|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$488.84 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$855.76
|
| Rate for Payer: BCBS Complete |
$513.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Meridian Medicaid |
$513.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$940.87
|
| Rate for Payer: Priority Health Narrow Network |
$940.87
|
| Rate for Payer: Priority Health SBD |
$940.87
|
| Rate for Payer: UMR Bronson Commercial |
$641.70
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$613.80 |
| Max. Negotiated Rate |
$1,255.50 |
| Rate for Payer: Aetna American Axle |
$906.75
|
| Rate for Payer: Aetna Commercial |
$1,185.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.75
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$1,199.70
|
| Rate for Payer: Cofinity Commercial |
$976.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,116.00
|
| Rate for Payer: Healthscope Commercial |
$1,255.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$976.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,046.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,185.75
|
| Rate for Payer: PHP Commercial |
$1,185.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.50
|
| Rate for Payer: Priority Health SBD |
$878.85
|
| Rate for Payer: UMR Bronson Commercial |
$613.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,046.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$442.19 |
| Max. Negotiated Rate |
$2,187.45 |
| Rate for Payer: Aetna Commercial |
$771.49
|
| Rate for Payer: BCBS Complete |
$464.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,187.45
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Meridian Medicaid |
$464.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$851.26
|
| Rate for Payer: Priority Health Narrow Network |
$851.26
|
| Rate for Payer: Priority Health SBD |
$851.26
|
| Rate for Payer: UMR Bronson Commercial |
$586.50
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR
|
Professional
|
Both
|
$1,046.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$358.69 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$627.05
|
| Rate for Payer: BCBS Complete |
$376.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Meridian Medicaid |
$376.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$358.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.54
|
| Rate for Payer: Priority Health Narrow Network |
$690.54
|
| Rate for Payer: Priority Health SBD |
$690.54
|
| Rate for Payer: UMR Bronson Commercial |
$481.16
|
|
|
PR DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$111.72 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS Trust/PPO |
$111.72
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.83
|
| Rate for Payer: Priority Health Narrow Network |
$30.83
|
| Rate for Payer: Priority Health SBD |
$30.83
|
| Rate for Payer: UMR Bronson Commercial |
$31.74
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$562.10 |
| Rate for Payer: Aetna Commercial |
$296.95
|
| Rate for Payer: BCBS Complete |
$184.74
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Meridian Medicaid |
$184.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.28
|
| Rate for Payer: Priority Health Narrow Network |
$338.28
|
| Rate for Payer: Priority Health SBD |
$338.28
|
| Rate for Payer: UMR Bronson Commercial |
$369.38
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$610.40 |
| Rate for Payer: Aetna Commercial |
$324.99
|
| Rate for Payer: BCBS Complete |
$198.60
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Meridian Medicaid |
$198.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.30
|
| Rate for Payer: Priority Health Narrow Network |
$361.30
|
| Rate for Payer: Priority Health SBD |
$361.30
|
| Rate for Payer: UMR Bronson Commercial |
$401.12
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,717.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$647.95 |
| Max. Negotiated Rate |
$4,478.93 |
| Rate for Payer: Aetna Commercial |
$1,352.98
|
| Rate for Payer: BCBS Complete |
$680.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,478.93
|
| Rate for Payer: Cash Price |
$1,373.60
|
| Rate for Payer: Cash Price |
$1,373.60
|
| Rate for Payer: Meridian Medicaid |
$680.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$647.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,201.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.21
|
| Rate for Payer: Priority Health SBD |
$1,544.21
|
| Rate for Payer: UMR Bronson Commercial |
$789.82
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,314.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$427.07 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$875.65
|
| Rate for Payer: BCBS Complete |
$448.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Meridian Medicaid |
$448.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,013.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.64
|
| Rate for Payer: Priority Health SBD |
$1,013.64
|
| Rate for Payer: UMR Bronson Commercial |
$604.44
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$788.95 |
| Max. Negotiated Rate |
$1,877.66 |
| Rate for Payer: Aetna Commercial |
$1,589.91
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.18
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Meridian Medicaid |
$828.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,877.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,877.66
|
| Rate for Payer: Priority Health SBD |
$1,877.66
|
| Rate for Payer: UMR Bronson Commercial |
$983.48
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$842.63 |
| Max. Negotiated Rate |
$2,015.03 |
| Rate for Payer: Aetna Commercial |
$1,702.85
|
| Rate for Payer: BCBS Complete |
$884.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Meridian Medicaid |
$884.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,015.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.03
|
| Rate for Payer: Priority Health SBD |
$2,015.03
|
| Rate for Payer: UMR Bronson Commercial |
$887.80
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$218.72 |
| Max. Negotiated Rate |
$1,250.90 |
| Rate for Payer: Aetna Commercial |
$1,042.37
|
| Rate for Payer: BCBS Complete |
$529.83
|
| Rate for Payer: BCBS Trust/PPO |
$218.72
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Meridian Medicaid |
$529.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,190.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,190.84
|
| Rate for Payer: Priority Health SBD |
$1,190.84
|
| Rate for Payer: UMR Bronson Commercial |
