|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$526.51 |
| Max. Negotiated Rate |
$2,864.30 |
| Rate for Payer: Aetna American Axle |
$924.95
|
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: Aetna Medicare |
$711.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.95
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,864.30
|
| Rate for Payer: BCN Commercial |
$2,864.30
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$996.10
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$996.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health SBD |
$896.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.98
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$755.44
|
| Rate for Payer: UMR Bronson Commercial |
$526.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.09
|
| Rate for Payer: BCBS Complete |
$514.85
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Meridian Medicaid |
$514.85
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Commercial |
$1,047.17
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.23
|
| Rate for Payer: Priority Health Medicare |
$747.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.23
|
| Rate for Payer: Priority Health SBD |
$1,036.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
| Rate for Payer: UHCCP Medicaid |
$490.33
|
| Rate for Payer: UMR Bronson Commercial |
$654.58
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.09
|
| Rate for Payer: BCBS Complete |
$514.85
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Meridian Medicaid |
$514.85
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Commercial |
$1,047.17
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.23
|
| Rate for Payer: Priority Health Medicare |
$747.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.23
|
| Rate for Payer: Priority Health SBD |
$1,036.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
| Rate for Payer: UHCCP Medicaid |
$490.33
|
| Rate for Payer: UMR Bronson Commercial |
$654.58
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$626.12 |
| Max. Negotiated Rate |
$1,280.70 |
| Rate for Payer: Aetna American Axle |
$924.95
|
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.95
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Cofinity Commercial |
$996.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$996.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health SBD |
$896.49
|
| Rate for Payer: UMR Bronson Commercial |
$626.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$2,187.45 |
| Rate for Payer: Aetna Commercial |
$907.61
|
| Rate for Payer: Aetna Medicare |
$704.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$907.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.34
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$677.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,187.45
|
| Rate for Payer: BCN Commercial |
$1,012.05
|
| Rate for Payer: BCN Medicare Advantage |
$677.32
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$907.61
|
| Rate for Payer: Cofinity Commercial |
$975.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$711.19
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Nomi Health Commercial |
$812.78
|
| Rate for Payer: PACE SWMI |
$677.32
|
| Rate for Payer: PHP Commercial |
$948.25
|
| Rate for Payer: PHP Medicare Advantage |
$677.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$937.35
|
| Rate for Payer: Priority Health Medicare |
$677.32
|
| Rate for Payer: Priority Health Narrow Network |
$937.35
|
| Rate for Payer: Priority Health SBD |
$937.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$677.32
|
| Rate for Payer: UHC Medicare Advantage |
$677.32
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$664.60 |
| Rate for Payer: Aetna Commercial |
$353.49
|
| Rate for Payer: Aetna Medicare |
$274.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.87
|
| Rate for Payer: BCBS Complete |
$186.30
|
| Rate for Payer: BCBS MAPPO |
$263.80
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$664.60
|
| Rate for Payer: BCN Medicare Advantage |
$263.80
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$353.49
|
| Rate for Payer: Cofinity Commercial |
$379.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.99
|
| Rate for Payer: Meridian Medicaid |
$186.30
|
| Rate for Payer: Nomi Health Commercial |
$316.56
|
| Rate for Payer: PACE SWMI |
$263.80
|
| Rate for Payer: PHP Commercial |
$369.32
|
| Rate for Payer: PHP Medicare Advantage |
$263.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.95
|
| Rate for Payer: Priority Health Medicare |
$263.80
|
| Rate for Payer: Priority Health Narrow Network |
$372.95
|
| Rate for Payer: Priority Health SBD |
$372.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.80
|
| Rate for Payer: UHC Medicare Advantage |
$263.80
|
| Rate for Payer: UHCCP Medicaid |
