Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%

Professional

Both

$49.00

Service Code	HCPCS 11001
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna Commercial	$15.82
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: BCBS Complete	$8.49
Rate for Payer: BCN Commercial	$17.28
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Mclaren Medicaid	$8.09
Rate for Payer: Meridian Medicaid	$8.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.75
Rate for Payer: Priority Health Choice Medicaid	$8.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$20.05
Rate for Payer: Priority Health Narrow/Tiered Network	$20.05
Rate for Payer: UHC Medicaid	$8.09
Rate for Payer: UHCCP Medicaid	$8.09

PR DBRDMT FX&/DISLC SUBQ T/M/F BONE

Professional

Both

$1,255.00

Service Code	HCPCS 11012
Min. Negotiated Rate	$231.11
Max. Negotiated Rate	$941.25
Rate for Payer: Aetna Commercial	$453.05
Rate for Payer: Aetna Medicare	$627.50
Rate for Payer: BCBS Complete	$242.67
Rate for Payer: BCN Commercial	$620.98
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Mclaren Medicaid	$231.11
Rate for Payer: Meridian Medicaid	$242.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$941.25
Rate for Payer: Priority Health Choice Medicaid	$231.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$568.36
Rate for Payer: Priority Health Narrow/Tiered Network	$568.36
Rate for Payer: UHC Medicaid	$231.11
Rate for Payer: UHCCP Medicaid	$231.11

PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER

Professional

Both

$1,099.00

Service Code	HCPCS 11004
Min. Negotiated Rate	$321.84
Max. Negotiated Rate	$842.09
Rate for Payer: Aetna Commercial	$627.05
Rate for Payer: Aetna Medicare	$549.50
Rate for Payer: BCBS Complete	$337.93
Rate for Payer: BCN Commercial	$842.09
Rate for Payer: Cash Price	$879.20
Rate for Payer: Cash Price	$879.20
Rate for Payer: Mclaren Medicaid	$321.84
Rate for Payer: Meridian Medicaid	$337.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$824.25
Rate for Payer: Priority Health Choice Medicaid	$321.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$770.73
Rate for Payer: Priority Health Narrow/Tiered Network	$770.73
Rate for Payer: UHC Medicaid	$321.84
Rate for Payer: UHCCP Medicaid	$321.84

PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL

Professional

Both

$1,466.00

Service Code	HCPCS 11005
Min. Negotiated Rate	$441.76
Max. Negotiated Rate	$1,146.36
Rate for Payer: Aetna Commercial	$855.76
Rate for Payer: Aetna Medicare	$733.00
Rate for Payer: BCBS Complete	$463.85
Rate for Payer: BCN Commercial	$1,146.36
Rate for Payer: Cash Price	$1,172.80
Rate for Payer: Cash Price	$1,172.80
Rate for Payer: Mclaren Medicaid	$441.76
Rate for Payer: Meridian Medicaid	$463.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,099.50
Rate for Payer: Priority Health Choice Medicaid	$441.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,049.21
Rate for Payer: Priority Health Narrow/Tiered Network	$1,049.21
Rate for Payer: UHC Medicaid	$441.76
Rate for Payer: UHCCP Medicaid	$441.76

PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL

Professional

Both

$1,340.00

Service Code	HCPCS 11006
Min. Negotiated Rate	$397.88
Max. Negotiated Rate	$1,040.78
Rate for Payer: Aetna Commercial	$771.49
Rate for Payer: Aetna Medicare	$670.00
Rate for Payer: BCBS Complete	$417.77
Rate for Payer: BCN Commercial	$1,040.78
Rate for Payer: Cash Price	$1,072.00
Rate for Payer: Cash Price	$1,072.00
Rate for Payer: Mclaren Medicaid	$397.88
Rate for Payer: Meridian Medicaid	$417.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,005.00
Rate for Payer: Priority Health Choice Medicaid	$397.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$952.58
Rate for Payer: Priority Health Narrow/Tiered Network	$952.58
Rate for Payer: UHC Medicaid	$397.88
Rate for Payer: UHCCP Medicaid	$397.88

PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS

Professional

Both

$844.00

Service Code	HCPCS 11010
Min. Negotiated Rate	$159.11
Max. Negotiated Rate	$633.00
Rate for Payer: Aetna Commercial	$296.95
Rate for Payer: Aetna Medicare	$422.00
Rate for Payer: BCBS Complete	$167.07
Rate for Payer: BCN Commercial	$414.82
Rate for Payer: Cash Price	$675.20
Rate for Payer: Cash Price	$675.20
Rate for Payer: Mclaren Medicaid	$159.11
Rate for Payer: Meridian Medicaid	$167.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$633.00
Rate for Payer: Priority Health Choice Medicaid	$159.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$379.67
Rate for Payer: Priority Health Narrow/Tiered Network	$379.67
Rate for Payer: UHC Medicaid	$159.11
Rate for Payer: UHCCP Medicaid	$159.11

PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC

Professional

Both

$916.00

Service Code	HCPCS 11011
Min. Negotiated Rate	$168.91
Max. Negotiated Rate	$687.00
Rate for Payer: Aetna Commercial	$324.99
Rate for Payer: Aetna Medicare	$458.00
Rate for Payer: BCBS Complete	$177.36
Rate for Payer: BCN Commercial	$446.69
Rate for Payer: Cash Price	$732.80
Rate for Payer: Cash Price	$732.80
Rate for Payer: Mclaren Medicaid	$168.91
Rate for Payer: Meridian Medicaid	$177.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$687.00
Rate for Payer: Priority Health Choice Medicaid	$168.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$408.84
Rate for Payer: Priority Health Narrow/Tiered Network	$408.84
Rate for Payer: UHC Medicaid	$168.91
Rate for Payer: UHCCP Medicaid	$168.91

PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI

Professional

Both

$1,804.00

Service Code	HCPCS 27057
Min. Negotiated Rate	$587.24
Max. Negotiated Rate	$1,631.58
Rate for Payer: Aetna Commercial	$1,352.98
Rate for Payer: Aetna Medicare	$902.00
Rate for Payer: BCBS Complete	$616.60
Rate for Payer: BCN Commercial	$1,526.31
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Mclaren Medicaid	$587.24
Rate for Payer: Meridian Medicaid	$616.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,353.00
Rate for Payer: Priority Health Choice Medicaid	$587.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,631.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,631.58
Rate for Payer: UHC Medicaid	$587.24
Rate for Payer: UHCCP Medicaid	$587.24

PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS

Professional

Both

$1,380.00

Service Code	HCPCS 27498
Min. Negotiated Rate	$398.52
Max. Negotiated Rate	$1,078.50
Rate for Payer: Aetna Commercial	$875.65
Rate for Payer: Aetna Medicare	$690.00
Rate for Payer: BCBS Complete	$418.45
Rate for Payer: BCN Commercial	$1,008.91
Rate for Payer: Cash Price	$1,104.00
Rate for Payer: Cash Price	$1,104.00
Rate for Payer: Mclaren Medicaid	$398.52
Rate for Payer: Meridian Medicaid	$418.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,035.00
Rate for Payer: Priority Health Choice Medicaid	$398.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,078.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,078.50
Rate for Payer: UHC Medicaid	$398.52
Rate for Payer: UHCCP Medicaid	$398.52

PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT

Professional

Both

$2,246.00

Service Code	HCPCS 25025
Min. Negotiated Rate	$716.96
Max. Negotiated Rate	$1,987.71
Rate for Payer: Aetna Commercial	$1,589.91
Rate for Payer: Aetna Medicare	$1,123.00
Rate for Payer: BCBS Complete	$752.81
Rate for Payer: BCN Commercial	$1,859.46
Rate for Payer: Cash Price	$1,796.80
Rate for Payer: Cash Price	$1,796.80
Rate for Payer: Mclaren Medicaid	$716.96
Rate for Payer: Meridian Medicaid	$752.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,684.50
Rate for Payer: Priority Health Choice Medicaid	$716.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,987.71
Rate for Payer: Priority Health Narrow/Tiered Network	$1,987.71
Rate for Payer: UHC Medicaid	$716.96
Rate for Payer: UHCCP Medicaid	$716.96

PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT

Professional

Both

$2,028.00

Service Code	HCPCS 25023
Min. Negotiated Rate	$805.99
Max. Negotiated Rate	$2,102.70
Rate for Payer: Aetna Commercial	$1,702.85
Rate for Payer: Aetna Medicare	$1,014.00
Rate for Payer: BCBS Complete	$846.29
Rate for Payer: BCN Commercial	$1,967.02
Rate for Payer: Cash Price	$1,622.40
Rate for Payer: Cash Price	$1,622.40
Rate for Payer: Mclaren Medicaid	$805.99
Rate for Payer: Meridian Medicaid	$846.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,521.00
Rate for Payer: Priority Health Choice Medicaid	$805.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,102.70
Rate for Payer: Priority Health Narrow/Tiered Network	$2,102.70
Rate for Payer: UHC Medicaid	$805.99
Rate for Payer: UHCCP Medicaid	$805.99

PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB

Professional

Both

$1,878.00

Service Code	HCPCS 25024
Min. Negotiated Rate	$463.49
Max. Negotiated Rate	$1,408.50
Rate for Payer: Aetna Commercial	$1,042.37
Rate for Payer: Aetna Medicare	$939.00
Rate for Payer: BCBS Complete	$486.66
Rate for Payer: BCN Commercial	$1,185.69
Rate for Payer: Cash Price	$1,502.40
Rate for Payer: Cash Price	$1,502.40
Rate for Payer: Mclaren Medicaid	$463.49
Rate for Payer: Meridian Medicaid	$486.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,408.50
Rate for Payer: Priority Health Choice Medicaid	$463.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,267.47
Rate for Payer: Priority Health Narrow/Tiered Network	$1,267.47
Rate for Payer: UHC Medicaid	$463.49
Rate for Payer: UHCCP Medicaid	$463.49

PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT

Professional

Both

$1,461.00

Service Code	HCPCS 25020
Min. Negotiated Rate	$460.29
Max. Negotiated Rate	$1,182.83
Rate for Payer: Aetna Commercial	$936.55
Rate for Payer: Aetna Medicare	$730.50
Rate for Payer: BCBS Complete	$483.30
Rate for Payer: BCN Commercial	$1,106.52
Rate for Payer: Cash Price	$1,168.80
Rate for Payer: Cash Price	$1,168.80
Rate for Payer: Mclaren Medicaid	$460.29
Rate for Payer: Meridian Medicaid	$483.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,095.75
Rate for Payer: Priority Health Choice Medicaid	$460.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,182.83
Rate for Payer: Priority Health Narrow/Tiered Network	$1,182.83
Rate for Payer: UHC Medicaid	$460.29
Rate for Payer: UHCCP Medicaid	$460.29

PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY

Professional

Both

$1,278.00

Service Code	HCPCS 27600
Min. Negotiated Rate	$239.63
Max. Negotiated Rate	$958.50
Rate for Payer: Aetna Commercial	$540.38
Rate for Payer: Aetna Medicare	$639.00
Rate for Payer: BCBS Complete	$251.61
Rate for Payer: BCN Commercial	$607.04
Rate for Payer: Cash Price	$1,022.40
Rate for Payer: Cash Price	$1,022.40
Rate for Payer: Mclaren Medicaid	$239.63
Rate for Payer: Meridian Medicaid	$251.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$958.50
Rate for Payer: Priority Health Choice Medicaid	$239.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$648.90
Rate for Payer: Priority Health Narrow/Tiered Network	$648.90
Rate for Payer: UHC Medicaid	$239.63
Rate for Payer: UHCCP Medicaid	$239.63

PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT

Professional

Both

$1,822.00

Service Code	HCPCS 27602
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$1,366.50
Rate for Payer: Aetna Commercial	$647.06
Rate for Payer: Aetna Medicare	$911.00
Rate for Payer: BCBS Complete	$297.23
Rate for Payer: BCN Commercial	$713.61
Rate for Payer: Cash Price	$1,457.60
Rate for Payer: Cash Price	$1,457.60
Rate for Payer: Mclaren Medicaid	$283.08
Rate for Payer: Meridian Medicaid	$297.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,366.50
Rate for Payer: Priority Health Choice Medicaid	$283.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$762.83
Rate for Payer: Priority Health Narrow/Tiered Network	$762.83
Rate for Payer: UHC Medicaid	$283.08
Rate for Payer: UHCCP Medicaid	$283.08

PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS

Professional

Both

$2,308.00

Service Code	HCPCS 27894
Min. Negotiated Rate	$482.87
Max. Negotiated Rate	$1,731.00
Rate for Payer: Aetna Commercial	$1,109.32
Rate for Payer: Aetna Medicare	$1,154.00
Rate for Payer: BCBS Complete	$507.01
Rate for Payer: BCN Commercial	$1,239.47
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Mclaren Medicaid	$482.87
Rate for Payer: Meridian Medicaid	$507.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,731.00
Rate for Payer: Priority Health Choice Medicaid	$482.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,324.96
Rate for Payer: Priority Health Narrow/Tiered Network	$1,324.96
Rate for Payer: UHC Medicaid	$482.87
Rate for Payer: UHCCP Medicaid	$482.87

PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE

Professional

Both

$1,694.00

Service Code	HCPCS 27892
Min. Negotiated Rate	$330.36
Max. Negotiated Rate	$1,270.50
Rate for Payer: Aetna Commercial	$716.58
Rate for Payer: Aetna Medicare	$847.00
Rate for Payer: BCBS Complete	$346.88
Rate for Payer: BCN Commercial	$822.16
Rate for Payer: Cash Price	$1,355.20
Rate for Payer: Cash Price	$1,355.20
Rate for Payer: Mclaren Medicaid	$330.36
Rate for Payer: Meridian Medicaid	$346.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,270.50
Rate for Payer: Priority Health Choice Medicaid	$330.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$878.87
Rate for Payer: Priority Health Narrow/Tiered Network	$878.87
Rate for Payer: UHC Medicaid	$330.36
Rate for Payer: UHCCP Medicaid	$330.36

PR DCMPRN FASCT LEG POST COMPARTMENT ONLY

Professional

Both

$1,430.00

Service Code	HCPCS 27601
Min. Negotiated Rate	$266.68
Max. Negotiated Rate	$1,072.50
Rate for Payer: Aetna Commercial	$591.31
Rate for Payer: Aetna Medicare	$715.00
Rate for Payer: BCBS Complete	$280.01
Rate for Payer: BCN Commercial	$666.30
Rate for Payer: Cash Price	$1,144.00
Rate for Payer: Cash Price	$1,144.00
Rate for Payer: Mclaren Medicaid	$266.68
Rate for Payer: Meridian Medicaid	$280.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,072.50
Rate for Payer: Priority Health Choice Medicaid	$266.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$712.26
Rate for Payer: Priority Health Narrow/Tiered Network	$712.26
Rate for Payer: UHC Medicaid	$266.68
Rate for Payer: UHCCP Medicaid	$266.68

PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE

Professional

Both

$1,191.00

Service Code	HCPCS 27499
Min. Negotiated Rate	$423.23
Max. Negotiated Rate	$1,148.22
Rate for Payer: Aetna Commercial	$936.47
Rate for Payer: Aetna Medicare	$595.50
Rate for Payer: BCBS Complete	$444.39
Rate for Payer: BCN Commercial	$1,074.15
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Mclaren Medicaid	$423.23
Rate for Payer: Meridian Medicaid	$444.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$893.25
Rate for Payer: Priority Health Choice Medicaid	$423.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,148.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,148.22
Rate for Payer: UHC Medicaid	$423.23
Rate for Payer: UHCCP Medicaid	$423.23

PR DCMPRN PERQ NUCLEUS PULPOSUS 1/MLT LEVELS LUMBAR

Professional

Both

$3,091.00

Service Code	HCPCS 62287
Min. Negotiated Rate	$340.37
Max. Negotiated Rate	$2,318.25
Rate for Payer: Aetna Commercial	$740.20
Rate for Payer: Aetna Medicare	$1,545.50
Rate for Payer: BCBS Complete	$357.39
Rate for Payer: BCN Commercial	$903.34
Rate for Payer: Cash Price	$2,472.80
Rate for Payer: Cash Price	$2,472.80
Rate for Payer: Mclaren Medicaid	$340.37
Rate for Payer: Meridian Medicaid	$357.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,318.25
Rate for Payer: Priority Health Choice Medicaid	$340.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,049.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,049.22
Rate for Payer: UHC Medicaid	$340.37
Rate for Payer: UHCCP Medicaid	$340.37

