|
PR DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$3,001.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$386.38 |
| Max. Negotiated Rate |
$99,106.00 |
| Rate for Payer: Aetna Commercial |
$761.80
|
| Rate for Payer: Aetna Medicare |
$591.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.65
|
| Rate for Payer: BCBS Complete |
$405.70
|
| Rate for Payer: BCBS MAPPO |
$568.51
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: BCN Commercial |
$820.49
|
| 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 |
$909.62
|
| Rate for Payer: Healthscope Commercial |
$1,051.74
|
| Rate for Payer: Mclaren Medicaid |
$386.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.94
|
| Rate for Payer: Meridian Medicaid |
$405.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99,106.00
|
| 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 Choice Medicaid |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.80
|
| Rate for Payer: Priority Health Medicare |
$568.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.80
|
| Rate for Payer: Priority Health SBD |
$1,028.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$568.51
|
| Rate for Payer: UHC Exchange |
$645.64
|
| Rate for Payer: UHC Medicare Advantage |
$568.51
|
| Rate for Payer: UHCCP Medicaid |
$386.38
|
|
|
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 |
$239.88 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$715.70
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$831.57
|
| Rate for Payer: BCN Commercial |
$831.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$724.12
|
| Rate for Payer: Cofinity Commercial |
$589.40
|
| 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 |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$757.80
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$715.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$530.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.88
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$39,944.00 |
| 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 |
$150.52
|
| Rate for Payer: BCBS MAPPO |
$215.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$452.52
|
| 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: Mclaren Medicaid |
$143.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.32
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,944.00
|
| 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 Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.42
|
| Rate for Payer: Priority Health Medicare |
$215.54
|
| Rate for Payer: Priority Health Narrow Network |
$303.42
|
| Rate for Payer: Priority Health SBD |
$303.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Exchange |
$362.14
|
| Rate for Payer: UHC Medicare Advantage |
$215.54
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
|
|
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 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$39,944.00 |
| 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 |
$150.52
|
| Rate for Payer: BCBS MAPPO |
$215.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$452.52
|
| 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: Mclaren Medicaid |
$143.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.32
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,944.00
|
| 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 Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.42
|
| Rate for Payer: Priority Health Medicare |
$215.54
|
| Rate for Payer: Priority Health Narrow Network |
$303.42
|
| Rate for Payer: Priority Health SBD |
$303.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Exchange |
$362.14
|
| Rate for Payer: UHC Medicare Advantage |
$215.54
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$17,278.00 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$97.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.37
|
| Rate for Payer: BCBS Complete |
$64.64
|
| Rate for Payer: BCBS MAPPO |
$93.31
|
| Rate for Payer: BCBS Trust/PPO |
$242.22
|
| Rate for Payer: BCN Commercial |
$175.93
|
| 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: Mclaren Medicaid |
$61.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.98
|
| Rate for Payer: Meridian Medicaid |
$64.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,278.00
|
| 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 Choice Medicaid |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.04
|
| Rate for Payer: Priority Health Medicare |
$93.31
|
| Rate for Payer: Priority Health Narrow Network |
$130.04
|
| Rate for Payer: Priority Health SBD |
$130.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.31
|
| Rate for Payer: UHC Medicare Advantage |
$93.31
|
| Rate for Payer: UHCCP Medicaid |
$61.56
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$23,827.00 |
| Rate for Payer: Aetna Commercial |
$171.06
|
| Rate for Payer: Aetna Medicare |
$132.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.83
|
| Rate for Payer: BCBS Complete |
$92.37
|
| Rate for Payer: BCBS MAPPO |
$127.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,975.31
|
| Rate for Payer: BCN Commercial |
$319.60
|
| 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: Mclaren Medicaid |
$87.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.04
|
| Rate for Payer: Meridian Medicaid |
$92.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,827.00
|
| 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 Choice Medicaid |
$87.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.36
|
| Rate for Payer: Priority Health Medicare |
$127.66
|
| Rate for Payer: Priority Health Narrow Network |
$201.36
|
| Rate for Payer: Priority Health SBD |
$201.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.66
|
| Rate for Payer: UHC Exchange |
$209.76
|
| Rate for Payer: UHC Medicare Advantage |
$127.66
|
| Rate for Payer: UHCCP Medicaid |
$87.97
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$9,074.00 |
| Rate for Payer: Aetna Commercial |
$66.28
|
| Rate for Payer: Aetna Medicare |
$51.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.22
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$49.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.09
|
| Rate for Payer: BCN Commercial |
$114.84
|
| 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 |
$91.50
|
| Rate for Payer: Healthscope Commercial |
$79.14
