|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
IP
|
$92.57
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$92.57 |
| Rate for Payer: Aetna Commercial |
$83.31
|
| Rate for Payer: ASR ASR |
$89.79
|
| Rate for Payer: BCBS Trust/PPO |
$71.77
|
| Rate for Payer: BCN Commercial |
$71.77
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.06
|
| Rate for Payer: Healthscope Commercial |
$92.57
|
| Rate for Payer: Healthscope Whirlpool |
$89.79
|
| Rate for Payer: Mclaren Commercial |
$83.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.46
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
OP
|
$92.57
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$128.27 |
| Rate for Payer: Aetna Commercial |
$83.31
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$89.79
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$71.77
|
| Rate for Payer: BCN Commercial |
$71.77
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$92.57
|
| Rate for Payer: Healthscope Whirlpool |
$89.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$83.31
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.68
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.27
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.46
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
OP
|
$112.22
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$112.22 |
| Rate for Payer: Aetna Commercial |
$101.00
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$108.85
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$87.00
|
| Rate for Payer: BCN Commercial |
$87.00
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$112.22
|
| Rate for Payer: Healthscope Whirlpool |
$108.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$101.00
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.39
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.12
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$79.68
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.75
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
IP
|
$112.22
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.55 |
| Max. Negotiated Rate |
$112.22 |
| Rate for Payer: Aetna Commercial |
$101.00
|
| Rate for Payer: ASR ASR |
$108.85
|
| Rate for Payer: BCBS Trust/PPO |
$87.00
|
| Rate for Payer: BCN Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.78
|
| Rate for Payer: Healthscope Commercial |
$112.22
|
| Rate for Payer: Healthscope Whirlpool |
$108.85
|
| Rate for Payer: Mclaren Commercial |
$101.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.75
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$1,091.56
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.09 |
| Max. Negotiated Rate |
$1,091.56 |
| Rate for Payer: Aetna Commercial |
$982.40
|
| Rate for Payer: ASR ASR |
$1,058.81
|
| Rate for Payer: BCBS Trust/PPO |
$846.29
|
| Rate for Payer: BCN Commercial |
$846.29
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cofinity Commercial |
$1,026.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.25
|
| Rate for Payer: Healthscope Commercial |
$1,091.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.81
|
| Rate for Payer: Mclaren Commercial |
$982.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$927.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$960.57
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,091.56
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.37 |
| Max. Negotiated Rate |
$1,091.56 |
| Rate for Payer: Aetna Commercial |
$982.40
|
| Rate for Payer: Aetna Medicare |
$558.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: ASR ASR |
$1,058.81
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$846.29
|
| Rate for Payer: BCN Commercial |
$846.29
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cofinity Commercial |
$1,026.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$1,091.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.26
|
| Rate for Payer: Mclaren Commercial |
$982.40
|
| 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 |
$927.83
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$614.09
|
| Rate for Payer: PHP Medicaid |
$305.37
|
| 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 |
$764.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.52
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$323.62
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$960.57
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: VA VA |
$558.26
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,295.00 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$1,665.00
|
| Rate for Payer: ASR ASR |
$1,794.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.30
|
| Rate for Payer: BCN Commercial |
$1,434.30
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,739.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,480.00
|
| Rate for Payer: Healthscope Commercial |
$1,850.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,794.50
|
| Rate for Payer: Mclaren Commercial |
$1,665.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,572.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,628.00
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.09 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$1,665.00
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$1,794.50
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.30
|
| Rate for Payer: BCN Commercial |
$1,434.30
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,739.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,480.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$1,850.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,794.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$1,665.00
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,572.50
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$719.35
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$575.48
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,628.00
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,800.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$3,600.00
|
| Rate for Payer: ASR ASR |
$3,880.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.20
|
| Rate for Payer: BCN Commercial |
$3,101.20
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,760.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,200.00
|
| Rate for Payer: Healthscope Commercial |
$4,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,880.00
|
| Rate for Payer: Mclaren Commercial |
