|
PR LAPAROSCOPY SURG PARTIAL NEPHRECTOMY
|
Professional
|
Both
|
$2,852.00
|
|
|
Service Code
|
HCPCS 50543
|
| Min. Negotiated Rate |
$948.28 |
| Max. Negotiated Rate |
$3,176.67 |
| Rate for Payer: Aetna Commercial |
$1,912.33
|
| Rate for Payer: Aetna Medicare |
$1,426.00
|
| Rate for Payer: BCBS Complete |
$995.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.67
|
| Rate for Payer: BCN Commercial |
$2,139.43
|
| Rate for Payer: Cash Price |
$2,281.60
|
| Rate for Payer: Cash Price |
$2,281.60
|
| Rate for Payer: Meridian Medicaid |
$995.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$948.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,357.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,357.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,802.38
|
| Rate for Payer: UHC Exchange |
$1,802.38
|
| Rate for Payer: UHCCP Medicaid |
$948.28
|
|
|
PR LAPAROSCOPY SURG PYELOPLASTY
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
HCPCS 50544
|
| Min. Negotiated Rate |
$788.74 |
| Max. Negotiated Rate |
$2,666.86 |
| Rate for Payer: Aetna Commercial |
$1,596.98
|
| Rate for Payer: Aetna Medicare |
$1,198.50
|
| Rate for Payer: BCBS Complete |
$828.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,666.86
|
| Rate for Payer: BCN Commercial |
$1,782.21
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Meridian Medicaid |
$828.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,960.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,960.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,514.09
|
| Rate for Payer: UHC Exchange |
$1,514.09
|
| Rate for Payer: UHCCP Medicaid |
$788.74
|
|
|
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
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$281.59 |
| Max. Negotiated Rate |
$4,463.08 |
| Rate for Payer: Aetna Commercial |
$580.39
|
| Rate for Payer: Aetna Medicare |
$780.50
|
| Rate for Payer: BCBS Complete |
$295.67
|
| Rate for Payer: BCBS Trust/PPO |
$4,463.08
|
| Rate for Payer: BCN Commercial |
$635.28
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Meridian Medicaid |
$295.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.73
|
| Rate for Payer: Priority Health Narrow Network |
$782.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.90
|
| Rate for Payer: UHC Exchange |
$503.90
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 49650
|
| Min. Negotiated Rate |
$281.59 |
| Max. Negotiated Rate |
$4,463.08 |
| Rate for Payer: Aetna Commercial |
$580.39
|
| Rate for Payer: Aetna Medicare |
$780.50
|
| Rate for Payer: BCBS Complete |
$295.67
|
| Rate for Payer: BCBS Trust/PPO |
$4,463.08
|
| Rate for Payer: BCN Commercial |
$635.28
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Meridian Medicaid |
$295.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.73
|
| Rate for Payer: Priority Health Narrow Network |
$782.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.90
|
| Rate for Payer: UHC Exchange |
$503.90
|
| Rate for Payer: UHCCP Medicaid |
$281.59
|
|
|
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 |
$8,860.40 |
| Rate for Payer: Aetna Commercial |
$1,404.90
|
| Rate for Payer: Aetna Medicare |
$5,716.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: ASR ASR |
$1,514.17
|
| Rate for Payer: ASR Commercial |
$1,514.17
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.30
|
| Rate for Payer: BCN Commercial |
$1,210.24
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| 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 |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$1,561.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,514.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,716.39
|
| Rate for Payer: Mclaren Commercial |
$1,404.90
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| 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 |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$6,288.03
|
| Rate for Payer: PHP Medicaid |
$3,063.99
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| 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 |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,094.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,373.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,860.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP DNSP |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 49321
|
| Min. Negotiated Rate |
$222.59 |
| Max. Negotiated Rate |
$1,478.18 |
| Rate for Payer: Aetna Commercial |
$463.87
|
| Rate for Payer: Aetna Medicare |
$785.00
|
| Rate for Payer: BCBS Complete |
$233.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.18
|
| Rate for Payer: BCN Commercial |
$503.83
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Meridian Medicaid |
$233.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.87
|
| Rate for Payer: Priority Health Narrow Network |
$619.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$417.20
|
| Rate for Payer: UHC Exchange |
$417.20
|
| Rate for Payer: UHCCP Medicaid |
$222.59
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM
|
Professional
|
Both
|
$2,970.00
|
|
|
Service Code
|
HCPCS 58572
|
| Min. Negotiated Rate |
$61.81 |
| Max. Negotiated Rate |
$1,930.50 |
| Rate for Payer: Aetna Commercial |
$1,237.81
|
| Rate for Payer: Aetna Medicare |
$1,485.00
|
| Rate for Payer: BCBS Complete |
$701.59
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$1,519.78
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Meridian Medicaid |
$701.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$668.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,930.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,515.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,515.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,312.22