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.93
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,074.00
|
| 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 Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.90
|
| Rate for Payer: Priority Health Medicare |
$49.46
|
| Rate for Payer: Priority Health Narrow Network |
$74.90
|
| Rate for Payer: Priority Health SBD |
$74.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.46
|
| Rate for Payer: UHC Exchange |
$127.04
|
| Rate for Payer: UHC Medicare Advantage |
$49.46
|
| Rate for Payer: UHCCP Medicaid |
$33.23
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
11043
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$27,151.00 |
| 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 |
$103.33
|
| Rate for Payer: BCBS MAPPO |
$147.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.50
|
| Rate for Payer: BCN Commercial |
$338.65
|
| 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: Mclaren Medicaid |
$98.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.84
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,151.00
|
| 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 Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.80
|
| Rate for Payer: Priority Health Medicare |
$147.47
|
| Rate for Payer: Priority Health Narrow Network |
$206.80
|
| Rate for Payer: Priority Health SBD |
$206.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.47
|
| Rate for Payer: UHC Exchange |
$294.90
|
| Rate for Payer: UHC Medicare Advantage |
$147.47
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$27,151.00 |
| 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 |
$103.33
|
| Rate for Payer: BCBS MAPPO |
$147.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.50
|
| Rate for Payer: BCN Commercial |
$338.65
|
| 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: Mclaren Medicaid |
$98.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.84
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,151.00
|
| 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 Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.80
|
| Rate for Payer: Priority Health Medicare |
$147.47
|
| Rate for Payer: Priority Health Narrow Network |
$206.80
|
| Rate for Payer: Priority Health SBD |
$206.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.47
|
| Rate for Payer: UHC Exchange |
$294.90
|
| Rate for Payer: UHC Medicare Advantage |
$147.47
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
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/<
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$162.71 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$430.20
|
| Rate for Payer: BCN Commercial |
$430.20
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Cofinity Commercial |
$335.30
|
| 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 |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Priority Health SBD |
$301.77
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.71
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$337.66
|
| Rate for Payer: VA VA |
$599.75
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$9,752.00 |
| 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 |
$36.24
|
| Rate for Payer: BCBS MAPPO |
$52.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,430.00
|
| Rate for Payer: BCN Commercial |
$106.04
|
| 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: Mclaren Medicaid |
$34.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.84
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,752.00
|
| 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 Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.60
|
| Rate for Payer: Priority Health Medicare |
$52.23
|
| Rate for Payer: Priority Health Narrow Network |
$73.60
|
| Rate for Payer: Priority Health SBD |
$73.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.23
|
| Rate for Payer: UHC Medicare Advantage |
$52.23
|
| Rate for Payer: UHCCP Medicaid |
$34.51
|
|
|
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
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$878.00 |
| 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: BCBS Trust/PPO |
$151.55
|
| Rate for Payer: BCN Commercial |
$151.55
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.58
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$9,752.00 |
| 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 |
$36.24
|
| Rate for Payer: BCBS MAPPO |
$52.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,430.00
|
| Rate for Payer: BCN Commercial |
$106.04
|
| 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: Mclaren Medicaid |
$34.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.84
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,752.00
|
| 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 Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.60
|
| Rate for Payer: Priority Health Medicare |
$52.23
|
| Rate for Payer: Priority Health Narrow Network |
$73.60
|
| Rate for Payer: Priority Health SBD |
$73.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.23
|
| Rate for Payer: UHC Medicare Advantage |
$52.23
|
| Rate for Payer: UHCCP Medicaid |
$34.51
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$2,603.00 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS MAPPO |
$13.85
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$38.48
|
| 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: Mclaren Medicaid |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.54
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,603.00
|
| 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 Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.96
|
| Rate for Payer: Priority Health Medicare |
$13.85
|
| Rate for Payer: Priority Health Narrow Network |
$18.96
|
| Rate for Payer: Priority Health SBD |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.85
|
| Rate for Payer: UHC Exchange |
$32.79
|
| Rate for Payer: UHC Medicare Advantage |
$13.85
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 11721
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$4,223.00 |
| Rate for Payer: Aetna Commercial |
$30.58
|
| Rate for Payer: Aetna Medicare |
$23.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.86
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$22.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,712.50
|
