|
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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.94
|
| 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 |
$574.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$568.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$568.51
|
| Rate for Payer: UHC Exchange |
$568.51
|
| Rate for Payer: UHC Medicare Advantage |
$568.51
|
|
|
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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.32
|
| 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 |
$217.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.32
|
| 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 |
$217.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Exchange |
$215.54
|
| Rate for Payer: UHC Medicare Advantage |
$215.54
|
|
|
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 |
$199.97 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$715.70
|
| Rate for Payer: Aetna Medicare |
$218.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.12
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$210.50
|
| Rate for Payer: BCBS Trust/PPO |
$692.21
|
| Rate for Payer: BCN Commercial |
$654.65
|
| Rate for Payer: BCN Medicare Advantage |
$210.50
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$724.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.50
|
| Rate for Payer: Healthscope Commercial |
$757.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.50
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.03
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: Nomi Health Commercial |
$690.44
|
| Rate for Payer: PACE Senior Care Partners |
$199.97
|
| Rate for Payer: PACE SWMI |
$210.50
|
| Rate for Payer: PHP Commercial |
$715.70
|
| Rate for Payer: PHP Medicare Advantage |
$210.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO |
$732.54
|
| Rate for Payer: Priority Health Medicare |
$212.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.14
|
| Rate for Payer: Railroad Medicare Medicare |
$210.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.96
|
| Rate for Payer: UHC Core |
$703.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.50
|
| Rate for Payer: UHC Exchange |
$210.50
|
| Rate for Payer: UHC Medicare Advantage |
$210.50
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$210.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.50
|
|
|
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 |
$547.30 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Aetna Commercial |
$715.70
|
| Rate for Payer: BCBS Trust/PPO |
$687.32
|
| Rate for Payer: BCN Commercial |
$650.70
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$724.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Healthscope Commercial |
$757.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: Nomi Health Commercial |
$690.44
|
| Rate for Payer: PHP Commercial |
$715.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO |
$732.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.96
|
| Rate for Payer: UHC Core |
$703.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.50
|
|
|
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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.98
|
| 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 |
$94.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.31
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.04
|
| 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 |
$128.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.66
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.93
|
| 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 |
$49.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.46
|
| Rate for Payer: UHC Exchange |
$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
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.84
|
| 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 |
$148.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.47
|
| Rate for Payer: UHC Exchange |
$147.47
|
| Rate for Payer: UHC Medicare Advantage |
$147.47
|
|
|
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 |
$311.35 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: BCBS Trust/PPO |
$391.01
|
| Rate for Payer: BCN Commercial |
$370.17
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO |
$416.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.52
|
| Rate for Payer: UHC Core |
$399.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.25
|
|
|
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 |
$113.76 |
| Max. Negotiated Rate |
$464.73 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Aetna Medicare |
$124.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.69
|
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: BCBS MAPPO |
$119.75
|
| Rate for Payer: BCBS Trust/PPO |
$393.79
|
| Rate for Payer: BCN Commercial |
$372.42
|
| Rate for Payer: BCN Medicare Advantage |
$119.75
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.75
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.25
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.74
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: PACE Senior Care Partners |
$113.76
|
| Rate for Payer: PACE SWMI |
$119.75
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: PHP Medicare Advantage |
$119.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO |
$416.73
|
| Rate for Payer: Priority Health Medicare |
$120.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.93
|
| Rate for Payer: Railroad Medicare Medicare |
$119.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.52
|
| Rate for Payer: UHC Core |
$399.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.75
|
| Rate for Payer: UHC Exchange |
$119.75
|
| Rate for Payer: UHC Medicare Advantage |
$119.75
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
| Rate for Payer: VA VA |
$119.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.25
|
|
|
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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.84
|
| 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 |
$148.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.47
|
| Rate for Payer: UHC Exchange |
$147.47
|
| Rate for Payer: UHC Medicare Advantage |
$147.47
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: BCBS Trust/PPO |
$82.45
|
| Rate for Payer: BCN Commercial |
$78.05
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: Nomi Health Commercial |
$82.82
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO |
$87.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.88
|
| Rate for Payer: UHC Core |
$84.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.75
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna Medicare |
$26.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$78.53
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: Nomi Health Commercial |
$82.82
|
| Rate for Payer: PACE Senior Care Partners |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO |
$87.87
|
| Rate for Payer: Priority Health Medicare |
$25.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.67
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.88
|
| Rate for Payer: UHC Core |
$84.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.25
|
| Rate for Payer: UHC Exchange |
$25.25
|
| Rate for Payer: UHC Medicare Advantage |
$25.25
|
| Rate for Payer: VA VA |
$25.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.75
|
|
|
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 |
$75.21 |
| Rate for Payer: Aetna Commercial |
$69.99
|
| Rate for Payer: Aetna Medicare |
$54.32
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.84
|
| 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 |
$52.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.23
|
| Rate for Payer: UHC Exchange |
$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
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$75.21 |
| Rate for Payer: Aetna Commercial |
$69.99
|
| Rate for Payer: Aetna Medicare |
$54.32
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.84
|
| 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 |
$52.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.23
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.54
|
| 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 |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.85
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.96
|
| 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 |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.82
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.26
|
| 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 |
$33.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.23
|
| 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 |
$23.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.08
|
| Rate for Payer: UHC Exchange |
$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: Priority Health Cigna Priority Health |
$50.70
|
|
|
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 |
$80.04 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: Aetna Commercial |
$286.45
|
| Rate for Payer: Aetna Medicare |
$87.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.31
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$84.25
|
| Rate for Payer: BCBS Trust/PPO |
$277.05
|
| Rate for Payer: BCN Commercial |
$262.02
|
| Rate for Payer: BCN Medicare Advantage |
$84.25
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$289.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.25
|
| Rate for Payer: Healthscope Commercial |
$303.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.75
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.46
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: Nomi Health Commercial |
$276.34
|
| Rate for Payer: PACE Senior Care Partners |
$80.04
|
| Rate for Payer: PACE SWMI |
$84.25
|
| Rate for Payer: PHP Commercial |
$286.45
|
| Rate for Payer: PHP Medicare Advantage |
$84.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO |
$293.19
|
| Rate for Payer: Priority Health Medicare |
$85.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.79
|
| Rate for Payer: Railroad Medicare Medicare |
$84.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.56
|
| Rate for Payer: UHC Core |
$281.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.25
|
| Rate for Payer: UHC Exchange |
$84.25
|
| Rate for Payer: UHC Medicare Advantage |
$84.25
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$84.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.75
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$59.95
|
| Rate for Payer: BCBS Complete |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$57.64
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.52
|
| 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 Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health Medicare |
$58.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.64
|
| Rate for Payer: UHC Exchange |
$57.64
|
| Rate for Payer: UHC Medicare Advantage |
$57.64
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
11042
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$77.24
|
| Rate for Payer: Aetna Medicare |
$59.95
|
| Rate for Payer: BCBS Complete |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$57.64
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.52
|
| 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 Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health Medicare |
$58.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.64
|
| Rate for Payer: UHC Exchange |
$57.64
|
| Rate for Payer: UHC Medicare Advantage |
$57.64
|
|
|
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 |
$219.05 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Aetna Commercial |
$286.45
|
| Rate for Payer: BCBS Trust/PPO |
$275.09
|
| Rate for Payer: BCN Commercial |
$260.43
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$289.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Healthscope Commercial |
$303.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: Nomi Health Commercial |
$276.34
|
| Rate for Payer: PHP Commercial |
$286.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO |
$293.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.56
|
| Rate for Payer: UHC Core |
$281.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.75
|
|
