|
DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$9,800.65
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,312.29 |
| Max. Negotiated Rate |
$8,820.58 |
| Rate for Payer: Aetna American Axle |
$6,370.42
|
| Rate for Payer: Aetna Commercial |
$8,330.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,370.42
|
| Rate for Payer: Cash Price |
$7,840.52
|
| Rate for Payer: Cofinity Commercial |
$6,860.46
|
| Rate for Payer: Cofinity Commercial |
$8,428.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,840.52
|
| Rate for Payer: Healthscope Commercial |
$8,820.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,860.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,350.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,330.55
|
| Rate for Payer: PHP Commercial |
$8,330.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,860.46
|
| Rate for Payer: Priority Health SBD |
$6,174.41
|
| Rate for Payer: UMR Bronson Commercial |
$4,312.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,350.49
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
IP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$636.90 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna American Axle |
$940.87
|
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,013.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.37
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.24
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: UMR Bronson Commercial |
$636.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
76966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna American Axle |
$940.87
|
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.66
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.93
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,013.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$2.93
|
| Rate for Payer: Meridian Medicaid |
$1.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.37
|
| Rate for Payer: PACE Medicare |
$2.78
|
| Rate for Payer: PACE SWMI |
$2.93
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: PHP Medicare Advantage |
$2.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$2.93
|
| Rate for Payer: Priority Health Narrow Network |
$6.92
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$535.57
|
| Rate for Payer: VA VA |
$2.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARBEPOETIN ALFA 60 MCG/ML IN POLYSORBATE INJECTION
|
Facility
|
IP
|
$1,447.49
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$636.90 |
| Max. Negotiated Rate |
$1,302.74 |
| Rate for Payer: Aetna American Axle |
$940.87
|
| Rate for Payer: Aetna Commercial |
$1,230.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.87
|
| Rate for Payer: Cash Price |
$1,157.99
|
| Rate for Payer: Cofinity Commercial |
$1,013.24
|
| Rate for Payer: Cofinity Commercial |
$1,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.99
|
| Rate for Payer: Healthscope Commercial |
$1,302.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,013.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.37
|
| Rate for Payer: PHP Commercial |
$1,230.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.24
|
| Rate for Payer: Priority Health SBD |
$911.92
|
| Rate for Payer: UMR Bronson Commercial |
$636.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.62
|
|
|
DARUNAVIR 800 MG-COBICISTAT 150 MG TABLET
|
Facility
|
IP
|
$8,639.47
|
|
|
Service Code
|
NDC 59676-575-30
|
| Hospital Charge Code |
173955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,801.37 |
| Max. Negotiated Rate |
$7,775.52 |
| Rate for Payer: Aetna American Axle |
$5,615.66
|
| Rate for Payer: Aetna Commercial |
$7,343.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,615.66
|
| Rate for Payer: Cash Price |
$6,911.58
|
| Rate for Payer: Cofinity Commercial |
$6,047.63
|
| Rate for Payer: Cofinity Commercial |
$7,429.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,911.58
|
| Rate for Payer: Healthscope Commercial |
$7,775.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,047.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,479.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,343.55
|
| Rate for Payer: PHP Commercial |
$7,343.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,047.63
|
| Rate for Payer: Priority Health SBD |
$5,442.87
|
| Rate for Payer: UMR Bronson Commercial |
$3,801.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,479.60
|
|
|
DARUNAVIR ETHANOLATE 800 MG TABLET
|
Facility
|
IP
|
$7,558.77
|
|
|
Service Code
|
NDC 59676-566-30
|
| Hospital Charge Code |
163784
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,325.86 |
| Max. Negotiated Rate |
$6,802.89 |
| Rate for Payer: Aetna American Axle |
$4,913.20
|
| Rate for Payer: Aetna Commercial |
$6,424.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,913.20
|
| Rate for Payer: Cash Price |
$6,047.02
|
| Rate for Payer: Cofinity Commercial |
$5,291.14
|
| Rate for Payer: Cofinity Commercial |
$6,500.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,047.02
|
| Rate for Payer: Healthscope Commercial |
$6,802.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,291.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,669.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,424.95
|
| Rate for Payer: PHP Commercial |
$6,424.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,291.14
|
| Rate for Payer: Priority Health SBD |
$4,762.03
|
| Rate for Payer: UMR Bronson Commercial |
$3,325.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,669.08
|
|
|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION
|
Facility
|
IP
|
$44,046.90
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
184345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,380.64 |
