|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 11604
|
| Hospital Charge Code |
11604
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$338.65 |
| Max. Negotiated Rate |
$521.00 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: ASR ASR |
$505.37
|
| Rate for Payer: ASR Commercial |
$505.37
|
| Rate for Payer: BCBS Trust/PPO |
$424.56
|
| Rate for Payer: BCN Commercial |
$403.93
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$489.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.80
|
| Rate for Payer: Healthscope Commercial |
$521.00
|
| Rate for Payer: Healthscope Whirlpool |
$505.37
|
| Rate for Payer: Mclaren Commercial |
$468.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.85
|
| Rate for Payer: Nomi Health Commercial |
$427.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.48
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 11604
|
| Hospital Charge Code |
11604
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$338.65 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$505.37
|
| Rate for Payer: ASR Commercial |
$505.37
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$426.65
|
| Rate for Payer: BCN Commercial |
$403.93
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$489.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$521.00
|
| Rate for Payer: Healthscope Whirlpool |
$505.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$468.90
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.85
|
| Rate for Payer: Nomi Health Commercial |
$427.22
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.50
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$365.22
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXCISION MAXILLARY TORUS PALATINUS
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 21032
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$542.92 |
| Rate for Payer: Aetna Commercial |
$350.61
|
| Rate for Payer: Aetna Medicare |
$396.50
|
| Rate for Payer: BCBS Complete |
$178.47
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$542.92
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Meridian Medicaid |
$178.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$399.46
|
| Rate for Payer: Priority Health Narrow Network |
$399.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.43
|
| Rate for Payer: UHC Exchange |
$318.43
|
| Rate for Payer: UHCCP Medicaid |
$169.97
|
|
|
PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 46230
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$1,777.73 |
| Rate for Payer: Aetna Commercial |
$230.39
|
| Rate for Payer: Aetna Medicare |
$339.50
|
| Rate for Payer: BCBS Complete |
$118.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: BCN Commercial |
$459.85
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Meridian Medicaid |
$118.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.62
|
| Rate for Payer: Priority Health Narrow Network |
$312.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.41
|
| Rate for Payer: UHC Exchange |
$203.41
|
| Rate for Payer: UHCCP Medicaid |
$112.68
|
|
|
PR EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 11750
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$313.95 |
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: Aetna Medicare |
$241.50
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS Trust/PPO |
$20.33
|
| Rate for Payer: BCN Commercial |
$187.30
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.16
|
| Rate for Payer: Priority Health Narrow Network |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.17
|
| Rate for Payer: UHC Exchange |
$182.17
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR EXCISION NASAL POLYP EXTENSIVE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 30115
|
| Min. Negotiated Rate |
$298.41 |
| Max. Negotiated Rate |
$893.36 |
| Rate for Payer: Aetna Commercial |
$587.21
|
| Rate for Payer: Aetna Medicare |
$406.50
|
| Rate for Payer: BCBS Complete |
$313.33
|
| Rate for Payer: BCBS Trust/PPO |
$893.36
|
| Rate for Payer: BCN Commercial |
$693.93
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Meridian Medicaid |
$313.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.96
|
| Rate for Payer: Priority Health Narrow Network |
$653.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$460.01
|
| Rate for Payer: UHC Exchange |
$460.01
|
| Rate for Payer: UHCCP Medicaid |
$298.41
|
|
|
PR EXCISION NASAL POLYP SIMPLE
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 30110
|
| Min. Negotiated Rate |
$86.27 |
| Max. Negotiated Rate |
$937.20 |
| Rate for Payer: Aetna Commercial |
$164.52
|
| Rate for Payer: Aetna Medicare |
$248.50
|
| Rate for Payer: BCBS Complete |
$90.58
|
| Rate for Payer: BCBS Trust/PPO |
$937.20
|
| Rate for Payer: BCN Commercial |
$367.97
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Meridian Medicaid |
$90.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.78
|
| Rate for Payer: Priority Health Narrow Network |
$186.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.50
|
| Rate for Payer: UHC Exchange |
$143.50
|
| Rate for Payer: UHCCP Medicaid |
$86.27
|
|
|
PR EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 64778
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$304.27 |
| Rate for Payer: Aetna Commercial |
$235.17
|
| Rate for Payer: Aetna Medicare |
$166.50
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS Trust/PPO |
$291.09
|
| Rate for Payer: BCN Commercial |
$261.93
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Meridian Medicaid |
$120.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.27