$177.43
|
| Rate for Payer: UMR Bronson Commercial |
$376.74
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$729.59 |
| Rate for Payer: Aetna Commercial |
$384.27
|
| Rate for Payer: Aetna Medicare |
$298.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.95
|
| Rate for Payer: BCBS Complete |
$200.61
|
| Rate for Payer: BCBS MAPPO |
$286.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$729.59
|
| Rate for Payer: BCN Medicare Advantage |
$286.77
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cofinity Commercial |
$384.27
|
| Rate for Payer: Cofinity Commercial |
$412.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.11
|
| Rate for Payer: Meridian Medicaid |
$200.61
|
| Rate for Payer: Nomi Health Commercial |
$344.12
|
| Rate for Payer: PACE SWMI |
$286.77
|
| Rate for Payer: PHP Commercial |
$401.48
|
| Rate for Payer: PHP Medicare Advantage |
$286.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.94
|
| Rate for Payer: Priority Health Medicare |
$286.77
|
| Rate for Payer: Priority Health Narrow Network |
$400.94
|
| Rate for Payer: Priority Health SBD |
$400.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.77
|
| Rate for Payer: UHC Medicare Advantage |
$286.77
|
| Rate for Payer: UHCCP Medicaid |
$191.06
|
| Rate for Payer: UMR Bronson Commercial |
$408.94
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$652.85 |
| Max. Negotiated Rate |
$4,478.93 |
| Rate for Payer: Aetna Commercial |
$1,302.31
|
| Rate for Payer: Aetna Medicare |
$1,010.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.49
|
| Rate for Payer: BCBS Complete |
$685.49
|
| Rate for Payer: BCBS MAPPO |
$971.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,478.93
|
| Rate for Payer: BCN Commercial |
$1,477.76
|
| Rate for Payer: BCN Medicare Advantage |
$971.87
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,302.31
|
| Rate for Payer: Cofinity Commercial |
$1,399.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$971.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,020.46
|
| Rate for Payer: Meridian Medicaid |
$685.49
|
| Rate for Payer: Nomi Health Commercial |
$1,166.24
|
| Rate for Payer: PACE SWMI |
$971.87
|
| Rate for Payer: PHP Commercial |
$1,360.62
|
| Rate for Payer: PHP Medicare Advantage |
$971.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,547.96
|
| Rate for Payer: Priority Health Medicare |
$971.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,547.96
|
| Rate for Payer: Priority Health SBD |
$1,547.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$971.87
|
| Rate for Payer: UHC Medicare Advantage |
$971.87
|
| Rate for Payer: UHCCP Medicaid |
$652.85
|
| Rate for Payer: UMR Bronson Commercial |
$805.46
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$853.62
|
| Rate for Payer: Aetna Medicare |
$662.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.32
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCBS MAPPO |
$637.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: BCN Commercial |
$970.03
|
| Rate for Payer: BCN Medicare Advantage |
$637.03
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$853.62
|
| Rate for Payer: Cofinity Commercial |
$917.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.88
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Nomi Health Commercial |
$764.44
|
| Rate for Payer: PACE SWMI |
$637.03
|
| Rate for Payer: PHP Commercial |
$891.84
|
| Rate for Payer: PHP Medicare Advantage |
$637.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.26
|
| Rate for Payer: Priority Health Medicare |
$637.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.26
|
| Rate for Payer: Priority Health SBD |
$1,020.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.03
|
| Rate for Payer: UHC Medicare Advantage |
$637.03
|
| Rate for Payer: UHCCP Medicaid |
$431.54
|
| Rate for Payer: UMR Bronson Commercial |
$616.40
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$795.34 |
| Max. Negotiated Rate |
$1,884.82 |
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Aetna Commercial |
$1,585.21
|
| Rate for Payer: Aetna Medicare |
$1,230.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,585.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.51
|
| Rate for Payer: BCBS Complete |
$835.11
|
| Rate for Payer: BCBS MAPPO |
$1,182.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.18
|
| Rate for Payer: BCN Commercial |
$1,796.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.99
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cofinity Commercial |
$1,585.21
|
| Rate for Payer: Cofinity Commercial |
$1,703.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,242.14
|
| Rate for Payer: Meridian Medicaid |
$835.11
|
| Rate for Payer: Nomi Health Commercial |
$1,419.59
|
| Rate for Payer: PACE SWMI |
$1,182.99
|
| Rate for Payer: PHP Commercial |