| Rate for Payer: BCN Commercial |
$51.83
|
| 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 |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$36.51
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.96
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,223.00
|
| 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 Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.60
|
| Rate for Payer: Priority Health Medicare |
$22.82
|
| Rate for Payer: Priority Health Narrow Network |
$31.60
|
| Rate for Payer: Priority Health SBD |
$31.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.82
|
| Rate for Payer: UHC Exchange |
$51.27
|
| Rate for Payer: UHC Medicare Advantage |
$22.82
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
|
PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$5,261.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.36
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$839.47
|
| Rate for Payer: BCN Commercial |
$147.09
|
| 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: Mclaren Medicaid |
$22.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,261.00
|
| 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 Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.95
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow Network |
$48.95
|
| Rate for Payer: Priority Health SBD |
$48.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Exchange |
$60.11
|
| Rate for Payer: UHC Medicare Advantage |
$33.58
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
|
|
PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$3,657.00 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.24
|
| Rate for Payer: BCBS Complete |
$16.11
|
| Rate for Payer: BCBS MAPPO |
$23.08
|
| Rate for Payer: BCBS Trust/PPO |
$514.04
|
| Rate for Payer: BCN Commercial |
$65.48
|
| 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 |
$42.70
|
| Rate for Payer: Healthscope Commercial |
$36.93
|
| Rate for Payer: Mclaren Medicaid |
$15.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.23
|
| Rate for Payer: Meridian Medicaid |
$16.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,657.00
|
| 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 Choice Medicaid |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.51
|
| Rate for Payer: Priority Health Medicare |
$23.08
|
| Rate for Payer: Priority Health Narrow Network |
$34.51
|
| Rate for Payer: Priority Health SBD |
$34.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.08
|
| Rate for Payer: UHC Exchange |
$76.26
|
| Rate for Payer: UHC Medicare Advantage |
$23.08
|
| Rate for Payer: UHCCP Medicaid |
$15.34
|
|
|
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
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$212.31 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Aetna Commercial |
$286.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.05
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$235.90
|
| Rate for Payer: Cofinity Commercial |
$289.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Healthscope Commercial |
$303.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: PHP Commercial |
$286.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health SBD |
$212.31
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.86 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$286.45
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$184.43
|
| Rate for Payer: BCN Commercial |
$184.43
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$289.82
|
| Rate for Payer: Cofinity Commercial |
$235.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$303.30
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$286.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$212.31
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.86
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
11042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$10,505.00 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$59.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.00
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS MAPPO |
$57.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: BCN Medicare Advantage |
$57.64
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$83.00
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.64
|
| Rate for Payer: Healthscope Commercial |
$92.22
|
| Rate for Payer: Healthscope Commercial |
$106.63
|
| Rate for Payer: Mclaren Medicaid |
$38.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.52
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,505.00
|
| Rate for Payer: Nomi Health Commercial |
$69.17
|
| Rate for Payer: PACE SWMI |
$57.64
|
| Rate for Payer: PHP Medicare Advantage |
$57.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.72
|
| Rate for Payer: Priority Health Medicare |
$57.64
|
| Rate for Payer: Priority Health Narrow Network |
$81.72
|
| Rate for Payer: Priority Health SBD |
$81.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.64
|
| Rate for Payer: UHC Exchange |
$108.92
|
| Rate for Payer: UHC Medicare Advantage |
$57.64
|
| Rate for Payer: UHCCP Medicaid |
$38.77
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$10,505.00 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$59.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.00
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS MAPPO |
$57.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: BCN Medicare Advantage |
$57.64
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$83.00
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.64
|
| Rate for Payer: Healthscope Commercial |
$92.22
|
| Rate for Payer: Healthscope Commercial |
$106.63
|
| Rate for Payer: Mclaren Medicaid |
$38.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.52
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,505.00
|
| Rate for Payer: Nomi Health Commercial |
$69.17
|
| Rate for Payer: PACE SWMI |
$57.64
|
| Rate for Payer: PHP Medicare Advantage |
$57.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.72
|
| Rate for Payer: Priority Health Medicare |
$57.64
|
| Rate for Payer: Priority Health Narrow Network |
$81.72
|
| Rate for Payer: Priority Health SBD |
$81.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.64
|
| Rate for Payer: UHC Exchange |
$108.92
|
| Rate for Payer: UHC Medicare Advantage |
$57.64
|
| Rate for Payer: UHCCP Medicaid |
$38.77
|
|