|
| Rate for Payer: Priority Health Narrow Network |
$304.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.34
|
| Rate for Payer: UHC Exchange |
$218.34
|
| Rate for Payer: UHCCP Medicaid |
$114.59
|
|
|
PR EXCISION NEUROMA SCIATIC NERVE
|
Professional
|
Both
|
$3,548.00
|
|
|
Service Code
|
HCPCS 64786
|
| Min. Negotiated Rate |
$154.26 |
| Max. Negotiated Rate |
$2,306.20 |
| Rate for Payer: Aetna Commercial |
$1,308.54
|
| Rate for Payer: Aetna Medicare |
$1,774.00
|
| Rate for Payer: BCBS Complete |
$680.35
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: BCN Commercial |
$1,470.43
|
| Rate for Payer: Cash Price |
$2,838.40
|
| Rate for Payer: Cash Price |
$2,838.40
|
| Rate for Payer: Meridian Medicaid |
$680.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$647.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,306.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,720.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,720.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,241.60
|
| Rate for Payer: UHC Exchange |
$1,241.60
|
| Rate for Payer: UHCCP Medicaid |
$647.95
|
|
|
PR EXCISION OF BULBOURETHRAL GLAND
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 53250
|
| Min. Negotiated Rate |
$256.24 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$505.90
|
| Rate for Payer: Aetna Medicare |
$568.50
|
| Rate for Payer: BCBS Complete |
$269.05
|
| Rate for Payer: BCBS Trust/PPO |
$419.47
|
| Rate for Payer: BCN Commercial |
$574.19
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Meridian Medicaid |
$269.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$634.86
|
| Rate for Payer: Priority Health Narrow Network |
$634.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.42
|
| Rate for Payer: UHC Exchange |
$498.42
|
| Rate for Payer: UHCCP Medicaid |
$256.24
|
|
|
PR EXCISION OF PENILE PLAQUE
|
Professional
|
Both
|
$1,186.00
|
|
|
Service Code
|
HCPCS 54110
|
| Min. Negotiated Rate |
$400.87 |
| Max. Negotiated Rate |
$2,843.84 |
| Rate for Payer: Aetna Commercial |
$802.52
|
| Rate for Payer: Aetna Medicare |
$593.00
|
| Rate for Payer: BCBS Complete |
$420.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,843.84
|
| Rate for Payer: BCN Commercial |
$901.13
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Meridian Medicaid |
$420.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$995.97
|
| Rate for Payer: Priority Health Narrow Network |
$995.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$750.56
|
| Rate for Payer: UHC Exchange |
$750.56
|
| Rate for Payer: UHCCP Medicaid |
$400.87
|
|
|
PR EXCISION OLECRANON BURSA
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$501.17
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.23
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$429.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$565.86 |
| Rate for Payer: Aetna Commercial |
$473.96
|
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$251.16
|
| Rate for Payer: BCBS Trust/PPO |
$206.04
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Meridian Medicaid |
$251.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.86
|
| Rate for Payer: Priority Health Narrow Network |
$565.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.67
|
| Rate for Payer: UHC Exchange |
$378.67
|
| Rate for Payer: UHCCP Medicaid |
$239.20
|
|
|
PR EXCISION OLECRANON BURSA
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
24105
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Trust/PPO |
$498.72
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
|
|
PR EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 24105
|
| Min. Negotiated Rate |
$206.04 |
| Max. Negotiated Rate |
$565.86 |
| Rate for Payer: Aetna Commercial |
$473.96
|
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$251.16
|
| Rate for Payer: BCBS Trust/PPO |
$206.04
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Meridian Medicaid |
$251.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.86
|
| Rate for Payer: Priority Health Narrow Network |
$565.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.67
|
| Rate for Payer: UHC Exchange |
$378.67
|
| Rate for Payer: UHCCP Medicaid |
$239.20
|
|
|
PR EXCISION OR FULGURATION SKENES GLANDS
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 53270
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$772.90 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: Aetna Medicare |
$201.00
|
| Rate for Payer: BCBS Complete |
$125.46
|
| Rate for Payer: BCBS Trust/PPO |
$772.90
|
| Rate for Payer: BCN Commercial |
$307.38
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$125.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.60
|
| Rate for Payer: Priority Health Narrow Network |
$295.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.08
|
| Rate for Payer: UHC Exchange |
$224.08
|
| Rate for Payer: UHCCP Medicaid |
$119.49
|
|
|
PR EXCISION PILONIDAL CYST/SINUS COMPLICATED
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
HCPCS 11772
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,453.51 |
| Rate for Payer: Aetna Commercial |
$633.90
|
| Rate for Payer: Aetna Medicare |
$577.00
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.51
|
| Rate for Payer: BCN Commercial |
$1,137.15
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$790.60
|
| Rate for Payer: Priority Health Narrow Network |
$790.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$574.60
|
| Rate for Payer: UHC Exchange |
$574.60
|
| Rate for Payer: UHCCP Medicaid |
$374.88
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