$3,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,520.00
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,381.58 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$3,600.00
|
| Rate for Payer: Aetna Medicare |
$2,525.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: ASR ASR |
$3,880.00
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.20
|
| Rate for Payer: BCN Commercial |
$3,101.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,760.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$4,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,880.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,525.74
|
| Rate for Payer: Mclaren Commercial |
$3,600.00
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$2,778.31
|
| Rate for Payer: PHP Medicaid |
$1,381.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,640.00
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,840.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,520.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$499.09
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.36 |
| Max. Negotiated Rate |
$499.09 |
| Rate for Payer: Aetna Commercial |
$449.18
|
| Rate for Payer: ASR ASR |
$484.12
|
| Rate for Payer: BCBS Trust/PPO |
$386.94
|
| Rate for Payer: BCN Commercial |
$386.94
|
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Cofinity Commercial |
$469.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.27
|
| Rate for Payer: Healthscope Commercial |
$499.09
|
| Rate for Payer: Healthscope Whirlpool |
$484.12
|
| Rate for Payer: Mclaren Commercial |
$449.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.20
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$499.09
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.64 |
| Max. Negotiated Rate |
$499.09 |
| Rate for Payer: Aetna Commercial |
$449.18
|
| Rate for Payer: ASR ASR |
$484.12
|
| Rate for Payer: BCBS Complete |
$199.64
|
| Rate for Payer: BCBS Trust/PPO |
$386.94
|
| Rate for Payer: BCN Commercial |
$386.94
|
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Cofinity Commercial |
$469.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.27
|
| Rate for Payer: Healthscope Commercial |
$499.09
|
| Rate for Payer: Healthscope Whirlpool |
$484.12
|
| Rate for Payer: Mclaren Commercial |
$449.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.17
|
| Rate for Payer: Priority Health Narrow Network |
$354.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.20
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$632.43
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$632.43 |
| Rate for Payer: Aetna Commercial |
$569.19
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$613.46
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$490.32
|
| Rate for Payer: BCN Commercial |
$490.32
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$505.94
|
| Rate for Payer: Cash Price |
$505.94
|
| Rate for Payer: Cofinity Commercial |
$594.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$632.43
|
| Rate for Payer: Healthscope Whirlpool |
$613.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$569.19
|
| 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 |
$537.57
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| 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 |
$442.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.52
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$323.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.54
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$632.43
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.70 |
| Max. Negotiated Rate |
$632.43 |
| Rate for Payer: Aetna Commercial |
$569.19
|
| Rate for Payer: ASR ASR |
$613.46
|
| Rate for Payer: BCBS Trust/PPO |
$490.32
|
| Rate for Payer: BCN Commercial |
$490.32
|
| Rate for Payer: Cash Price |
$505.94
|
| Rate for Payer: Cofinity Commercial |
$594.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.94
|
| Rate for Payer: Healthscope Commercial |
$632.43
|
| Rate for Payer: Healthscope Whirlpool |
$613.46
|
| Rate for Payer: Mclaren Commercial |
$569.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.54
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$36.82
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$36.82 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: ASR ASR |
$35.72
|
| Rate for Payer: BCBS Trust/PPO |
$28.55
|
| Rate for Payer: BCN Commercial |
$28.55
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$34.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Healthscope Commercial |
$36.82
|
| Rate for Payer: Healthscope Whirlpool |
$35.72
|
| Rate for Payer: Mclaren Commercial |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.40
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$36.82
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$68.76 |
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: ASR ASR |
$35.72
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS Trust/PPO |
$28.55
|
| Rate for Payer: BCN Commercial |
$28.55
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$34.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Healthscope Commercial |
$36.82
|
| Rate for Payer: Healthscope Whirlpool |
$35.72
|
| Rate for Payer: Mclaren Commercial |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.76
|
| Rate for Payer: Priority Health Narrow Network |
$55.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.40
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$473.69
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.66 |
| Max. Negotiated Rate |
$473.69 |
| Rate for Payer: Aetna Commercial |
$426.32
|
| Rate for Payer: Aetna Medicare |
$301.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: ASR ASR |
$459.48
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$367.25
|
| Rate for Payer: BCN Commercial |
$367.25
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cofinity Commercial |
$445.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$473.69
|
| Rate for Payer: Healthscope Whirlpool |
$459.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$301.03
|
| Rate for Payer: Mclaren Commercial |
$426.32
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.64
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$331.13
|
| Rate for Payer: PHP Medicaid |
$164.66
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$431.06
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$336.32
