|
HC D-DIMER QUANTITATIVE
|
Facility
|
IP
|
$127.13
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.09 |
| Max. Negotiated Rate |
$114.42 |
| Rate for Payer: Aetna Commercial |
$108.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.63
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cofinity Advantage |
$88.99
|
| Rate for Payer: Cofinity Commercial |
$109.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.70
|
| Rate for Payer: Healthscope Commercial |
$114.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.35
|
| Rate for Payer: PHP Commercial |
$108.06
|
| Rate for Payer: Priority Health SBD |
$80.09
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
OP
|
$127.13
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$114.42 |
| Rate for Payer: Aetna Commercial |
$108.06
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$10.86
|
| Rate for Payer: BCN Commercial |
$10.86
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cofinity Advantage |
$88.99
|
| Rate for Payer: Cofinity Commercial |
$109.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$114.42
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.06
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.35
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$108.06
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.18
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health SBD |
$80.09
|
| Rate for Payer: Priority Health Tiered Network |
$8.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC Core |
$15.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.27
|
| Rate for Payer: UHC Medicaid |
$5.32
|
| Rate for Payer: UHCCP Medicaid |
$5.32
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$2,253.05
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$1,915.09
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.14
|
| Rate for Payer: BCN Commercial |
$1,065.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,802.44
|
| Rate for Payer: Cash Price |
$1,802.44
|
| Rate for Payer: Cash Price |
$1,802.44
|
| Rate for Payer: Cofinity Advantage |
$1,577.13
|
| Rate for Payer: Cofinity Commercial |
$1,937.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,802.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,027.74
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.09
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,689.79
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,915.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$1,419.42
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,464.48
|
| Rate for Payer: UHC Core |
$1,173.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$885.45
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$2,253.05
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,419.42 |
| Max. Negotiated Rate |
$2,027.74 |
| Rate for Payer: Aetna Commercial |
$1,915.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.48
|
| Rate for Payer: Cash Price |
$1,802.44
|
| Rate for Payer: Cofinity Advantage |
$1,577.13
|
| Rate for Payer: Cofinity Commercial |
$1,937.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,802.44
|
| Rate for Payer: Healthscope Commercial |
$2,027.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,689.79
|
| Rate for Payer: PHP Commercial |
$1,915.09
|
| Rate for Payer: Priority Health SBD |
$1,419.42
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
IP
|
$545.88
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$491.29 |
| Rate for Payer: Aetna Commercial |
$464.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.82
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cofinity Advantage |
$382.12
|
| Rate for Payer: Cofinity Commercial |
$469.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.70
|
| Rate for Payer: Healthscope Commercial |
$491.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.41
|
| Rate for Payer: PHP Commercial |
$464.00
|
| Rate for Payer: Priority Health SBD |
$343.90
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
OP
|
$545.88
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$464.00
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$31.07
|
| Rate for Payer: BCN Commercial |
$31.07
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cofinity Advantage |
$382.12
|
| Rate for Payer: Cofinity Commercial |
$469.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$491.29
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.00
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$464.00
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$343.90
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.82
|
| Rate for Payer: UHC Core |
$284.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$214.53
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
IP
|
$1,369.17
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$862.58 |
| Max. Negotiated Rate |
$1,232.25 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna Commercial |
$1,745.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.94
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cofinity Advantage |
$958.42
|
| Rate for Payer: Cofinity Advantage |
$1,437.62
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Cofinity Commercial |
$1,766.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Healthscope Commercial |
$1,848.38
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: PHP Commercial |
$1,745.69
|
| Rate for Payer: Priority Health SBD |
$862.58
|
| Rate for Payer: Priority Health SBD |
$1,293.86
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
OP
|
$1,369.17
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.18 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna Commercial |
$1,745.69
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$159.18
|
| Rate for Payer: BCBS Trust/PPO |
$159.18
|
| Rate for Payer: BCN Commercial |
$159.18
|
| Rate for Payer: BCN Commercial |
$159.18
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cofinity Advantage |
$1,437.62
|
| Rate for Payer: Cofinity Advantage |
$958.42
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Cofinity Commercial |
$1,766.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Healthscope Commercial |
$1,848.38
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: PHP Commercial |
$1,745.69
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$1,293.86
|
| Rate for Payer: Priority Health SBD |
$862.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,334.94
|
| Rate for Payer: UHC Core |
$1,070.00
|
| Rate for Payer: UHC Core |
$713.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$807.12
|
| Rate for Payer: UHC Exchange |
$538.08
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,690.34
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.73 |
| Max. Negotiated Rate |
$1,521.31 |
| Rate for Payer: Aetna Commercial |
$1,436.79
|
| Rate for Payer: Aetna Medicare |
$845.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.72
|
| Rate for Payer: BCBS Complete |
$676.14
|
