|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: Aetna Medicare |
$509.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$855.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.96
|
| Rate for Payer: BCBS Complete |
$281.21
|
| Rate for Payer: BCBS MAPPO |
$489.57
|
| Rate for Payer: BCBS Trust/PPO |
$120.68
|
| Rate for Payer: BCN Medicare Advantage |
$489.57
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Cofinity Commercial |
$921.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.57
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Mclaren Medicaid |
$267.79
|
| Rate for Payer: Mclaren Medicare |
$489.57
|
| Rate for Payer: Meridian Medicaid |
$281.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PACE Medicare |
$465.09
|
| Rate for Payer: PACE SWMI |
$489.57
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: PHP Medicare Advantage |
$489.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health Medicare |
$489.57
|
| Rate for Payer: Priority Health SBD |
$829.08
|
| Rate for Payer: Railroad Medicare Medicare |
$489.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.57
|
| Rate for Payer: UHC Exchange |
$135.56
|
| Rate for Payer: UHC Medicare Advantage |
$504.26
|
| Rate for Payer: VA VA |
$489.57
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$855.40
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Cofinity Commercial |
$921.20
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health SBD |
$829.08
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,624.71
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,023.57 |
| Max. Negotiated Rate |
$1,462.24 |
| Rate for Payer: Aetna Commercial |
$1,381.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.06
|
| Rate for Payer: Cash Price |
$1,299.77
|
| Rate for Payer: Cofinity Commercial |
$1,137.30
|
| Rate for Payer: Cofinity Commercial |
$1,397.25
|
| Rate for Payer: Healthscope Commercial |
$1,462.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,381.00
|
| Rate for Payer: PHP Commercial |
$1,381.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.30
|
| Rate for Payer: Priority Health SBD |
$1,023.57
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,624.71
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$1,462.24 |
| Rate for Payer: Aetna Commercial |
$1,381.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.06
|
| Rate for Payer: BCBS Complete |
$649.88
|
| Rate for Payer: BCBS Trust/PPO |
$249.98
|
| Rate for Payer: Cash Price |
$1,299.77
|
| Rate for Payer: Cash Price |
$1,299.77
|
| Rate for Payer: Cofinity Commercial |
$1,397.25
|
| Rate for Payer: Cofinity Commercial |
$1,137.30
|
| Rate for Payer: Healthscope Commercial |
$1,462.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,381.00
|
| Rate for Payer: PHP Commercial |
$1,381.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.30
|
| Rate for Payer: Priority Health SBD |
$1,023.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.73
|
| Rate for Payer: UHC Exchange |
$94.30
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.84 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.20
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health SBD |
$231.84
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.90 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.20
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: BCBS Trust/PPO |
$49.30
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health SBD |
$231.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.29
|
| Rate for Payer: UHC Exchange |
$23.90
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.48 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.98
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$262.75
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.06
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.75
|
| Rate for Payer: Priority Health SBD |
$236.48
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
OP
|
$375.36
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.98
|
| 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 |
$92.48
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Cofinity Commercial |
$262.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| 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 |
$319.06
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$319.06
|
| 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 |
$262.75
|
| 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 |
$236.48
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| 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 |
$58.90
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| 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 |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| 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 |
$433.50
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$433.50
|
| 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 |
$357.00
|
| 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 |
$321.30
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$50.43
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$834.46
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$751.01 |
| Rate for Payer: Aetna Commercial |
$709.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.40
|
| Rate for Payer: BCBS Complete |
$333.78
|
| Rate for Payer: BCBS Trust/PPO |
$147.17
|
| Rate for Payer: Cash Price |
$667.57
|
| Rate for Payer: Cash Price |
$667.57
|
| Rate for Payer: Cofinity Commercial |
$584.12
|
| Rate for Payer: Cofinity Commercial |
$717.64
|
| Rate for Payer: Healthscope Commercial |
$751.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$709.29
|
| Rate for Payer: PHP Commercial |
$709.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.12
|
| Rate for Payer: Priority Health SBD |
$525.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Exchange |
$53.37
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$834.46
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.71 |
| Max. Negotiated Rate |
$751.01 |
| Rate for Payer: Aetna Commercial |
$709.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.40
|
| Rate for Payer: Cash Price |
$667.57
|
| Rate for Payer: Cofinity Commercial |
$584.12
|
| Rate for Payer: Cofinity Commercial |
$717.64
|
| Rate for Payer: Healthscope Commercial |
$751.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$709.29
|
| Rate for Payer: PHP Commercial |
$709.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.12
|
| Rate for Payer: Priority Health SBD |
$525.71
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
IP
|
$92.57
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Aetna Commercial |
$78.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.17
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cofinity Commercial |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$79.61
|
| Rate for Payer: Healthscope Commercial |
$83.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.68
|
| Rate for Payer: PHP Commercial |
$78.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health SBD |
$58.32
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
OP
|
$92.57
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$173.33 |
