|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$793.15 |
| Max. Negotiated Rate |
$1,467.33 |
| Rate for Payer: Aetna Commercial |
$1,062.82
|
| Rate for Payer: Aetna Medicare |
$824.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.82
|
| Rate for Payer: BCBS Complete |
$896.40
|
| Rate for Payer: BCBS MAPPO |
$793.15
|
| Rate for Payer: BCN Medicare Advantage |
$793.15
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cofinity Commercial |
$1,142.14
|
| Rate for Payer: Cofinity Commercial |
$1,062.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.15
|
| Rate for Payer: Healthscope Commercial |
$1,269.04
|
| Rate for Payer: Healthscope Commercial |
$1,467.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,456.65
|
| Rate for Payer: Nomi Health Commercial |
$951.78
|
| Rate for Payer: PACE SWMI |
$793.15
|
| Rate for Payer: PHP Medicare Advantage |
$793.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health Medicare |
$793.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.15
|
| Rate for Payer: UHC Medicare Advantage |
$793.15
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$522.84 |
| Max. Negotiated Rate |
$1,069.25 |
| Rate for Payer: Aetna Commercial |
$700.61
|
| Rate for Payer: Aetna Medicare |
$543.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.61
|
| Rate for Payer: BCBS Complete |
$658.00
|
| Rate for Payer: BCBS MAPPO |
$522.84
|
| Rate for Payer: BCN Medicare Advantage |
$522.84
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$752.89
|
| Rate for Payer: Cofinity Commercial |
$700.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.84
|
| Rate for Payer: Healthscope Commercial |
$967.25
|
| Rate for Payer: Healthscope Commercial |
$836.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,069.25
|
| Rate for Payer: Nomi Health Commercial |
$627.41
|
| Rate for Payer: PACE SWMI |
$522.84
|
| Rate for Payer: PHP Medicare Advantage |
$522.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.25
|
| Rate for Payer: Priority Health Medicare |
$522.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$522.84
|
| Rate for Payer: UHC Medicare Advantage |
$522.84
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$564.73
|
| Rate for Payer: Aetna Medicare |
$438.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.73
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$421.44
|
| Rate for Payer: BCN Medicare Advantage |
$421.44
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$606.87
|
| Rate for Payer: Cofinity Commercial |
$564.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.44
|
| Rate for Payer: Healthscope Commercial |
$674.30
|
| Rate for Payer: Healthscope Commercial |
$779.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.20
|
| Rate for Payer: Nomi Health Commercial |
$505.73
|
| Rate for Payer: PACE SWMI |
$421.44
|
| Rate for Payer: PHP Medicare Advantage |
$421.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$421.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.44
|
| Rate for Payer: UHC Medicare Advantage |
$421.44
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$1,256.22 |
| Rate for Payer: Aetna Commercial |
$909.91
|
| Rate for Payer: Aetna Medicare |
$706.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$909.91
|
| Rate for Payer: BCBS Complete |
$462.40
|
| Rate for Payer: BCBS MAPPO |
$679.04
|
| Rate for Payer: BCN Medicare Advantage |
$679.04
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$977.82
|
| Rate for Payer: Cofinity Commercial |
$909.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.04
|
| Rate for Payer: Healthscope Commercial |
$1,256.22
|
| Rate for Payer: Healthscope Commercial |
$1,086.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.40
|
| Rate for Payer: Nomi Health Commercial |
$814.85
|
| Rate for Payer: PACE SWMI |
$679.04
|
| Rate for Payer: PHP Medicare Advantage |
$679.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health Medicare |
$679.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.04
|
| Rate for Payer: UHC Medicare Advantage |
$679.04
|
|
|
PR DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$3,001.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$568.51 |
| Max. Negotiated Rate |
$1,950.65 |
| Rate for Payer: Aetna Commercial |
$761.80
|
| Rate for Payer: Aetna Medicare |
$591.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.80
|
| Rate for Payer: BCBS Complete |
$1,200.40
|
| Rate for Payer: BCBS MAPPO |
$568.51
|
| Rate for Payer: BCN Medicare Advantage |
$568.51
|
| Rate for Payer: Cash Price |
$2,400.80
|
| Rate for Payer: Cash Price |
$2,400.80
|
| Rate for Payer: Cofinity Commercial |
$818.65
|
| Rate for Payer: Cofinity Commercial |
$761.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$568.51
|
| Rate for Payer: Healthscope Commercial |
$1,051.74
|
| Rate for Payer: Healthscope Commercial |
$909.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,950.65
|
| Rate for Payer: Nomi Health Commercial |
$682.21
|
| Rate for Payer: PACE SWMI |
$568.51
|
| Rate for Payer: PHP Medicare Advantage |
$568.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.65
|
| Rate for Payer: Priority Health Medicare |
$568.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$568.51
|
| Rate for Payer: UHC Medicare Advantage |
$568.51
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$530.46 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$715.70
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$589.40
|
| Rate for Payer: Cofinity Commercial |
$724.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$589.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$757.80
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$715.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$530.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$215.54 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Aetna Commercial |
$288.82
|
| Rate for Payer: Aetna Medicare |
$224.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.38
|
| Rate for Payer: BCBS Complete |
$336.80
|
| Rate for Payer: BCBS MAPPO |
$215.54
|
| Rate for Payer: BCN Medicare Advantage |
$215.54
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$310.38
|
| Rate for Payer: Cofinity Commercial |
$288.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.54
