|
PR EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$559.67 |
| Rate for Payer: Aetna Commercial |
$473.96
|
| Rate for Payer: BCBS Complete |
$248.70
|
| Rate for Payer: BCBS Trust/PPO |
$206.04
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Mclaren Medicaid |
$236.86
|
| Rate for Payer: Meridian Medicaid |
$248.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.67
|
| Rate for Payer: Priority Health Narrow Network |
$559.67
|
| Rate for Payer: Priority Health SBD |
$559.67
|
|
|
PR EXCISION OLECRANON BURSA
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$510.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$516.00
|
| Rate for Payer: Healthscope Commercial |
$540.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.00
|
| Rate for Payer: PHP Commercial |
$510.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health SBD |
$378.00
|
|
|
PR EXCISION OR FULGURATION SKENES GLANDS
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 53270
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$772.90 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: BCBS Complete |
$124.13
|
| Rate for Payer: BCBS Trust/PPO |
$772.90
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Mclaren Medicaid |
$118.22
|
| Rate for Payer: Meridian Medicaid |
$124.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.57
|
| Rate for Payer: Priority Health Narrow Network |
$295.57
|
| Rate for Payer: Priority Health SBD |
$295.57
|
|
|
PR EXCISION PILONIDAL CYST/SINUS COMPLICATED
|
Professional
|
Both
|
$1,131.00
|
|
|
Service Code
|
HCPCS 11772
|
| Min. Negotiated Rate |
$372.96 |
| Max. Negotiated Rate |
$1,453.51 |
| Rate for Payer: Aetna Commercial |
$633.90
|
| Rate for Payer: BCBS Complete |
$391.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Mclaren Medicaid |
$372.96
|
| Rate for Payer: Meridian Medicaid |
$391.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$714.39
|
| Rate for Payer: Priority Health Narrow Network |
$714.39
|
| Rate for Payer: Priority Health SBD |
$714.39
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Facility
|
IP
|
$1,317.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
11771
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$829.71 |
| Max. Negotiated Rate |
$1,185.30 |
| Rate for Payer: Aetna Commercial |
$1,119.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.05
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cofinity Commercial |
$1,132.62
|
| Rate for Payer: Cofinity Commercial |
$921.90
|
| Rate for Payer: Healthscope Commercial |
$1,185.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,119.45
|
| Rate for Payer: PHP Commercial |
$1,119.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.90
|
| Rate for Payer: Priority Health SBD |
$829.71
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$1,317.00
|
|
|
Service Code
|
HCPCS 11771
|
| Min. Negotiated Rate |
$290.11 |
| Max. Negotiated Rate |
$921.90 |
| Rate for Payer: Aetna Commercial |
$483.14
|
| Rate for Payer: BCBS Complete |
$304.62
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Mclaren Medicaid |
$290.11
|
| Rate for Payer: Meridian Medicaid |
$304.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.08
|
| Rate for Payer: Priority Health Narrow Network |
$554.08
|
| Rate for Payer: Priority Health SBD |
$554.08
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Facility
|
OP
|
$1,317.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
11771
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$445.98 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Commercial |
$1,119.45
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cofinity Commercial |
$921.90
|
| Rate for Payer: Cofinity Commercial |
$1,132.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$1,185.30
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,119.45
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$1,119.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,382.58
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,906.06
|
| Rate for Payer: Priority Health SBD |
$829.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$445.98
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$1,317.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
11771
|
| Min. Negotiated Rate |
$290.11 |
| Max. Negotiated Rate |
$921.90 |
| Rate for Payer: Aetna Commercial |
$483.14
|
| Rate for Payer: BCBS Complete |
$304.62
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Mclaren Medicaid |
$290.11
|
| Rate for Payer: Meridian Medicaid |
$304.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.08
|
| Rate for Payer: Priority Health Narrow Network |
$554.08
|
| Rate for Payer: Priority Health SBD |
$554.08
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
11770
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$183.37 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,632.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.50
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,382.58
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,906.06
|
| Rate for Payer: Priority Health SBD |
$321.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$183.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 11770
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Mclaren Medicaid |
$119.28
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.12
|
| Rate for Payer: Priority Health Narrow Network |
$228.12
|
| Rate for Payer: Priority Health SBD |
$228.12
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
11770
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Mclaren Medicaid |
$119.28
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.12
|
| Rate for Payer: Priority Health Narrow Network |
$228.12
|
| Rate for Payer: Priority Health SBD |
$228.12
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
11770
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health SBD |
$321.30
|
|
|
PR EXCISION PREPATELLAR BURSA
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
27340
|
| Min. Negotiated Rate |
$378.20 |
| Max. Negotiated Rate |
$8,817.68 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$892.50
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,083.75
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,817.68
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,054.14
|
| Rate for Payer: Priority Health SBD |
$803.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$378.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PR EXCISION PREPATELLAR BURSA
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
27340
|
| Min. Negotiated Rate |