| Rate for Payer: BCBS Trust/PPO |
$329.73
|
| Rate for Payer: BCN Commercial |
$329.73
|
| Rate for Payer: Cash Price |
$1,352.27
|
| Rate for Payer: Cash Price |
$1,352.27
|
| Rate for Payer: Cofinity Advantage |
$1,183.24
|
| Rate for Payer: Cofinity Commercial |
$1,453.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.27
|
| Rate for Payer: Healthscope Commercial |
$1,521.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,352.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,436.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,267.76
|
| Rate for Payer: PHP Commercial |
$1,436.79
|
| Rate for Payer: Priority Health SBD |
$1,064.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.72
|
| Rate for Payer: UHC Core |
$880.67
|
| Rate for Payer: UHC Exchange |
$664.30
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,690.34
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,064.91 |
| Max. Negotiated Rate |
$1,521.31 |
| Rate for Payer: Aetna Commercial |
$1,436.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.72
|
| Rate for Payer: Cash Price |
$1,352.27
|
| Rate for Payer: Cofinity Advantage |
$1,183.24
|
| Rate for Payer: Cofinity Commercial |
$1,453.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.27
|
| Rate for Payer: Healthscope Commercial |
$1,521.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,436.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,267.76
|
| Rate for Payer: PHP Commercial |
$1,436.79
|
| Rate for Payer: Priority Health SBD |
$1,064.91
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
IP
|
$382.87
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.21 |
| Max. Negotiated Rate |
$344.58 |
| Rate for Payer: Aetna Commercial |
$325.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.87
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Advantage |
$268.01
|
| Rate for Payer: Cofinity Commercial |
$329.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$344.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.15
|
| Rate for Payer: PHP Commercial |
$325.44
|
| Rate for Payer: Priority Health SBD |
$241.21
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
OP
|
$382.87
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$344.58 |
| Rate for Payer: Aetna Commercial |
$325.44
|
| Rate for Payer: Aetna Medicare |
$191.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.87
|
| Rate for Payer: BCBS Complete |
$153.15
|
| Rate for Payer: BCBS Trust/PPO |
$65.02
|
| Rate for Payer: BCN Commercial |
$65.02
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Advantage |
$268.01
|
| Rate for Payer: Cofinity Commercial |
$329.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$344.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.15
|
| Rate for Payer: PHP Commercial |
$325.44
|
| Rate for Payer: Priority Health SBD |
$241.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.87
|
| Rate for Payer: UHC Core |
$199.48
|
| Rate for Payer: UHC Exchange |
$150.47
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
OP
|
$390.53
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$331.95
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$121.98
|
| Rate for Payer: BCN Commercial |
$121.98
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$312.42
|
| Rate for Payer: Cash Price |
$312.42
|
| Rate for Payer: Cash Price |
$312.42
|
| Rate for Payer: Cofinity Advantage |
$273.37
|
| Rate for Payer: Cofinity Commercial |
$335.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$351.48
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.95
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.90
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$331.95
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$246.03
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.84
|
| Rate for Payer: UHC Core |
$203.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$153.48
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
IP
|
$390.53
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.03 |
| Max. Negotiated Rate |
$351.48 |
| Rate for Payer: Aetna Commercial |
$331.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.84
|
| Rate for Payer: Cash Price |
$312.42
|
| Rate for Payer: Cofinity Advantage |
$273.37
|
| Rate for Payer: Cofinity Commercial |
$335.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.42
|
| Rate for Payer: Healthscope Commercial |
$351.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.90
|
| Rate for Payer: PHP Commercial |
$331.95
|
| Rate for Payer: Priority Health SBD |
$246.03
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$530.60
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.28 |
| Max. Negotiated Rate |
$477.54 |
| Rate for Payer: Aetna Commercial |
$451.01
|
| Rate for Payer: Aetna Commercial |
$676.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.34
|
| Rate for Payer: Cash Price |
$424.48
|
| Rate for Payer: Cash Price |
$636.73
|
| Rate for Payer: Cofinity Advantage |
$371.42
|
| Rate for Payer: Cofinity Advantage |
$557.14
|
| Rate for Payer: Cofinity Commercial |
$456.32
|
| Rate for Payer: Cofinity Commercial |
$684.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.48
|
| Rate for Payer: Healthscope Commercial |
$716.32
|
| Rate for Payer: Healthscope Commercial |
$477.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.93
|
| Rate for Payer: PHP Commercial |
$451.01
|
| Rate for Payer: PHP Commercial |
$676.52
|
| Rate for Payer: Priority Health SBD |
$334.28
|
| Rate for Payer: Priority Health SBD |
$501.42
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$530.60
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.68 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$451.01
|
| Rate for Payer: Aetna Commercial |
$676.52
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$77.68
|
| Rate for Payer: BCN Commercial |
$77.68
|
| Rate for Payer: BCN Commercial |
$77.68
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$424.48
|
| Rate for Payer: Cash Price |
$424.48
|
| Rate for Payer: Cash Price |
$636.73
|
| Rate for Payer: Cash Price |
$636.73
|
| Rate for Payer: Cash Price |
$636.73
|
| Rate for Payer: Cash Price |
$424.48
|
| Rate for Payer: Cofinity Advantage |
$557.14
|
| Rate for Payer: Cofinity Advantage |
$371.42
|
| Rate for Payer: Cofinity Commercial |
$456.32
|
| Rate for Payer: Cofinity Commercial |
$684.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$477.54
|
| Rate for Payer: Healthscope Commercial |
$716.32
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.52
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.95
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$451.01
|
| Rate for Payer: PHP Commercial |
$676.52
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$501.42
|
| Rate for Payer: Priority Health SBD |
$334.28
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.34
|
| Rate for Payer: UHC Core |
$414.67
|
| Rate for Payer: UHC Core |
$276.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$312.79