| Max. Negotiated Rate |
$39,642.21 |
| Rate for Payer: Aetna American Axle |
$28,630.48
|
| Rate for Payer: Aetna Commercial |
$37,439.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,630.48
|
| Rate for Payer: Cash Price |
$35,237.52
|
| Rate for Payer: Cofinity Commercial |
$30,832.83
|
| Rate for Payer: Cofinity Commercial |
$37,880.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,237.52
|
| Rate for Payer: Healthscope Commercial |
$39,642.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,832.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,035.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37,439.86
|
| Rate for Payer: PHP Commercial |
$37,439.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,832.83
|
| Rate for Payer: Priority Health SBD |
$27,749.55
|
| Rate for Payer: UMR Bronson Commercial |
$19,380.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,035.18
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,153.96
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$1,038.56 |
| Rate for Payer: Aetna American Axle |
$750.07
|
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Medicare |
$37.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.59
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.67
|
| Rate for Payer: BCBS Trust/PPO |
$115.26
|
| Rate for Payer: BCN Medicare Advantage |
$35.67
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.67
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$807.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$865.47
|
| Rate for Payer: Mclaren Medicaid |
$19.51
|
| Rate for Payer: Mclaren Medicare |
$35.67
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$980.87
|
| Rate for Payer: PACE Medicare |
$33.89
|
| Rate for Payer: PACE SWMI |
$35.67
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.90
|
| Rate for Payer: Priority Health Medicare |
$35.67
|
| Rate for Payer: Priority Health Narrow Network |
$74.32
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Railroad Medicare Medicare |
$35.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.67
|
| Rate for Payer: UHC Medicare Advantage |
$36.74
|
| Rate for Payer: UMR Bronson Commercial |
$426.97
|
| Rate for Payer: VA VA |
$35.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$865.47
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,153.96
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$507.74 |
| Max. Negotiated Rate |
$1,038.56 |
| Rate for Payer: Aetna American Axle |
$750.07
|
| Rate for Payer: Aetna American Axle |
$331.93
|
| Rate for Payer: Aetna American Axle |
$208.44
|
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Commercial |
$434.06
|
| Rate for Payer: Aetna Commercial |
$272.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.44
|
| Rate for Payer: Cash Price |
$256.54
|
| Rate for Payer: Cash Price |
$408.53
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Cofinity Commercial |
$224.47
|
| Rate for Payer: Cofinity Commercial |
$275.78
|
| Rate for Payer: Cofinity Commercial |
$439.17
|
| Rate for Payer: Cofinity Commercial |
$357.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.54
|
| Rate for Payer: Healthscope Commercial |
$459.59
|
| Rate for Payer: Healthscope Commercial |
$288.60
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$807.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$865.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$980.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.06
|
| Rate for Payer: PHP Commercial |
$272.57
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Commercial |
$434.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.46
|
| Rate for Payer: Priority Health SBD |
$202.02
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Priority Health SBD |
$321.72
|
| Rate for Payer: UMR Bronson Commercial |
$141.09
|
| Rate for Payer: UMR Bronson Commercial |
$507.74
|
| Rate for Payer: UMR Bronson Commercial |
$224.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$865.47
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$32,361.13
|
|
|
Service Code
|
MS-DRG 744
|
| Min. Negotiated Rate |
$14,267.28 |
| Max. Negotiated Rate |
$32,361.13 |
| Rate for Payer: Aetna Medicare |
$15,618.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,772.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,772.74
|
| Rate for Payer: BCBS MAPPO |
$15,018.19
|
| Rate for Payer: BCBS Trust/PPO |
$32,361.13
|
| Rate for Payer: BCN Medicare Advantage |
$15,018.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,018.19
|
| Rate for Payer: Mclaren Medicare |
$15,018.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,769.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,270.92
|
| Rate for Payer: PACE Medicare |
$14,267.28
|
| Rate for Payer: PACE SWMI |
$15,018.19
|
| Rate for Payer: PHP Medicare Advantage |
$15,018.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,012.29
|
| Rate for Payer: Priority Health Medicare |
$15,018.19
|
| Rate for Payer: Priority Health Narrow Network |
$21,609.83
|
| Rate for Payer: Railroad Medicare Medicare |
$15,018.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,714.13
|
| Rate for Payer: UHC Core |
$23,545.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,018.19
|
| Rate for Payer: UHC Exchange |
$18,718.59
|
| Rate for Payer: UHC Medicare Advantage |
$15,468.74
|
| Rate for Payer: VA VA |
$15,018.19
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$25,827.59
|
|
|
Service Code
|
MS-DRG 745
|
| Min. Negotiated Rate |
$8,070.27 |
| Max. Negotiated Rate |
$25,827.59 |
| Rate for Payer: Aetna Medicare |
$8,834.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,618.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,618.78
|