$1,656.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$795.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,884.82
|
| Rate for Payer: Priority Health Medicare |
$1,182.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,884.82
|
| Rate for Payer: Priority Health SBD |
$1,884.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.99
|
| Rate for Payer: UHCCP Medicaid |
$795.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,003.26
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$1,969.00
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$841.35 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$1,644.19
|
| Rate for Payer: Aetna Medicare |
$1,276.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,766.89
|
| Rate for Payer: BCBS Complete |
$883.42
|
| Rate for Payer: BCBS MAPPO |
$1,227.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$1,928.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,227.01
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,644.19
|
| Rate for Payer: Cofinity Commercial |
$1,766.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,227.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,288.36
|
| Rate for Payer: Meridian Medicaid |
$883.42
|
| Rate for Payer: Nomi Health Commercial |
$1,472.41
|
| Rate for Payer: PACE SWMI |
$1,227.01
|
| Rate for Payer: PHP Commercial |
$1,717.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,227.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$841.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,013.05
|
| Rate for Payer: Priority Health Medicare |
$1,227.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,013.05
|
| Rate for Payer: Priority Health SBD |
$2,013.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,227.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,227.01
|
| Rate for Payer: UHCCP Medicaid |
$841.35
|
| Rate for Payer: UMR Bronson Commercial |
$905.74
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$1,823.00
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$218.72 |
| Max. Negotiated Rate |
$1,205.49 |
| Rate for Payer: Aetna Commercial |
$1,006.33
|
| Rate for Payer: Aetna Medicare |
$781.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.43
|
| Rate for Payer: BCBS Complete |
$532.51
|
| Rate for Payer: BCBS MAPPO |
$750.99
|
| Rate for Payer: BCBS Trust/PPO |
$218.72
|
| Rate for Payer: BCN Commercial |
$1,139.60
|
| Rate for Payer: BCN Medicare Advantage |
$750.99
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Cofinity Commercial |
$1,006.33
|
| Rate for Payer: Cofinity Commercial |
$1,081.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.54
|
| Rate for Payer: Meridian Medicaid |
$532.51
|
| Rate for Payer: Nomi Health Commercial |
$901.19
|
| Rate for Payer: PACE SWMI |
$750.99
|
| Rate for Payer: PHP Commercial |
$1,051.39
|
| Rate for Payer: PHP Medicare Advantage |
$750.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$507.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,184.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,205.49
|
| Rate for Payer: Priority Health Medicare |
$750.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,205.49
|
| Rate for Payer: Priority Health SBD |
$1,205.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.99
|
| Rate for Payer: UHC Medicare Advantage |
$750.99
|
| Rate for Payer: UHCCP Medicaid |
$507.15
|
| Rate for Payer: UMR Bronson Commercial |
$838.58
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,140.35 |
| Rate for Payer: Aetna Commercial |
$913.83
|
| Rate for Payer: Aetna Medicare |
$709.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.02
|
| Rate for Payer: BCBS Complete |
$496.95
|
| Rate for Payer: BCBS MAPPO |
$681.96
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: BCN Commercial |
$1,100.99
|
| Rate for Payer: BCN Medicare Advantage |
$681.96
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$913.83
|
| Rate for Payer: Cofinity Commercial |
$982.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$716.06
|
| Rate for Payer: Meridian Medicaid |
$496.95
|
| Rate for Payer: Nomi Health Commercial |
$818.35
|
| Rate for Payer: PACE SWMI |
$681.96
|
| Rate for Payer: PHP Commercial |
$954.74
|
| Rate for Payer: PHP Medicare Advantage |
$681.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,140.35
|
| Rate for Payer: Priority Health Medicare |
$681.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.35
|
| Rate for Payer: Priority Health SBD |
$1,140.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.96
|
| Rate for Payer: UHC Medicare Advantage |
$681.96
|
| Rate for Payer: UHCCP Medicaid |
$473.29
|
| Rate for Payer: UMR Bronson Commercial |
$652.28
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$259.65 |
| Max. Negotiated Rate |
$863.24 |
| Rate for Payer: Aetna Commercial |
$518.69
|
| Rate for Payer: Aetna Medicare |
