|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$1,803.09 |
| Rate for Payer: Aetna Commercial |
$57.79
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.09
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.14
|
| Rate for Payer: Priority Health Narrow Network |
$72.14
|
| Rate for Payer: Priority Health SBD |
$72.14
|
| Rate for Payer: UMR Bronson Commercial |
$101.20
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| 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: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| 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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.50
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| 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: Priority Health SBD |
$296.10
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| 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: UMR Bronson Commercial |
$173.90
|
| Rate for Payer: VA VA |
$558.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: UMR Bronson Commercial |
$206.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
PR DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Aetna Commercial |
$168.37
|
| Rate for Payer: BCBS Complete |
$102.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.50
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Meridian Medicaid |
$102.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.03
|
| Rate for Payer: Priority Health Narrow Network |
$187.03
|
| Rate for Payer: Priority Health SBD |
$187.03
|
| Rate for Payer: UMR Bronson Commercial |
$216.20
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,430.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.59
|
| Rate for Payer: Priority Health Narrow Network |
$66.59
|
| Rate for Payer: Priority Health SBD |
$66.59
|
| Rate for Payer: UMR Bronson Commercial |
$45.54
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$251.78 |
| Rate for Payer: Aetna American Axle |
$64.35
|
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Trust/PPO |
$251.78
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.15
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health SBD |
$62.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Exchange |
$53.37
|
| Rate for Payer: UMR Bronson Commercial |
$36.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna American Axle |
$64.35
|
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.15
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health SBD |
$62.37
|
| Rate for Payer: UMR Bronson Commercial |
$43.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,430.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.59
|
| Rate for Payer: Priority Health Narrow Network |
$66.59
|
| Rate for Payer: Priority Health SBD |
$66.59
|
| Rate for Payer: UMR Bronson Commercial |
$45.54
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$57.48 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.67
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 11721
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Aetna Commercial |
$25.22
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,712.50
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.77
|
| Rate for Payer: Priority Health Narrow Network |
$28.77
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: UMR Bronson Commercial |
$34.96
|
|
|
PR DEBRIDEMENT OPEN WOUND 20 SQ CM/<
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$839.47 |
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS Trust/PPO |
$839.47
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.95
|
| Rate for Payer: Priority Health Narrow Network |
$48.95
|
| Rate for Payer: Priority Health SBD |
$48.95
|
| Rate for Payer: UMR Bronson Commercial |
$54.28
|
|
|
PR DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$514.04 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$514.04
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.51
|
| Rate for Payer: Priority Health Narrow Network |
$34.51
|
| Rate for Payer: Priority Health SBD |
$34.51
|
| Rate for Payer: UMR Bronson Commercial |
$62.56
|
|
|
PR DEBRIDEMENT, SKIN, PARTIAL THICKNESS
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 11040
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: BCBS Complete |
$30.40
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: UMR Bronson Commercial |
$34.96
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$214.50
|
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$306.39
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$283.80
|
| Rate for Payer: Cofinity Commercial |
$231.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$297.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.50
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.50
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$280.50
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$207.90
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$59.27
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$122.10
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.50
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna American Axle |
$214.50
|
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.50
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$231.00
|
| Rate for Payer: Cofinity Commercial |
$283.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.00
|
| Rate for Payer: Healthscope Commercial |
$297.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.50
|