| Rate for Payer: BCBS MAPPO |
$8,495.02
|
| Rate for Payer: BCBS Trust/PPO |
$25,827.59
|
| Rate for Payer: BCN Medicare Advantage |
$8,495.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,495.02
|
| Rate for Payer: Mclaren Medicare |
$8,495.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,919.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,769.27
|
| Rate for Payer: PACE Medicare |
$8,070.27
|
| Rate for Payer: PACE SWMI |
$8,495.02
|
| Rate for Payer: PHP Medicare Advantage |
$8,495.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,865.08
|
| Rate for Payer: Priority Health Medicare |
$8,495.02
|
| Rate for Payer: Priority Health Narrow Network |
$11,892.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8,495.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,801.62
|
| Rate for Payer: UHC Core |
$12,957.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,495.02
|
| Rate for Payer: UHC Exchange |
$10,300.99
|
| Rate for Payer: UHC Medicare Advantage |
$8,749.87
|
| Rate for Payer: VA VA |
$8,495.02
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$4,536.73
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,381.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.04
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$220.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$158.22
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.69
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$18.95
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES
|
Facility
|
OP
|
$1,968.76
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.47 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$586.35
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.52
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$270.47
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES
|
Facility
|
OP
|
$1,968.76
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$270.47 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$586.35
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.52
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$270.47
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE
|
Facility
|
OP
|
$1,968.76
|
|
|
Service Code
|
CPT 11011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$290.77 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$432.63
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.85
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$290.77
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE
|
Facility
|
OP
|
$7,951.14
|
|
|
Service Code
|
CPT 11012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$406.03 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,531.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.63
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$406.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE
|
Facility
|
OP
|
$7,951.14
|
|
|
Service Code
|
CPT 11012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.03 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,531.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.63
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$406.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA OR MORE THAN ROUTINE CLEANING)
|
Facility
|
OP
|
$1,539.60
|
|
|
Service Code
|
CPT 69222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$135.56 |
| Max. Negotiated Rate |
$1,539.60 |
| Rate for Payer: Aetna Medicare |
$508.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.32
|
| Rate for Payer: BCBS Complete |
$280.92
|
| Rate for Payer: BCBS MAPPO |
$489.06
|
| Rate for Payer: BCBS Trust/PPO |
$206.46
|
| Rate for Payer: BCN Medicare Advantage |
$489.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.06
|
| Rate for Payer: Mclaren Medicaid |
$267.52
|
| Rate for Payer: Mclaren Medicare |
$489.06
|
| Rate for Payer: Meridian Medicaid |
$280.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.42
|
| Rate for Payer: PACE Medicare |
$464.61
|
| Rate for Payer: PACE SWMI |
$489.06
|
| Rate for Payer: PHP Medicare Advantage |
$489.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,539.60
|
| Rate for Payer: Priority Health Medicare |
$489.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,231.68
|
| Rate for Payer: Railroad Medicare Medicare |
$489.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.06
|
| Rate for Payer: UHC Exchange |
$135.56
|
| Rate for Payer: UHC Medicare Advantage |
$503.73
|
| Rate for Payer: VA VA |
$489.06
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$251.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$53.37
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$714.71
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.26
|
| Rate for Payer: UHC Exchange |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: VA VA |
$558.26
|
|
|
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 11000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$40.29
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.54
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.26
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: VA VA |
$558.26
|
|
|
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 1 TO 5
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$56.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$49.33
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.15
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$136.92
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.37
|
| Rate for Payer: UHC Exchange |
$13.75
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$139.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$24.56
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$139.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$24.56
|
|