$402.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.40
|
| Rate for Payer: BCBS Complete |
$272.63
|
| Rate for Payer: BCBS MAPPO |
$387.08
|
| Rate for Payer: BCBS Trust/PPO |
$863.24
|
| Rate for Payer: BCN Commercial |
$588.36
|
| Rate for Payer: BCN Medicare Advantage |
$387.08
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cofinity Commercial |
$518.69
|
| Rate for Payer: Cofinity Commercial |
$557.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.43
|
| Rate for Payer: Meridian Medicaid |
$272.63
|
| Rate for Payer: Nomi Health Commercial |
$464.50
|
| Rate for Payer: PACE SWMI |
$387.08
|
| Rate for Payer: PHP Commercial |
$541.91
|
| Rate for Payer: PHP Medicare Advantage |
$387.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.69
|
| Rate for Payer: Priority Health Medicare |
$387.08
|
| Rate for Payer: Priority Health Narrow Network |
$613.69
|
| Rate for Payer: Priority Health SBD |
$613.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.08
|
| Rate for Payer: UHC Medicare Advantage |
$387.08
|
| Rate for Payer: UHCCP Medicaid |
$259.65
|
| Rate for Payer: UMR Bronson Commercial |
$570.86
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$305.23 |
| Max. Negotiated Rate |
$1,903.46 |
| Rate for Payer: Aetna Commercial |
$617.36
|
| Rate for Payer: Aetna Medicare |
$479.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.44
|
| Rate for Payer: BCBS Complete |
$320.49
|
| Rate for Payer: BCBS MAPPO |
$460.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,903.46
|
| Rate for Payer: BCN Commercial |
$695.39
|
| Rate for Payer: BCN Medicare Advantage |
$460.72
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cofinity Commercial |
$617.36
|
| Rate for Payer: Cofinity Commercial |
$663.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.76
|
| Rate for Payer: Meridian Medicaid |
$320.49
|
| Rate for Payer: Nomi Health Commercial |
$552.86
|
| Rate for Payer: PACE SWMI |
$460.72
|
| Rate for Payer: PHP Commercial |
$645.01
|
| Rate for Payer: PHP Medicare Advantage |
$460.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$726.66
|
| Rate for Payer: Priority Health Medicare |
$460.72
|
| Rate for Payer: Priority Health Narrow Network |
$726.66
|
| Rate for Payer: Priority Health SBD |
$726.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$460.72
|
| Rate for Payer: UHC Medicare Advantage |
$460.72
|
| Rate for Payer: UHCCP Medicaid |
$305.23
|
| Rate for Payer: UMR Bronson Commercial |
$813.74
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$530.16 |
| Max. Negotiated Rate |
$2,785.73 |
| Rate for Payer: Aetna Commercial |
$1,062.82
|
| Rate for Payer: Aetna Medicare |
$824.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.14
|
| Rate for Payer: BCBS Complete |
$556.67
|
| Rate for Payer: BCBS MAPPO |
$793.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.73
|
| Rate for Payer: BCN Commercial |
$1,189.44
|
| Rate for Payer: BCN Medicare Advantage |
$793.15
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cofinity Commercial |
$1,062.82
|
| Rate for Payer: Cofinity Commercial |
$1,142.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.81
|
| Rate for Payer: Meridian Medicaid |
$556.67
|
| Rate for Payer: Nomi Health Commercial |
$951.78
|
| Rate for Payer: PACE SWMI |
$793.15
|
| Rate for Payer: PHP Commercial |
$1,110.41
|
| Rate for Payer: PHP Medicare Advantage |
$793.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,247.22
|
| Rate for Payer: Priority Health Medicare |
$793.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,247.22
|
| Rate for Payer: Priority Health SBD |
$1,247.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.15
|
| Rate for Payer: UHC Medicare Advantage |
$793.15
|
| Rate for Payer: UHCCP Medicaid |
$530.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,030.86
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$351.66 |
| Max. Negotiated Rate |
$2,576.52 |
| Rate for Payer: Aetna Commercial |
$700.61
|
| Rate for Payer: Aetna Medicare |
$543.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.89
|
| Rate for Payer: BCBS Complete |
$369.24
|
| Rate for Payer: BCBS MAPPO |
$522.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,576.52
|
| Rate for Payer: BCN Commercial |
$784.82
|
| Rate for Payer: BCN Medicare Advantage |
$522.84
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cofinity Commercial |
$700.61
|
| Rate for Payer: Cofinity Commercial |
$752.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.98
|
| Rate for Payer: Meridian Medicaid |
$369.24
|
| Rate for Payer: Nomi Health Commercial |
$627.41
|
| Rate for Payer: PACE SWMI |
$522.84
|
| Rate for Payer: PHP Commercial |
$731.98
|
| Rate for Payer: PHP Medicare Advantage |
$522.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.86
|
| Rate for Payer: Priority Health Medicare |
$522.84
|