11771
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$872.95 |
| Max. Negotiated Rate |
$1,343.00 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: ASR ASR |
$1,302.71
|
| Rate for Payer: ASR Commercial |
$1,302.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,094.41
|
| Rate for Payer: BCN Commercial |
$1,041.23
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,262.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.40
|
| Rate for Payer: Healthscope Commercial |
$1,343.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.71
|
| Rate for Payer: Mclaren Commercial |
$1,208.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.55
|
| Rate for Payer: Nomi Health Commercial |
$1,101.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.84
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 11771
|
| Min. Negotiated Rate |
$291.81 |
| Max. Negotiated Rate |
$925.56 |
| Rate for Payer: Aetna Commercial |
$483.14
|
| Rate for Payer: Aetna Medicare |
$671.50
|
| Rate for Payer: BCBS Complete |
$306.40
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$925.56
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Meridian Medicaid |
$306.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.97
|
| Rate for Payer: Priority Health Narrow Network |
$614.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$442.28
|
| Rate for Payer: UHC Exchange |
$442.28
|
| Rate for Payer: UHCCP Medicaid |
$291.81
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
11771
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$872.95 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$1,302.71
|
| Rate for Payer: ASR Commercial |
$1,302.71
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.78
|
| Rate for Payer: BCN Commercial |
$1,041.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,262.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$1,343.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,302.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$1,208.70
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.55
|
| Rate for Payer: Nomi Health Commercial |
$1,101.26
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,176.74
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$941.44
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,181.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
11771
|
| Min. Negotiated Rate |
$291.81 |
| Max. Negotiated Rate |
$925.56 |
| Rate for Payer: Aetna Commercial |
$483.14
|
| Rate for Payer: Aetna Medicare |
$671.50
|
| Rate for Payer: BCBS Complete |
$306.40
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$925.56
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Meridian Medicaid |
$306.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.97
|
| Rate for Payer: Priority Health Narrow Network |
$614.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$442.28
|
| Rate for Payer: UHC Exchange |
$442.28
|
| Rate for Payer: UHCCP Medicaid |
$291.81
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
11770
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$523.86 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: Aetna Medicare |
$260.00
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$523.86
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.85
|
| Rate for Payer: Priority Health Narrow Network |
$252.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.96
|
| Rate for Payer: UHC Exchange |
$188.96
|
| Rate for Payer: UHCCP Medicaid |
$119.28
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
11770
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$468.00
|
| Rate for Payer: ASR ASR |
$504.40
|
| Rate for Payer: ASR Commercial |
$504.40
|
| Rate for Payer: BCBS Trust/PPO |
$423.75
|
| Rate for Payer: BCN Commercial |
$403.16
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$488.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.00
|
| Rate for Payer: Healthscope Commercial |
$520.00
|
| Rate for Payer: Healthscope Whirlpool |
$504.40
|
| Rate for Payer: Mclaren Commercial |
$468.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.00
|
| Rate for Payer: Nomi Health Commercial |
$426.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.60
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 11770
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$523.86 |
| Rate for Payer: Aetna Commercial |
$202.59
|
| Rate for Payer: Aetna Medicare |
$260.00
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$523.86
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.85
|
| Rate for Payer: Priority Health Narrow Network |
$252.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.96
|
| Rate for Payer: UHC Exchange |
$188.96
|
| Rate for Payer: UHCCP Medicaid |
$119.28
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
11770
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$468.00
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$504.40
|
| Rate for Payer: ASR Commercial |
$504.40
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$425.83
|
| Rate for Payer: BCN Commercial |
$403.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$488.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$520.00
|
| Rate for Payer: Healthscope Whirlpool |
$504.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$468.00
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.00
|
| Rate for Payer: Nomi Health Commercial |
$426.40
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.62
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$364.52
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