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.85
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: VA VA |
$301.03
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$473.69
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.58 |
| Max. Negotiated Rate |
$473.69 |
| Rate for Payer: Aetna Commercial |
$426.32
|
| Rate for Payer: ASR ASR |
$459.48
|
| Rate for Payer: BCBS Trust/PPO |
$367.25
|
| Rate for Payer: BCN Commercial |
$367.25
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cofinity Commercial |
$445.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.95
|
| Rate for Payer: Healthscope Commercial |
$473.69
|
| Rate for Payer: Healthscope Whirlpool |
$459.48
|
| Rate for Payer: Mclaren Commercial |
$426.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.85
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$140.57
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$140.57 |
| Rate for Payer: Aetna Commercial |
$126.51
|
| Rate for Payer: ASR ASR |
$136.35
|
| Rate for Payer: BCBS Complete |
$56.23
|
| Rate for Payer: BCBS Trust/PPO |
$108.98
|
| Rate for Payer: BCN Commercial |
$108.98
|
| Rate for Payer: Cash Price |
$112.46
|
| Rate for Payer: Cofinity Commercial |
$132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.46
|
| Rate for Payer: Healthscope Commercial |
$140.57
|
| Rate for Payer: Healthscope Whirlpool |
$136.35
|
| Rate for Payer: Mclaren Commercial |
$126.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.92
|
| Rate for Payer: Priority Health Narrow Network |
$99.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.70
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$140.57
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$140.57 |
| Rate for Payer: Aetna Commercial |
$126.51
|
| Rate for Payer: ASR ASR |
$136.35
|
| Rate for Payer: BCBS Trust/PPO |
$108.98
|
| Rate for Payer: BCN Commercial |
$108.98
|
| Rate for Payer: Cash Price |
$112.46
|
| Rate for Payer: Cofinity Commercial |
$132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.46
|
| Rate for Payer: Healthscope Commercial |
$140.57
|
| Rate for Payer: Healthscope Whirlpool |
$136.35
|
| Rate for Payer: Mclaren Commercial |
$126.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.70
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$807.11
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$564.98 |
| Max. Negotiated Rate |
$807.11 |
| Rate for Payer: Aetna Commercial |
$726.40
|
| Rate for Payer: ASR ASR |
$782.90
|
| Rate for Payer: BCBS Trust/PPO |
$625.75
|
| Rate for Payer: BCN Commercial |
$625.75
|
| Rate for Payer: Cash Price |
$645.69
|
| Rate for Payer: Cofinity Commercial |
$758.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.69
|
| Rate for Payer: Healthscope Commercial |
$807.11
|
| Rate for Payer: Healthscope Whirlpool |
$782.90
|
| Rate for Payer: Mclaren Commercial |
$726.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$686.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$710.26
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$807.11
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$322.84 |
| Max. Negotiated Rate |
$807.11 |
| Rate for Payer: Aetna Commercial |
$726.40
|
| Rate for Payer: ASR ASR |
$782.90
|
| Rate for Payer: BCBS Complete |
$322.84
|
| Rate for Payer: BCBS Trust/PPO |
$625.75
|
| Rate for Payer: BCN Commercial |
$625.75
|
| Rate for Payer: Cash Price |
$645.69
|
| Rate for Payer: Cofinity Commercial |
$758.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.69
|
| Rate for Payer: Healthscope Commercial |
$807.11
|
| Rate for Payer: Healthscope Whirlpool |
$782.90
|
| Rate for Payer: Mclaren Commercial |
$726.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$686.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$734.47
|
| Rate for Payer: Priority Health Narrow Network |
$573.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$710.26
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,614.20
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,129.94 |
| Max. Negotiated Rate |
$1,614.20 |
| Rate for Payer: Aetna Commercial |
$1,452.78
|
| Rate for Payer: ASR ASR |
$1,565.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,251.49
|
| Rate for Payer: BCN Commercial |
$1,251.49
|
| Rate for Payer: Cash Price |
$1,291.36
|
| Rate for Payer: Cofinity Commercial |
$1,517.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,291.36
|
| Rate for Payer: Healthscope Commercial |
$1,614.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,565.77
|
| Rate for Payer: Mclaren Commercial |
$1,452.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,372.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,420.50
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,614.20
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$645.68 |
| Max. Negotiated Rate |
$1,614.20 |
| Rate for Payer: Aetna Commercial |
$1,452.78
|
| Rate for Payer: ASR ASR |
$1,565.77
|
| Rate for Payer: BCBS Complete |
$645.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,251.49
|
| Rate for Payer: BCN Commercial |
$1,251.49
|
| Rate for Payer: Cash Price |
$1,291.36
|
| Rate for Payer: Cofinity Commercial |
$1,517.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,291.36
|
| Rate for Payer: Healthscope Commercial |
$1,614.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,565.77
|
| Rate for Payer: Mclaren Commercial |
$1,452.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,372.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,468.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,146.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,420.50
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$290.29
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.12 |
| Max. Negotiated Rate |
$290.29 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| Rate for Payer: ASR ASR |
$281.58
|
| Rate for Payer: BCBS Complete |
$116.12
|
| Rate for Payer: BCBS Trust/PPO |
$225.06
|
| Rate for Payer: BCN Commercial |
$225.06
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cofinity Commercial |
$272.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Healthscope Commercial |
$290.29
|
| Rate for Payer: Healthscope Whirlpool |
$281.58
|
| Rate for Payer: Mclaren Commercial |
$261.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.16
|
| Rate for Payer: Priority Health Narrow Network |
$206.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.46
|
|