|
| Rate for Payer: UHC Exchange |
$1,312.22
|
| Rate for Payer: UHCCP Medicaid |
$668.18
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$3,465.00
|
|
|
Service Code
|
HCPCS 58573
|
| Min. Negotiated Rate |
$61.81 |
| Max. Negotiated Rate |
$2,252.25 |
| Rate for Payer: Aetna Commercial |
$1,450.88
|
| Rate for Payer: Aetna Medicare |
$1,732.50
|
| Rate for Payer: BCBS Complete |
$820.34
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$1,779.27
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Meridian Medicaid |
$820.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,821.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,821.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,498.82
|
| Rate for Payer: UHC Exchange |
$1,498.82
|
| Rate for Payer: UHCCP Medicaid |
$781.28
|
|
|
PR LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$2,687.00
|
|
|
Service Code
|
HCPCS 58660
|
| Min. Negotiated Rate |
$440.91 |
| Max. Negotiated Rate |
$1,746.55 |
| Rate for Payer: Aetna Commercial |
$813.78
|
| Rate for Payer: Aetna Medicare |
$1,343.50
|
| Rate for Payer: BCBS Complete |
$462.96
|
| Rate for Payer: BCBS Trust/PPO |
$540.45
|
| Rate for Payer: BCN Commercial |
$999.34
|
| Rate for Payer: Cash Price |
$2,149.60
|
| Rate for Payer: Cash Price |
$2,149.60
|
| Rate for Payer: Meridian Medicaid |
$462.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,746.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,024.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,024.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.20
|
| Rate for Payer: UHC Exchange |
$769.20
|
| Rate for Payer: UHCCP Medicaid |
$440.91
|
|
|
PR LAPAROSCOPY W/OMENTOPEXY
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 49326
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$1,426.41 |
| Rate for Payer: Aetna Commercial |
$255.96
|
| Rate for Payer: Aetna Medicare |
$172.00
|
| Rate for Payer: BCBS Complete |
$125.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.41
|
| Rate for Payer: BCN Commercial |
$272.19
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Meridian Medicaid |
$125.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.50
|
| Rate for Payer: Priority Health Narrow Network |
$333.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.39
|
| Rate for Payer: UHC Exchange |
$234.39
|
| Rate for Payer: UHCCP Medicaid |
$119.49
|
|
|
PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 58671
|
| Min. Negotiated Rate |
$48.39 |
| Max. Negotiated Rate |
$991.90 |
| Rate for Payer: Aetna Commercial |
$442.77
|
| Rate for Payer: Aetna Medicare |
$763.00
|
| Rate for Payer: BCBS Complete |
$250.94
|
| Rate for Payer: BCBS Trust/PPO |
$48.39
|
| Rate for Payer: BCN Commercial |
$546.34
|
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Meridian Medicaid |
$250.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$558.05
|
| Rate for Payer: Priority Health Narrow Network |
$558.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.94
|
| Rate for Payer: UHC Exchange |
$415.94
|
| Rate for Payer: UHCCP Medicaid |
$238.99
|
|
|
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
|
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 |
$8,860.40 |
| Rate for Payer: Aetna Commercial |
$2,469.60
|
| Rate for Payer: Aetna Medicare |
$5,716.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: ASR ASR |
$2,661.68
|
| Rate for Payer: ASR Commercial |
$2,661.68
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,247.06
|
| Rate for Payer: BCN Commercial |
$2,127.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| 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 |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$2,744.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,661.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,716.39
|
| Rate for Payer: Mclaren Commercial |
$2,469.60
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| 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 |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$6,288.03
|
| Rate for Payer: PHP Medicaid |
$3,063.99
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| 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 |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,923.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,414.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,860.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP DNSP |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,744.00
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
58661
|
| Min. Negotiated Rate |
$183.85 |
| Max. Negotiated Rate |
$1,783.60 |
| Rate for Payer: Aetna Commercial |
$780.25
|
| Rate for Payer: Aetna Medicare |
$1,372.00
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS Trust/PPO |
$183.85
|
| Rate for Payer: BCN Commercial |
$955.85
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,783.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$974.73
|
| Rate for Payer: Priority Health Narrow Network |
$974.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.22
|
| Rate for Payer: UHC Exchange |
$738.22
|
| Rate for Payer: UHCCP Medicaid |
$418.55
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,744.00
|
|
|
Service Code
|
HCPCS 58661
|
| Min. Negotiated Rate |
$183.85 |
| Max. Negotiated Rate |
$1,783.60 |
| Rate for Payer: Aetna Commercial |
$780.25
|
| Rate for Payer: Aetna Medicare |
$1,372.00
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS Trust/PPO |
$183.85
|
| Rate for Payer: BCN Commercial |
$955.85
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Cash Price |
$2,195.20