|
| Rate for Payer: Healthscope Commercial |
$344.86
|
| Rate for Payer: Healthscope Commercial |
$398.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.30
|
| Rate for Payer: Nomi Health Commercial |
$258.65
|
| Rate for Payer: PACE SWMI |
$215.54
|
| Rate for Payer: PHP Medicare Advantage |
$215.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$215.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Medicare Advantage |
$215.54
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$215.54 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Aetna Commercial |
$288.82
|
| Rate for Payer: Aetna Medicare |
$224.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.82
|
| Rate for Payer: BCBS Complete |
$336.80
|
| Rate for Payer: BCBS MAPPO |
$215.54
|
| Rate for Payer: BCN Medicare Advantage |
$215.54
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$310.38
|
| Rate for Payer: Cofinity Commercial |
$288.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.54
|
| Rate for Payer: Healthscope Commercial |
$398.75
|
| Rate for Payer: Healthscope Commercial |
$344.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.30
|
| Rate for Payer: Nomi Health Commercial |
$258.65
|
| Rate for Payer: PACE SWMI |
$215.54
|
| Rate for Payer: PHP Medicare Advantage |
$215.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$215.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Medicare Advantage |
$215.54
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$530.46 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Aetna Commercial |
$715.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.30
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$589.40
|
| Rate for Payer: Cofinity Commercial |
$724.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$589.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Healthscope Commercial |
$757.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: PHP Commercial |
$715.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health SBD |
$530.46
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$93.31 |
| Max. Negotiated Rate |
$238.55 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$97.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.04
|
| Rate for Payer: BCBS Complete |
$146.80
|
| Rate for Payer: BCBS MAPPO |
$93.31
|
| Rate for Payer: BCN Medicare Advantage |
$93.31
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$134.37
|
| Rate for Payer: Cofinity Commercial |
$125.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.31
|
| Rate for Payer: Healthscope Commercial |
$149.30
|
| Rate for Payer: Healthscope Commercial |
$172.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.55
|
| Rate for Payer: Nomi Health Commercial |
$111.97
|
| Rate for Payer: PACE SWMI |
$93.31
|
| Rate for Payer: PHP Medicare Advantage |
$93.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health Medicare |
$93.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.31
|
| Rate for Payer: UHC Medicare Advantage |
$93.31
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$127.66 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$171.06
|
| Rate for Payer: Aetna Medicare |
$132.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.06
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$127.66
|
| Rate for Payer: BCN Medicare Advantage |
$127.66
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$183.83
|
| Rate for Payer: Cofinity Commercial |
$171.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.66
|
| Rate for Payer: Healthscope Commercial |
$236.17
|
| Rate for Payer: Healthscope Commercial |
$204.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.50
|
| Rate for Payer: Nomi Health Commercial |
$153.19
|
| Rate for Payer: PACE SWMI |
$127.66
|
| Rate for Payer: PHP Medicare Advantage |
$127.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health Medicare |
$127.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.66
|
| Rate for Payer: UHC Medicare Advantage |
$127.66
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Commercial |
$66.28
|
| Rate for Payer: Aetna Medicare |
$51.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.28
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$49.46
|
| Rate for Payer: BCN Medicare Advantage |
$49.46
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$71.22
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.46
|
| Rate for Payer: Healthscope Commercial |
$79.14
|
| Rate for Payer: Healthscope Commercial |
$91.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.60
|
| Rate for Payer: Nomi Health Commercial |
$59.35
|
| Rate for Payer: PACE SWMI |
$49.46
|
| Rate for Payer: PHP Medicare Advantage |
$49.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$49.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.46
|
| Rate for Payer: UHC Medicare Advantage |
$49.46
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$147.47 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$197.61
|
| Rate for Payer: Aetna Medicare |
$153.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.61
|
| Rate for Payer: BCBS Complete |
$191.60
|
| Rate for Payer: BCBS MAPPO |
$147.47
|
| Rate for Payer: BCN Medicare Advantage |
$147.47
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$212.36
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.47
|
| Rate for Payer: Healthscope Commercial |
$272.82
|
| Rate for Payer: Healthscope Commercial |
$235.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.35
|
| Rate for Payer: Nomi Health Commercial |
$176.96
|
| Rate for Payer: PACE SWMI |
$147.47
|
| Rate for Payer: PHP Medicare Advantage |
$147.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health Medicare |
$147.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.47
|
| Rate for Payer: UHC Medicare Advantage |
$147.47
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$301.77 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$335.30
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$301.77
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$301.77 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.35
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$335.30
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health SBD |