| Rate for Payer: PHP Commercial |
$280.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.00
|
| Rate for Payer: Priority Health SBD |
$207.90
|
| Rate for Payer: UMR Bronson Commercial |
$145.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.50
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna Commercial |
$65.33
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.75
|
| Rate for Payer: Priority Health Narrow Network |
$72.75
|
| Rate for Payer: Priority Health SBD |
$72.75
|
| Rate for Payer: UMR Bronson Commercial |
$151.80
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna American Axle |
$44.85
|
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS Trust/PPO |
$139.75
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health SBD |
$43.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Exchange |
$24.56
|
| Rate for Payer: UMR Bronson Commercial |
$25.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna American Axle |
$44.85
|
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health SBD |
$43.47
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 36593
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$549.96 |
| Rate for Payer: Aetna Commercial |
$41.26
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$549.96
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.67
|
| Rate for Payer: Priority Health Narrow Network |
$52.67
|
| Rate for Payer: Priority Health SBD |
$52.67
|
| Rate for Payer: UMR Bronson Commercial |
$27.14
|
|
|
PR DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI
|
Professional
|
Both
|
$1,798.00
|
|
|
Service Code
|
HCPCS 27027
|
| Min. Negotiated Rate |
$570.41 |
| Max. Negotiated Rate |
$1,369.56 |
| Rate for Payer: Aetna Commercial |
$1,179.09
|
| Rate for Payer: BCBS Complete |
$598.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.34
|
| Rate for Payer: Cash Price |
$1,438.40
|
| Rate for Payer: Cash Price |
$1,438.40
|
| Rate for Payer: Meridian Medicaid |
$598.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,258.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,369.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,369.56
|
| Rate for Payer: Priority Health SBD |
$1,369.56
|
| Rate for Payer: UMR Bronson Commercial |
$827.08
|
|
|
PR DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 27496
|
| Min. Negotiated Rate |
$358.27 |
| Max. Negotiated Rate |
$1,098.34 |
| Rate for Payer: Aetna Commercial |
$728.83
|
| Rate for Payer: BCBS Complete |
$376.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.34
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Meridian Medicaid |
$376.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$358.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$847.68
|
| Rate for Payer: Priority Health Narrow Network |
$847.68
|
| Rate for Payer: Priority Health SBD |
$847.68
|
| Rate for Payer: UMR Bronson Commercial |
$427.34
|
|
|
PR DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 24495
|
| Min. Negotiated Rate |
$501.36 |
| Max. Negotiated Rate |
$1,430.84 |
| Rate for Payer: Aetna Commercial |
$1,009.58
|
| Rate for Payer: BCBS Complete |
$623.76
|
| Rate for Payer: BCBS Trust/PPO |
$501.36
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Meridian Medicaid |
$623.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,430.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,430.84
|
| Rate for Payer: Priority Health SBD |
$1,430.84
|
| Rate for Payer: UMR Bronson Commercial |
$763.14
|
|
|
PR DECOMPRESSION FINGERS&/HAND INJECTION INJURY
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 26035
|
| Min. Negotiated Rate |
$89.15 |
| Max. Negotiated Rate |
$1,500.10 |
| Rate for Payer: Aetna Commercial |
$1,146.22
|
| Rate for Payer: BCBS Complete |
$585.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.15
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Meridian Medicaid |
$585.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,325.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,325.13
|
| Rate for Payer: Priority Health SBD |
$1,325.13
|
| Rate for Payer: UMR Bronson Commercial |
$985.78
|
|
|
PR DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH
|
Professional
|
Both
|
$5,633.00
|
|
|
Service Code
|
HCPCS 61330
|
| Min. Negotiated Rate |
$322.79 |
| Max. Negotiated Rate |
$3,943.10 |
| Rate for Payer: Aetna Commercial |
$2,316.66
|
| Rate for Payer: BCBS Complete |
$1,223.82
|
| Rate for Payer: BCBS Trust/PPO |
$322.79
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Meridian Medicaid |
$1,223.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,165.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,068.94
|
| Rate for Payer: Priority Health Narrow Network |
$3,068.94
|
| Rate for Payer: Priority Health SBD |
$3,068.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,591.18
|
|
|
PR DECOMPRESSION PLANTAR DIGITAL NERVE
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 64726
|
| Min. Negotiated Rate |
$173.17 |
| Max. Negotiated Rate |
$1,254.71 |
| Rate for Payer: Aetna Commercial |
$341.98
|
| Rate for Payer: BCBS Complete |
$181.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.71
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Meridian Medicaid |
$181.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,079.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.37
|
| Rate for Payer: Priority Health Narrow Network |
$456.37
|
| Rate for Payer: Priority Health SBD |
$456.37
|
| Rate for Payer: UMR Bronson Commercial |
$709.32
|
|