| Rate for Payer: Aetna Commercial |
$78.68
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$28.84
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cofinity Commercial |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$79.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$83.31
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.68
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$78.68
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$58.32
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$13.75
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
OP
|
$112.22
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$173.33 |
| Rate for Payer: Aetna Commercial |
$95.39
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$47.05
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$96.51
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.39
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$95.39
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$70.70
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$22.92
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
IP
|
$112.22
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$95.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.94
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$78.55
|
| Rate for Payer: Cofinity Commercial |
$96.51
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.39
|
| Rate for Payer: PHP Commercial |
$95.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.55
|
| Rate for Payer: Priority Health SBD |
$70.70
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$1,091.56
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.68 |
| Max. Negotiated Rate |
$982.40 |
| Rate for Payer: Aetna Commercial |
$927.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.51
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cofinity Commercial |
$764.09
|
| Rate for Payer: Cofinity Commercial |
$938.74
|
| Rate for Payer: Healthscope Commercial |
$982.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$927.83
|
| Rate for Payer: PHP Commercial |
$927.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.09
|
| Rate for Payer: Priority Health SBD |
$687.68
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,091.56
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$927.83
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$417.77
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cofinity Commercial |
$764.09
|
| Rate for Payer: Cofinity Commercial |
$938.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$982.40
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$927.83
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$927.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$687.68
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,165.50 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Aetna Commercial |
$1,572.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.50
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,295.00
|
| Rate for Payer: Cofinity Commercial |
$1,591.00
|
| Rate for Payer: Healthscope Commercial |
$1,665.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,572.50
|
| Rate for Payer: PHP Commercial |
$1,572.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.00
|
| Rate for Payer: Priority Health SBD |
$1,165.50
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.47 |
| Max. Negotiated Rate |
$1,937.58 |
| Rate for Payer: Aetna Commercial |
$1,572.50
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$342.74
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,591.00
|
| Rate for Payer: Cofinity Commercial |
$1,295.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$1,665.00
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,572.50
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$1,572.50
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,937.58
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,550.06
|
| Rate for Payer: Priority Health SBD |
$1,165.50
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$270.47
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.03 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Commercial |
$3,400.00
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,600.00
|
| 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 |
$895.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$3,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$3,600.00
|
| 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 |
$3,400.00
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$3,400.00
|
| 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 |
$2,800.00
|
| 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 |
$2,520.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$406.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$3,400.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,600.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$3,440.00
|
| Rate for Payer: Healthscope Commercial |
$3,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: PHP Commercial |
$3,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: Priority Health SBD |
$2,520.00
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$499.09
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.43 |
| Max. Negotiated Rate |
$449.18 |
| Rate for Payer: Aetna Commercial |
$424.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.41
|
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Cofinity Commercial |
$349.36
|
| Rate for Payer: Cofinity Commercial |
$429.22
|
| Rate for Payer: Healthscope Commercial |
$449.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.23
|
| Rate for Payer: PHP Commercial |
$424.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.36
|
| Rate for Payer: Priority Health SBD |
$314.43
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$499.09
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$449.18 |
| Rate for Payer: Aetna Commercial |
$424.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.41
|
| Rate for Payer: BCBS Complete |
$199.64
|
| Rate for Payer: BCBS Trust/PPO |
$81.69
|
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Cofinity Commercial |
$349.36
|
| Rate for Payer: Cofinity Commercial |
$429.22
|
| Rate for Payer: Healthscope Commercial |
$449.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.23
|
| Rate for Payer: PHP Commercial |
$424.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.36
|
| Rate for Payer: Priority Health SBD |
$314.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Exchange |
$24.56
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$632.43
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.43 |
| Max. Negotiated Rate |
$569.19 |
| Rate for Payer: Aetna Commercial |
$537.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.08
|
| Rate for Payer: Cash Price |
$505.94
|
| Rate for Payer: Cofinity Commercial |
$442.70
|
| Rate for Payer: Cofinity Commercial |
$543.89
|
| Rate for Payer: Healthscope Commercial |
$569.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.57
|
| Rate for Payer: PHP Commercial |
$537.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.70
|
| Rate for Payer: Priority Health SBD |
$398.43
|
|