$301.77
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
11043
|
| Min. Negotiated Rate |
$147.47 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$197.61
|
| Rate for Payer: Aetna Medicare |
$153.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.36
|
| Rate for Payer: BCBS Complete |
$191.60
|
| Rate for Payer: BCBS MAPPO |
$147.47
|
| Rate for Payer: BCN Medicare Advantage |
$147.47
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$212.36
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.47
|
| Rate for Payer: Healthscope Commercial |
$235.95
|
| Rate for Payer: Healthscope Commercial |
$272.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.35
|
| Rate for Payer: Nomi Health Commercial |
$176.96
|
| Rate for Payer: PACE SWMI |
$147.47
|
| Rate for Payer: PHP Medicare Advantage |
$147.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health Medicare |
$147.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.47
|
| Rate for Payer: UHC Medicare Advantage |
$147.47
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna Medicare |
$50.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.65
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$70.70
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health SBD |
$63.63
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.65
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$70.70
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health SBD |
$63.63
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$96.63 |
| Rate for Payer: Aetna Commercial |
$69.99
|
| Rate for Payer: Aetna Medicare |
$54.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.21
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$52.23
|
| Rate for Payer: BCN Medicare Advantage |
$52.23
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Cofinity Commercial |
$75.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.23
|
| Rate for Payer: Healthscope Commercial |
$96.63
|
| Rate for Payer: Healthscope Commercial |
$83.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.65
|
| Rate for Payer: Nomi Health Commercial |
$62.68
|
| Rate for Payer: PACE SWMI |
$52.23
|
| Rate for Payer: PHP Medicare Advantage |
$52.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health Medicare |
$52.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.23
|
| Rate for Payer: UHC Medicare Advantage |
$52.23
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$96.63 |
| Rate for Payer: Aetna Commercial |
$69.99
|
| Rate for Payer: Aetna Medicare |
$54.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.99
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$52.23
|
| Rate for Payer: BCN Medicare Advantage |
$52.23
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$75.21
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.23
|
| Rate for Payer: Healthscope Commercial |
$83.57
|
| Rate for Payer: Healthscope Commercial |
$96.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.65
|
| Rate for Payer: Nomi Health Commercial |
$62.68
|
| Rate for Payer: PACE SWMI |
$52.23
|
| Rate for Payer: PHP Medicare Advantage |
$52.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health Medicare |
$52.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.23
|
| Rate for Payer: UHC Medicare Advantage |
$52.23
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$13.85
|
| Rate for Payer: BCN Medicare Advantage |
$13.85
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$25.62
|
| Rate for Payer: Healthscope Commercial |
$22.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.75
|
| Rate for Payer: Nomi Health Commercial |
$16.62
|
| Rate for Payer: PACE SWMI |
$13.85
|
| Rate for Payer: PHP Medicare Advantage |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health Medicare |
$13.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.85
|
| Rate for Payer: UHC Medicare Advantage |
$13.85
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 11721
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Aetna Commercial |
$30.58
|
| Rate for Payer: Aetna Medicare |
$23.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.58
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$22.82
|
| Rate for Payer: BCN Medicare Advantage |
$22.82
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$32.86
|
| Rate for Payer: Cofinity Commercial |
$30.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$36.51
|
| Rate for Payer: Healthscope Commercial |
$42.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.70
|
| Rate for Payer: Nomi Health Commercial |
$27.38
|
| Rate for Payer: PACE SWMI |
$22.82
|
| Rate for Payer: PHP Medicare Advantage |
$22.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$22.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.82
|
| Rate for Payer: UHC Medicare Advantage |
$22.82
|
|
|
PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.00
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$48.36
|
| Rate for Payer: Cofinity Commercial |
$45.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$62.12
|
| Rate for Payer: Healthscope Commercial |
$53.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.00
|
| Rate for Payer: Nomi Health Commercial |
$40.30
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$33.58
|
|
|
PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.93
|
| Rate for Payer: BCBS Complete |
$55.60
|
| Rate for Payer: BCBS MAPPO |
$23.08
|
| Rate for Payer: BCN Medicare Advantage |
$23.08
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$33.24
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.08
|
| Rate for Payer: Healthscope Commercial |
$36.93
|
| Rate for Payer: Healthscope Commercial |
$42.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.35
|
| Rate for Payer: Nomi Health Commercial |
$27.70
|
| Rate for Payer: PACE SWMI |
$23.08
|
| Rate for Payer: PHP Medicare Advantage |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.35
|
| Rate for Payer: Priority Health Medicare |
$23.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.08
|
| Rate for Payer: UHC Medicare Advantage |
$23.08
|
|
|
PR DEBRIDEMENT, SKIN, PARTIAL THICKNESS
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 11040
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
|