$822.02
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,150.50 |
| Rate for Payer: Aetna Commercial |
$936.55
|
| Rate for Payer: BCBS Complete |
$501.20
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Meridian Medicaid |
$501.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.50
|
| Rate for Payer: Priority Health SBD |
$1,150.50
|
| Rate for Payer: UMR Bronson Commercial |
$639.40
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$256.88 |
| Max. Negotiated Rate |
$863.24 |
| Rate for Payer: Aetna Commercial |
$540.38
|
| Rate for Payer: BCBS Complete |
$269.72
|
| Rate for Payer: BCBS Trust/PPO |
$863.24
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Meridian Medicaid |
$269.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.82
|
| Rate for Payer: Priority Health Narrow Network |
$614.82
|
| Rate for Payer: Priority Health SBD |
$614.82
|
| Rate for Payer: UMR Bronson Commercial |
$559.82
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$304.16 |
| Max. Negotiated Rate |
$1,903.46 |
| Rate for Payer: Aetna Commercial |
$647.06
|
| Rate for Payer: BCBS Complete |
$319.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,903.46
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Meridian Medicaid |
$319.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$726.65
|
| Rate for Payer: Priority Health Narrow Network |
$726.65
|
| Rate for Payer: Priority Health SBD |
$726.65
|
| Rate for Payer: UMR Bronson Commercial |
$797.64
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$522.06 |
| Max. Negotiated Rate |
$2,785.73 |
| Rate for Payer: Aetna Commercial |
$1,109.32
|
| Rate for Payer: BCBS Complete |
$548.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.73
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Meridian Medicaid |
$548.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,242.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,242.92
|
| Rate for Payer: Priority Health SBD |
$1,242.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,010.62
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$345.27 |
| Max. Negotiated Rate |
$2,576.52 |
| Rate for Payer: Aetna Commercial |
$716.58
|
| Rate for Payer: BCBS Complete |
$362.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,576.52
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Meridian Medicaid |
$362.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$820.11
|
| Rate for Payer: Priority Health Narrow Network |
$820.11
|
| Rate for Payer: Priority Health SBD |
$820.11
|
| Rate for Payer: UMR Bronson Commercial |
$741.98
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$591.31
|
| Rate for Payer: BCBS Complete |
$299.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Meridian Medicaid |
$299.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$677.63
|
| Rate for Payer: Priority Health Narrow Network |
$677.63
|
| Rate for Payer: Priority Health SBD |
$677.63
|
| Rate for Payer: UMR Bronson Commercial |
$626.06
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$455.61 |
| Max. Negotiated Rate |
$2,735.54 |
| Rate for Payer: Aetna Commercial |
$936.47
|
| Rate for Payer: BCBS Complete |
$478.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.54
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Meridian Medicaid |
$478.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,082.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,082.58
|
| Rate for Payer: Priority Health SBD |
$1,082.58
|
| Rate for Payer: UMR Bronson Commercial |
$521.18
|
|
|
PR DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$2,942.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$385.32 |
| Max. Negotiated Rate |
$2,059.40 |
| Rate for Payer: Aetna Commercial |
$740.20
|
| Rate for Payer: BCBS Complete |
$404.59
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Meridian Medicaid |
$404.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,059.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.70
|
| Rate for Payer: Priority Health Narrow Network |
$950.70
|
| Rate for Payer: Priority Health SBD |
$950.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,353.32
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna American Axle |
$536.25
|
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.25
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$577.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health SBD |
$519.75
|
| Rate for Payer: UMR Bronson Commercial |
$363.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.75
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$536.25
|
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.25
|
| 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: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$577.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.75
|
| 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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| 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: Priority Health SBD |
$519.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.04
|
| 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: UMR Bronson Commercial |
$305.25
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.75
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$61.34 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$106.69
|
| Rate for Payer: BCBS Complete |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$242.22
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Meridian Medicaid |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.97
|
| Rate for Payer: Priority Health Narrow Network |
$117.97
|
| Rate for Payer: Priority Health SBD |
$117.97
|
| Rate for Payer: UMR Bronson Commercial |
$165.60
|
|
|
PR DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna Commercial |
$245.41
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.17
|
| Rate for Payer: Priority Health Narrow Network |
$274.17
|
| Rate for Payer: Priority Health SBD |
$274.17
|
| Rate for Payer: UMR Bronson Commercial |
$379.50
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$1,975.31 |
| Rate for Payer: Aetna Commercial |
$150.51
|
| Rate for Payer: BCBS Complete |
$92.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,975.31
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Meridian Medicaid |
$92.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.77
|
| Rate for Payer: Priority Health Narrow Network |
$193.77
|
| Rate for Payer: Priority Health SBD |
$193.77
|
| Rate for Payer: UMR Bronson Commercial |
$166.98
|
|