|
| Rate for Payer: UHC Exchange |
$208.53
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$868.17
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$781.35 |
| Rate for Payer: Aetna Commercial |
$737.94
|
| Rate for Payer: Aetna Medicare |
$434.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.31
|
| Rate for Payer: BCBS Complete |
$347.27
|
| Rate for Payer: BCBS Trust/PPO |
$194.12
|
| Rate for Payer: BCN Commercial |
$194.12
|
| Rate for Payer: Cash Price |
$694.54
|
| Rate for Payer: Cash Price |
$694.54
|
| Rate for Payer: Cofinity Advantage |
$607.72
|
| Rate for Payer: Cofinity Commercial |
$746.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.54
|
| Rate for Payer: Healthscope Commercial |
$781.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$694.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$651.13
|
| Rate for Payer: PHP Commercial |
$737.94
|
| Rate for Payer: Priority Health SBD |
$546.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.31
|
| Rate for Payer: UHC Core |
$452.32
|
| Rate for Payer: UHC Exchange |
$341.19
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$868.17
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.95 |
| Max. Negotiated Rate |
$781.35 |
| Rate for Payer: Aetna Commercial |
$737.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.31
|
| Rate for Payer: Cash Price |
$694.54
|
| Rate for Payer: Cofinity Advantage |
$607.72
|
| Rate for Payer: Cofinity Commercial |
$746.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.54
|
| Rate for Payer: Healthscope Commercial |
$781.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$651.13
|
| Rate for Payer: PHP Commercial |
$737.94
|
| Rate for Payer: Priority Health SBD |
$546.95
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
OP
|
$96.31
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$81.86
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$38.03
|
| Rate for Payer: BCN Commercial |
$38.03
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cofinity Advantage |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$82.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$86.68
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.23
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$81.86
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$60.68
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.60
|
| Rate for Payer: UHC Core |
$50.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$37.85
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
IP
|
$96.31
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.68 |
| Max. Negotiated Rate |
$86.68 |
| Rate for Payer: Aetna Commercial |
$81.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.60
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cofinity Advantage |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$82.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.05
|
| Rate for Payer: Healthscope Commercial |
$86.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.23
|
| Rate for Payer: PHP Commercial |
$81.86
|
| Rate for Payer: Priority Health SBD |
$60.68
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
IP
|
$116.75
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.55 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Aetna Commercial |
$99.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.89
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cofinity Advantage |
$81.72
|
| Rate for Payer: Cofinity Commercial |
$100.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.40
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.56
|
| Rate for Payer: PHP Commercial |
$99.24
|
| Rate for Payer: Priority Health SBD |
$73.55
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
OP
|
$116.75
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$99.24
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$62.05
|
| Rate for Payer: BCN Commercial |
$62.05
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cofinity Advantage |
$81.72
|
| Rate for Payer: Cofinity Commercial |
$100.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$105.08
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.24
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.56
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$99.24
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$73.55
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.89
|
| Rate for Payer: UHC Core |
$60.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$45.88
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$1,135.66
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.47 |
| Max. Negotiated Rate |
$1,022.09 |
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.53
|
| Rate for Payer: Aetna Commercial |
$965.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.18
|
| Rate for Payer: Cash Price |
$908.53
|
| Rate for Payer: Cofinity Advantage |
$794.96
|
| Rate for Payer: Cofinity Commercial |
$976.67
|
| Rate for Payer: Healthscope Commercial |
$1,022.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.75
|
| Rate for Payer: PHP Commercial |
$965.31
|
| Rate for Payer: Priority Health SBD |
$715.47
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,135.66
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$965.31
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$551.04
|
| Rate for Payer: BCN Commercial |
$551.04
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$908.53
|
| Rate for Payer: Cash Price |
$908.53
|
| Rate for Payer: Cash Price |
$908.53
|
| Rate for Payer: Cofinity Advantage |
$794.96
|
| Rate for Payer: Cofinity Commercial |
$976.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$1,022.09
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.31
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.75
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$965.31
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$715.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.18
|
| Rate for Payer: UHC Core |
$591.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$446.31
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,924.74
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$1,636.03
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$452.07
|
| Rate for Payer: BCN Commercial |
$452.07
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cofinity Advantage |
$1,347.32
|
| Rate for Payer: Cofinity Commercial |
$1,655.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$1,732.27
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.03
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,443.56
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$1,636.03
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,212.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,251.08
|
| Rate for Payer: UHC Core |
$1,002.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Exchange |
$756.42
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