| Rate for Payer: Priority Health Narrow Network |
$824.86
|
| Rate for Payer: Priority Health SBD |
$824.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$522.84
|
| Rate for Payer: UHC Medicare Advantage |
$522.84
|
| Rate for Payer: UHCCP Medicaid |
$351.66
|
| Rate for Payer: UMR Bronson Commercial |
$756.70
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$284.99 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$564.73
|
| Rate for Payer: Aetna Medicare |
$438.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.87
|
| Rate for Payer: BCBS Complete |
$299.24
|
| Rate for Payer: BCBS MAPPO |
$421.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: BCN Medicare Advantage |
$421.44
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$564.73
|
| Rate for Payer: Cofinity Commercial |
$606.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.51
|
| Rate for Payer: Meridian Medicaid |
$299.24
|
| Rate for Payer: Nomi Health Commercial |
$505.73
|
| Rate for Payer: PACE SWMI |
$421.44
|
| Rate for Payer: PHP Commercial |
$590.02
|
| Rate for Payer: PHP Medicare Advantage |
$421.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.39
|
| Rate for Payer: Priority Health Medicare |
$421.44
|
| Rate for Payer: Priority Health Narrow Network |
$682.39
|
| Rate for Payer: Priority Health SBD |
$682.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.44
|
| Rate for Payer: UHC Medicare Advantage |
$421.44
|
| Rate for Payer: UHCCP Medicaid |
$284.99
|
| Rate for Payer: UMR Bronson Commercial |
$638.48
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$459.44 |
| Max. Negotiated Rate |
$2,735.54 |
| Rate for Payer: Aetna Commercial |
$909.91
|
| Rate for Payer: Aetna Medicare |
$706.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$909.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.82
|
| Rate for Payer: BCBS Complete |
$482.41
|
| Rate for Payer: BCBS MAPPO |
$679.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.54
|
| Rate for Payer: BCN Commercial |
$1,036.00
|
| Rate for Payer: BCN Medicare Advantage |
$679.04
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$909.91
|
| Rate for Payer: Cofinity Commercial |
$977.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.99
|
| Rate for Payer: Meridian Medicaid |
$482.41
|
| Rate for Payer: Nomi Health Commercial |
$814.85
|
| Rate for Payer: PACE SWMI |
$679.04
|
| Rate for Payer: PHP Commercial |
$950.66
|
| Rate for Payer: PHP Medicare Advantage |
$679.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.45
|
| Rate for Payer: Priority Health Medicare |
$679.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.45
|
| Rate for Payer: Priority Health SBD |
$1,088.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.04
|
| Rate for Payer: UHC Medicare Advantage |
$679.04
|
| Rate for Payer: UHCCP Medicaid |
$459.44
|
| Rate for Payer: UMR Bronson Commercial |
$531.76
|
|
|
PR DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$3,001.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$386.38 |
| Max. Negotiated Rate |
$1,950.65 |
| Rate for Payer: Aetna Commercial |
$761.80
|
| Rate for Payer: Aetna Medicare |
$591.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.65
|
| Rate for Payer: BCBS Complete |
$405.70
|
| Rate for Payer: BCBS MAPPO |
$568.51
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: BCN Commercial |
$820.49
|
| Rate for Payer: BCN Medicare Advantage |
$568.51
|
| Rate for Payer: Cash Price |
$2,400.80
|
| Rate for Payer: Cash Price |
$2,400.80
|
| Rate for Payer: Cofinity Commercial |
$761.80
|
| Rate for Payer: Cofinity Commercial |
$818.65
|
| 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: Meridian Medicaid |
$405.70
|
| Rate for Payer: Nomi Health Commercial |
$682.21
|
| Rate for Payer: PACE SWMI |
$568.51
|
| Rate for Payer: PHP Commercial |
$795.91
|
| Rate for Payer: PHP Medicare Advantage |
$568.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.80
|
| Rate for Payer: Priority Health Medicare |
$568.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.80
|
| Rate for Payer: Priority Health SBD |
$1,028.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$568.51
|
| Rate for Payer: UHC Medicare Advantage |
$568.51
|
| Rate for Payer: UHCCP Medicaid |
$386.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,380.46
|
|
|
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 |
$370.48 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Aetna American Axle |
$547.30
|
| Rate for Payer: Aetna Commercial |
$715.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.30
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$589.40
|
| Rate for Payer: Cofinity Commercial |
$724.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$589.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Healthscope Commercial |