$803.25 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.75
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$892.50
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,083.75
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health SBD |
$803.25
|
|
|
PR EXCISION PREPATELLAR BURSA
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27340
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$2,642.03 |
| Rate for Payer: Aetna Commercial |
$495.88
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,642.03
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Mclaren Medicaid |
$246.02
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$581.13
|
| Rate for Payer: Priority Health Narrow Network |
$581.13
|
| Rate for Payer: Priority Health SBD |
$581.13
|
|
|
PR EXCISION PREPATELLAR BURSA
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27340
|
| Hospital Charge Code |
27340
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$2,642.03 |
| Rate for Payer: Aetna Commercial |
$495.88
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,642.03
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Mclaren Medicaid |
$246.02
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$581.13
|
| Rate for Payer: Priority Health Narrow Network |
$581.13
|
| Rate for Payer: Priority Health SBD |
$581.13
|
|
|
PR EXCISION RADIAL HEAD
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 24130
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$861.70 |
| Rate for Payer: Aetna Commercial |
$679.15
|
| Rate for Payer: BCBS Complete |
$350.02
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: Cash Price |
$984.80
|
| Rate for Payer: Cash Price |
$984.80
|
| Rate for Payer: Mclaren Medicaid |
$333.35
|
| Rate for Payer: Meridian Medicaid |
$350.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$794.56
|
| Rate for Payer: Priority Health Narrow Network |
$794.56
|
| Rate for Payer: Priority Health SBD |
$794.56
|
|
|
PR EXCISION & REPAIR EYELID < ONE-FOURTH LID MARGIN
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 67961
|
| Min. Negotiated Rate |
$287.55 |
| Max. Negotiated Rate |
$2,721.27 |
| Rate for Payer: Aetna Commercial |
$587.78
|
| Rate for Payer: BCBS Complete |
$301.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,721.27
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Mclaren Medicaid |
$287.55
|
| Rate for Payer: Meridian Medicaid |
$301.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$780.96
|
| Rate for Payer: Priority Health Narrow Network |
$780.96
|
| Rate for Payer: Priority Health SBD |
$780.96
|
|
|
PR EXCISION RIB PARTIAL
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
HCPCS 21600
|
| Min. Negotiated Rate |
$57.05 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: Aetna Commercial |
$740.10
|
| Rate for Payer: BCBS Complete |
$384.23
|
| Rate for Payer: BCBS Trust/PPO |
$57.05
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Mclaren Medicaid |
$365.93
|
| Rate for Payer: Meridian Medicaid |
$384.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,115.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.08
|
| Rate for Payer: Priority Health Narrow Network |
$867.08
|
| Rate for Payer: Priority Health SBD |
$867.08
|
|
|
PR EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 15931
|
| Min. Negotiated Rate |
$48.31 |
| Max. Negotiated Rate |
$869.75 |
| Rate for Payer: Aetna Commercial |
$766.63
|
| Rate for Payer: BCBS Complete |
$475.26
|
| Rate for Payer: BCBS Trust/PPO |
$48.31
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Mclaren Medicaid |
$452.63
|
| Rate for Payer: Meridian Medicaid |
$475.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$452.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$869.75
|
| Rate for Payer: Priority Health Narrow Network |
$869.75
|
| Rate for Payer: Priority Health SBD |
$869.75
|
|
|
PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
46220
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$1,565.88 |
| Rate for Payer: Aetna Commercial |
$159.56
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.88
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.02
|
| Rate for Payer: Priority Health Narrow Network |
$214.02
|
| Rate for Payer: Priority Health SBD |
$214.02
|
|
|
PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 46220
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$1,565.88 |
| Rate for Payer: Aetna Commercial |
$159.56
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.88
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.02
|
| Rate for Payer: Priority Health Narrow Network |
$214.02
|
| Rate for Payer: Priority Health SBD |
$214.02
|
|
|
PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
46220
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Aetna Commercial |
$366.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.15
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$301.70
|
| Rate for Payer: Cofinity Commercial |
$370.66
|
| Rate for Payer: Healthscope Commercial |
$387.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.35
|
| Rate for Payer: PHP Commercial |
$366.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.70
|
| Rate for Payer: Priority Health SBD |
$271.53
|
|
|
PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
46220
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$1,312.52 |
| Rate for Payer: Aetna Commercial |
$366.35
|
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$664.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$370.66
|
| Rate for Payer: Cofinity Commercial |
$301.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Healthscope Commercial |
$387.90
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.35
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Commercial |
$366.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.70
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health SBD |
$271.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$120.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
PR EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 15830
|
| Min. Negotiated Rate |
$226.01 |
| Max. Negotiated Rate |
$1,820.00 |
| Rate for Payer: Aetna Commercial |
$1,270.12
|
| Rate for Payer: BCBS Complete |
$787.03
|
| Rate for Payer: BCBS Trust/PPO |
$226.01
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Mclaren Medicaid |
$749.55
|
| Rate for Payer: Meridian Medicaid |
$787.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,820.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,439.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,439.87
|
| Rate for Payer: Priority Health SBD |
$1,439.87
|
|