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,783.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$974.73
|
| Rate for Payer: Priority Health Narrow Network |
$974.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.22
|
| Rate for Payer: UHC Exchange |
$738.22
|
| Rate for Payer: UHCCP Medicaid |
$418.55
|
|
|
PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58570
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$1,608.75 |
| Rate for Payer: Aetna Commercial |
$956.81
|
| Rate for Payer: Aetna Medicare |
$1,237.50
|
| Rate for Payer: BCBS Complete |
$545.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$1,184.06
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Meridian Medicaid |
$545.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$519.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,055.96
|
| Rate for Payer: UHC Exchange |
$1,055.96
|
| Rate for Payer: UHCCP Medicaid |
$519.08
|
|
|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 49654
|
| Min. Negotiated Rate |
$1,128.40 |
| Max. Negotiated Rate |
$1,833.65 |
| Rate for Payer: Aetna Medicare |
$1,410.50
|
| Rate for Payer: BCBS Complete |
$1,128.40
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.65
|
|
|
PR LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,116.00
|
|
|
Service Code
|
HCPCS 49653
|
| Min. Negotiated Rate |
$1,246.40 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Aetna Medicare |
$1,558.00
|
| Rate for Payer: BCBS Complete |
$1,246.40
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,025.40
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 49320
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$1,309.66 |
| Rate for Payer: Aetna Commercial |
$441.92
|
| Rate for Payer: Aetna Medicare |
$703.50
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.66
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$593.02
|
| Rate for Payer: Priority Health Narrow Network |
$593.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.00
|
| Rate for Payer: UHC Exchange |
$395.00
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$914.55 |
| Max. Negotiated Rate |
$8,860.40 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: Aetna Medicare |
$5,716.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: ASR ASR |
$1,364.79
|
| Rate for Payer: ASR Commercial |
$1,364.79
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.19
|
| Rate for Payer: BCN Commercial |
$1,090.85
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$1,407.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,364.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,716.39
|
| Rate for Payer: Mclaren Commercial |
$1,266.30
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$6,288.03
|
| Rate for Payer: PHP Medicaid |
$3,063.99
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.81
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$986.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,238.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,860.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP DNSP |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
49320
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$1,309.66 |
| Rate for Payer: Aetna Commercial |
$441.92
|
| Rate for Payer: Aetna Medicare |
$703.50
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.66
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$593.02
|
| Rate for Payer: Priority Health Narrow Network |
$593.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.00
|
| Rate for Payer: UHC Exchange |
$395.00
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
49320
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$914.55 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: ASR ASR |
$1,364.79
|
| Rate for Payer: ASR Commercial |
$1,364.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.56
|
| Rate for Payer: BCN Commercial |
$1,090.85
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Healthscope Commercial |
$1,407.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,364.79
|
| Rate for Payer: Mclaren Commercial |
$1,266.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,238.16
|
|
|
PR LAPS ABLTJ RENAL MASS LESION W/INTRAOP US
|
Professional
|
Both
|
$2,115.00
|
|
|
Service Code
|
HCPCS 50542
|
| Min. Negotiated Rate |
$742.94 |
| Max. Negotiated Rate |
$3,188.29 |
| Rate for Payer: Aetna Commercial |
$1,499.49
|
| Rate for Payer: Aetna Medicare |
$1,057.50
|
| Rate for Payer: BCBS Complete |
$780.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,188.29
|
| Rate for Payer: BCN Commercial |
$1,678.61
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Meridian Medicaid |
$780.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$742.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,838.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,838.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,411.73
|
| Rate for Payer: UHC Exchange |
$1,411.73
|
| Rate for Payer: UHCCP Medicaid |
$742.94
|
|
|
PR LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1
|
Professional
|
Both
|
$1,869.00
|
|
|
Service Code
|
HCPCS 38572
|
| Min. Negotiated Rate |
$503.47 |
| Max. Negotiated Rate |
$1,792.20 |
| Rate for Payer: Aetna Commercial |
$1,126.54
|
| Rate for Payer: Aetna Medicare |
$934.50
|
| Rate for Payer: BCBS Complete |
$603.63
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$1,316.01
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Meridian Medicaid |
$603.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,214.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,792.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,077.76
|
| Rate for Payer: UHC Exchange |
$1,077.76
|
| Rate for Payer: UHCCP Medicaid |
$574.89
|
|
