rate for Payer: BCBS Complete |
$1,097.60
|
| Rate for Payer: BCBS MAPPO |
$627.90
|
| Rate for Payer: BCN Medicare Advantage |
$627.90
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cofinity Commercial |
$904.18
|
| Rate for Payer: Cofinity Commercial |
$841.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.90
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Healthscope Whirlpool |
$753.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$659.29
|
| Rate for Payer: Nomi Health Commercial |
$753.48
|
| Rate for Payer: PACE SWMI |
$627.90
|
| Rate for Payer: PHP Medicare Advantage |
$627.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,783.60
|
| Rate for Payer: Priority Health Medicare |
$627.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$627.90
|
| Rate for Payer: UHC Medicare Advantage |
$627.90
|
| Rate for Payer: UHCCP DNSP |
$627.90
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,744.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
58661
|
| Min. Negotiated Rate |
$627.90 |
| Max. Negotiated Rate |
$1,783.60 |
| Rate for Payer: Aetna Commercial |
$841.39
|
| Rate for Payer: Aetna Medicare |
$627.90
|
| Rate for Payer: BCBS Complete |
$1,097.60
|
| Rate for Payer: BCBS MAPPO |
$627.90
|
| Rate for Payer: BCN Medicare Advantage |
$627.90
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cofinity Commercial |
$904.18
|
| Rate for Payer: Cofinity Commercial |
$841.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.90
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Healthscope Whirlpool |
$753.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$659.29
|
| Rate for Payer: Nomi Health Commercial |
$753.48
|
| Rate for Payer: PACE SWMI |
$627.90
|
| Rate for Payer: PHP Medicare Advantage |
$627.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,783.60
|
| Rate for Payer: Priority Health Medicare |
$627.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$627.90
|
| Rate for Payer: UHC Medicare Advantage |
$627.90
|
| Rate for Payer: UHCCP DNSP |
$627.90
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Facility
|
OP
|
$2,744.00
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
58661
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,783.60 |
| Max. Negotiated Rate |
$8,819.70 |
| Rate for Payer: Aetna Commercial |
$2,469.60
|
| 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 |
$2,661.68
|
| Rate for Payer: ASR Commercial |
$2,661.68
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,247.06
|
| Rate for Payer: BCN Commercial |
$2,127.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cofinity Commercial |
$2,579.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,195.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$2,744.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,661.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,690.13
|
| Rate for Payer: Mclaren Commercial |
$2,469.60
|
| 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 |
$2,332.40
|
| Rate for Payer: Nomi Health Commercial |
$2,250.08
|
| 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 |
$1,783.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,404.29
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,923.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,414.72
|
| 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 W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58570
|
| Min. Negotiated Rate |
$775.49 |
| Max. Negotiated Rate |
$1,608.75 |
| Rate for Payer: Aetna Commercial |
$1,039.16
|
| Rate for Payer: Aetna Medicare |
$775.49
|
| Rate for Payer: BCBS Complete |
$990.00
|
| Rate for Payer: BCBS MAPPO |
$775.49
|
| Rate for Payer: BCN Medicare Advantage |
$775.49
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,116.71
|
| Rate for Payer: Cofinity Commercial |
$1,039.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.49
|
| Rate for Payer: Healthscope Commercial |
$930.59
|
| Rate for Payer: Healthscope Whirlpool |
$930.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.26
|
| Rate for Payer: Nomi Health Commercial |
$930.59
|
| Rate for Payer: PACE SWMI |
$775.49
|
| Rate for Payer: PHP Medicare Advantage |
$775.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health Medicare |
$775.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$775.49
|
| Rate for Payer: UHC Medicare Advantage |
$775.49
|
| Rate for Payer: UHCCP DNSP |
$775.49
|
|