$757.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$589.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: PHP Commercial |
$715.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health SBD |
$530.46
|
| Rate for Payer: UMR Bronson Commercial |
$370.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.50
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Aetna Commercial |
$288.82
|
| Rate for Payer: Aetna Medicare |
$224.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.38
|
| Rate for Payer: BCBS Complete |
$150.52
|
| Rate for Payer: BCBS MAPPO |
$215.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$452.52
|
| Rate for Payer: BCN Medicare Advantage |
$215.54
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$310.38
|
| Rate for Payer: Cofinity Commercial |
$288.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.32
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Nomi Health Commercial |
$258.65
|
| Rate for Payer: PACE SWMI |
$215.54
|
| Rate for Payer: PHP Commercial |
$301.76
|
| Rate for Payer: PHP Medicare Advantage |
$215.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.42
|
| Rate for Payer: Priority Health Medicare |
$215.54
|
| Rate for Payer: Priority Health Narrow Network |
$303.42
|
| Rate for Payer: Priority Health SBD |
$303.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Medicare Advantage |
$215.54
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
| Rate for Payer: UMR Bronson Commercial |
$387.32
|
|
|
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 |
$218.07 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna American Axle |
$547.30
|
| Rate for Payer: Aetna Commercial |
$715.70
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,448.95
|
| Rate for Payer: BCN Commercial |
$1,448.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$589.40
|
| Rate for Payer: Cofinity Commercial |
$724.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$589.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$757.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$589.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.50
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$715.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$530.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.88
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$218.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: UMR Bronson Commercial |
$311.54
|
| Rate for Payer: VA VA |
$1,587.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.50
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Aetna Commercial |
$288.82
|
| Rate for Payer: Aetna Medicare |
$224.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.38
|
| Rate for Payer: BCBS Complete |
$150.52
|
| Rate for Payer: BCBS MAPPO |
$215.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$452.52
|
| Rate for Payer: BCN Medicare Advantage |
$215.54
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$310.38
|
| 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: Meridian Medicaid |
$150.52
|
| Rate for Payer: Nomi Health Commercial |
$258.65
|
| Rate for Payer: PACE SWMI |
$215.54
|
| Rate for Payer: PHP Commercial |
$301.76
|
| Rate for Payer: PHP Medicare Advantage |
$215.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.42
|
| Rate for Payer: Priority Health Medicare |
$215.54
|
| Rate for Payer: Priority Health Narrow Network |
$303.42
|
| Rate for Payer: Priority Health SBD |
$303.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.54
|
| Rate for Payer: UHC Medicare Advantage |
$215.54
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
| Rate for Payer: UMR Bronson Commercial |
$387.32
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$242.22 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$97.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.37
|
| Rate for Payer: BCBS Complete |
$64.64
|
| Rate for Payer: BCBS MAPPO |
$93.31
|
| Rate for Payer: BCBS Trust/PPO |
$242.22
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: BCN Medicare Advantage |
$93.31
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$125.04
|
| Rate for Payer: Cofinity Commercial |
$134.37
|
| 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: Meridian Medicaid |
$64.64
|
| Rate for Payer: Nomi Health Commercial |
$111.97
|
| Rate for Payer: PACE SWMI |
$93.31
|
| Rate for Payer: PHP Commercial |
$130.63
|
| Rate for Payer: PHP Medicare Advantage |
$93.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.04
|
| Rate for Payer: Priority Health Medicare |
$93.31
|
| Rate for Payer: Priority Health Narrow Network |
$130.04
|
| Rate for Payer: Priority Health SBD |
$130.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.31
|
| Rate for Payer: UHC Medicare Advantage |
$93.31
|
| Rate for Payer: UHCCP Medicaid |
$61.56
|
| Rate for Payer: UMR Bronson Commercial |
$168.82
|
|