PR DEBRIDEMENT BONE 1ST 20 SQ CM/<

Facility

$867.00

Service Code	CPT 11044
Hospital Charge Code	11044
Hospital Revenue Code	960
Min. Negotiated Rate	$152.85
Max. Negotiated Rate	$780.30
Rate for Payer: Aetna Commercial	$736.95
Rate for Payer: Aetna Medicare	$225.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$270.94
Rate for Payer: Amish Plain Church Group Commercial	$270.94
Rate for Payer: BCBS Complete	$160.48
Rate for Payer: BCBS MAPPO	$216.75
Rate for Payer: BCBS Trust/PPO	$712.76
Rate for Payer: BCN Commercial	$712.76
Rate for Payer: BCN Medicare Advantage	$216.75
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cofinity Commercial	$745.62
Rate for Payer: Encore Health Key Benefits Commercial	$693.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$216.75
Rate for Payer: Healthscope Commercial	$780.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$650.25
Rate for Payer: Mclaren Medicaid	$152.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$227.59
Rate for Payer: Meridian Medicaid	$160.48
Rate for Payer: MI Amish Medical Board Commercial	$249.26
Rate for Payer: Molina Medicare/Medicaid	$238.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$736.95
Rate for Payer: Nomi Health Commercial	$710.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$650.25
Rate for Payer: PACE Senior Care Partners	$205.91
Rate for Payer: PACE SWMI	$216.75
Rate for Payer: PHP Commercial	$736.95
Rate for Payer: PHP Medicare Advantage	$216.75
Rate for Payer: Priority Health Choice Medicaid	$152.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$754.29
Rate for Payer: Priority Health Medicare	$218.92
Rate for Payer: Priority Health Narrow/Tiered Network	$603.43
Rate for Payer: Railroad Medicare Medicare	$216.75
Rate for Payer: UHC Core	$723.95
Rate for Payer: UHC Exchange	$216.75
Rate for Payer: UHC Medicaid	$152.85
Rate for Payer: UHC Medicare Advantage	$216.75
Rate for Payer: UHCCP Medicaid	$152.85
Rate for Payer: VA VA	$216.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$650.25

PR DEBRIDEMENT BONE 1ST 20 SQ CM/<

Professional

Both

$867.00

Service Code	HCPCS 11044
Hospital Charge Code	11044
Min. Negotiated Rate	$128.23
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$245.41
Rate for Payer: Aetna Medicare	$433.50
Rate for Payer: BCBS Complete	$134.64
Rate for Payer: BCN Commercial	$335.14
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Mclaren Medicaid	$128.23
Rate for Payer: Meridian Medicaid	$134.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$650.25
Rate for Payer: Priority Health Choice Medicaid	$128.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$306.74
Rate for Payer: Priority Health Narrow/Tiered Network	$306.74
Rate for Payer: UHC Medicaid	$128.23
Rate for Payer: UHCCP Medicaid	$128.23

PR DEBRIDEMENT BONE 1ST 20 SQ CM/<

Facility

$867.00

Service Code	CPT 11044
Hospital Charge Code	11044
Hospital Revenue Code	960
Min. Negotiated Rate	$603.43
Max. Negotiated Rate	$780.30
Rate for Payer: Aetna Commercial	$736.95
Rate for Payer: BCBS Trust/PPO	$716.06
Rate for Payer: BCN Commercial	$716.06
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cofinity Commercial	$745.62
Rate for Payer: Encore Health Key Benefits Commercial	$693.60
Rate for Payer: Healthscope Commercial	$780.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$650.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$736.95
Rate for Payer: Nomi Health Commercial	$710.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$650.25
Rate for Payer: PHP Commercial	$736.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$754.29
Rate for Payer: Priority Health Narrow/Tiered Network	$603.43
Rate for Payer: UHC Core	$723.95
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$650.25

PR DEBRIDEMENT BONE 1ST 20 SQ CM/<

Professional

Both

$867.00

Service Code	HCPCS 11044
Min. Negotiated Rate	$128.23
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$245.41
Rate for Payer: Aetna Medicare	$433.50
Rate for Payer: BCBS Complete	$134.64
Rate for Payer: BCN Commercial	$335.14
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Mclaren Medicaid	$128.23
Rate for Payer: Meridian Medicaid	$134.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$650.25
Rate for Payer: Priority Health Choice Medicaid	$128.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$306.74
Rate for Payer: Priority Health Narrow/Tiered Network	$306.74
Rate for Payer: UHC Medicaid	$128.23
Rate for Payer: UHCCP Medicaid	$128.23

PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM

Professional

Both

$378.00

Service Code	HCPCS 11047
Min. Negotiated Rate	$54.32
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna Commercial	$106.69
Rate for Payer: Aetna Medicare	$189.00
Rate for Payer: BCBS Complete	$57.04
Rate for Payer: BCN Commercial	$143.92
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Mclaren Medicaid	$54.32
Rate for Payer: Meridian Medicaid	$57.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.50
Rate for Payer: Priority Health Choice Medicaid	$54.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$131.72
Rate for Payer: Priority Health Narrow/Tiered Network	$131.72
Rate for Payer: UHC Medicaid	$54.32
Rate for Payer: UHCCP Medicaid	$54.32

Know your out-of-pocket cost for care.

All Charges