|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 10060
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$129.07 |
| Rate for Payer: Aetna Commercial |
$109.76
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS Trust/PPO |
$10.31
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Mclaren Medicaid |
$68.59
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Narrow Network |
$129.07
|
| Rate for Payer: Priority Health SBD |
$129.07
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
10060
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
10060
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$146.34
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$105.44
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
PR INCISION&DRAINAGE BURSA FOOT
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 28001
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$795.62 |
| Rate for Payer: Aetna Commercial |
$222.73
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS Trust/PPO |
$795.62
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Mclaren Medicaid |
$60.92
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.54
|
| Rate for Payer: Priority Health Narrow Network |
$145.54
|
| Rate for Payer: Priority Health SBD |
$145.54
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
10180
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$561.00
|
| Rate for Payer: PHP Commercial |
$561.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health SBD |
$415.80
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
10180
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$191.63
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.50
|
| Rate for Payer: Priority Health Narrow Network |
$219.50
|
| Rate for Payer: Priority Health SBD |
$219.50
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 10180
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$191.63
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.50
|
| Rate for Payer: Priority Health Narrow Network |
$219.50
|
| Rate for Payer: Priority Health SBD |
$219.50
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
10180
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$176.49 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.00
|
| 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 |
$1,480.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| 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 |
$561.00
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$561.00
|
| 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 |
$462.00
|
| 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 |
$415.80
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$176.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
PR INCISION & DRAINAGE FOREARM&/WRIST BURSA
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 25031
|
| Min. Negotiated Rate |
$241.76 |
| Max. Negotiated Rate |
$942.49 |
| Rate for Payer: Aetna Commercial |
$487.91
|
| Rate for Payer: BCBS Complete |
$253.85
|
| Rate for Payer: BCBS Trust/PPO |
$942.49
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Mclaren Medicaid |
$241.76
|
| Rate for Payer: Meridian Medicaid |
$253.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.93
|
| Rate for Payer: Priority Health Narrow Network |
$571.93
|
| Rate for Payer: Priority Health SBD |
$571.93
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,118.00
|
|
|
Service Code
|
HCPCS 27603
|
| Min. Negotiated Rate |
$251.77 |
| Max. Negotiated Rate |
$1,557.43 |
| Rate for Payer: Aetna Commercial |
$521.21
|
| Rate for Payer: BCBS Complete |
$264.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.43
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Mclaren Medicaid |
$251.77
|
| Rate for Payer: Meridian Medicaid |
$264.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.03
|
| Rate for Payer: Priority Health Narrow Network |
$601.03
|
| Rate for Payer: Priority Health SBD |
$601.03
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 27604
|
| Min. Negotiated Rate |
$208.74 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$437.25
|
| Rate for Payer: BCBS Complete |
$219.18
|
| Rate for Payer: BCBS Trust/PPO |
$557.88
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Mclaren Medicaid |
$208.74
|
| Rate for Payer: Meridian Medicaid |
$219.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$493.80
|
| Rate for Payer: Priority Health Narrow Network |
$493.80
|
| Rate for Payer: Priority Health SBD |
$493.80
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 10081
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$311.50 |
| Rate for Payer: Aetna Commercial |
$186.54
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.91
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Mclaren Medicaid |
$109.70
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$209.62
|
| Rate for Payer: Priority Health SBD |
$209.62
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 10080
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$214.90 |
| Rate for Payer: Aetna Commercial |
$111.66
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Mclaren Medicaid |
$67.73
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.25
|
| Rate for Payer: Priority Health Narrow Network |
$128.25
|
| Rate for Payer: Priority Health SBD |
$128.25
|
|
|
PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 23931
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$508.90 |
| Rate for Payer: Aetna Commercial |
$210.92
|
| Rate for Payer: BCBS Complete |
$110.04
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Mclaren Medicaid |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$110.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.17
|
| Rate for Payer: Priority Health Narrow Network |
$248.17
|
| Rate for Payer: Priority Health SBD |
$248.17
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$173.81 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$452.93
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: BCBS Trust/PPO |
$173.81
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Mclaren Medicaid |
$227.48
|
| Rate for Payer: Meridian Medicaid |
$238.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$537.71
|
| Rate for Payer: Priority Health Narrow Network |
$537.71
|
| Rate for Payer: Priority Health SBD |
$537.71
|
|
|
PR INCISION FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$1,124.75 |
| Rate for Payer: Aetna Commercial |
$455.72
|
| Rate for Payer: BCBS Complete |
$239.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.75
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Mclaren Medicaid |
$228.55
|
| Rate for Payer: Meridian Medicaid |
$239.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.22
|
| Rate for Payer: Priority Health Narrow Network |
$538.22
|
| Rate for Payer: Priority Health SBD |
$538.22
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$393.58 |
| Rate for Payer: Aetna Commercial |
$37.05
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS Trust/PPO |
$393.58
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Mclaren Medicaid |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.56
|
| Rate for Payer: Priority Health Narrow Network |
$50.56
|
| Rate for Payer: Priority Health SBD |
$50.56
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$386.81 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna Commercial |
$800.75
|
| Rate for Payer: BCBS Complete |
$406.15
|
| Rate for Payer: BCBS Trust/PPO |
$864.83
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Mclaren Medicaid |
$386.81
|
| Rate for Payer: Meridian Medicaid |
$406.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.11
|
| Rate for Payer: Priority Health Narrow Network |
$916.11
|
| Rate for Payer: Priority Health SBD |
$916.11
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$971.54 |
| Rate for Payer: Aetna Commercial |
$142.03
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Trust/PPO |
$971.54
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Mclaren Medicaid |
$70.93
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.21
|
| Rate for Payer: Priority Health Narrow Network |
$195.21
|
| Rate for Payer: Priority Health SBD |
$195.21
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna Commercial |
$199.20
|
| Rate for Payer: BCBS Complete |
$123.46
|
| Rate for Payer: BCBS Trust/PPO |
$234.52
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Mclaren Medicaid |
$117.58
|
| Rate for Payer: Meridian Medicaid |
$123.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.83
|
| Rate for Payer: Priority Health Narrow Network |
$224.83
|
| Rate for Payer: Priority Health SBD |
$224.83
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
10120
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$172.20 |
| Rate for Payer: Aetna Commercial |
$110.83
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Narrow Network |
$129.07
|
| Rate for Payer: Priority Health SBD |
$129.07
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$1,076.20 |
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$233.21
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.20
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$860.96
|
| Rate for Payer: Priority Health SBD |
$154.98
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$104.45
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$172.20 |
| Rate for Payer: Aetna Commercial |
$110.83
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Narrow Network |
$129.07
|
| Rate for Payer: Priority Health SBD |
$129.07
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$154.98 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.90
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$172.20
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health SBD |
$154.98
|
|
|
PR INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF
|
Professional
|
Both
|
$1,562.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$56.02 |
| Max. Negotiated Rate |
$1,093.40 |
| Rate for Payer: Aetna Commercial |
$113.39
|
| Rate for Payer: BCBS Complete |
$58.82
|
| Rate for Payer: BCBS Trust/PPO |
$305.36
|
| Rate for Payer: Cash Price |
$1,249.60
|
| Rate for Payer: Cash Price |
$1,249.60
|
| Rate for Payer: Mclaren Medicaid |
$56.02
|
| Rate for Payer: Meridian Medicaid |
$58.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,093.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.34
|
| Rate for Payer: Priority Health Narrow Network |
$148.34
|
| Rate for Payer: Priority Health SBD |
$148.34
|
|
