|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,657.20
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$662.88 |
| Max. Negotiated Rate |
$1,657.20 |
| Rate for Payer: Aetna Commercial |
$1,491.48
|
| Rate for Payer: Aetna Medicare |
$828.60
|
| Rate for Payer: ASR ASR |
$1,607.48
|
| Rate for Payer: ASR Commercial |
$1,607.48
|
| Rate for Payer: BCBS Complete |
$662.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.08
|
| Rate for Payer: BCN Commercial |
$1,284.83
|
| Rate for Payer: Cash Price |
$1,325.76
|
| Rate for Payer: Cofinity Commercial |
$1,557.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.76
|
| Rate for Payer: Healthscope Commercial |
$1,657.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,607.48
|
| Rate for Payer: Mclaren Commercial |
$1,491.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.62
|
| Rate for Payer: Nomi Health Commercial |
$1,358.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,452.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,161.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,458.34
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.98 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: ASR ASR |
$364.10
|
| Rate for Payer: ASR Commercial |
$364.10
|
| Rate for Payer: BCBS Trust/PPO |
$305.88
|
| Rate for Payer: BCN Commercial |
$291.02
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$352.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$375.36
|
| Rate for Payer: Healthscope Whirlpool |
$364.10
|
| Rate for Payer: Mclaren Commercial |
$337.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.32
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
OP
|
$375.36
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.14 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare |
$187.68
|
| Rate for Payer: ASR ASR |
$364.10
|
| Rate for Payer: ASR Commercial |
$364.10
|
| Rate for Payer: BCBS Complete |
$150.14
|
| Rate for Payer: BCBS Trust/PPO |
$307.38
|
| Rate for Payer: BCN Commercial |
$291.02
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$352.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$375.36
|
| Rate for Payer: Healthscope Whirlpool |
$364.10
|
| Rate for Payer: Mclaren Commercial |
$337.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.89
|
| Rate for Payer: Priority Health Narrow Network |
$263.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.32
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
OP
|
$382.87
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$382.87 |
| Rate for Payer: Aetna Commercial |
$344.58
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$371.38
|
| Rate for Payer: ASR Commercial |
$371.38
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$313.53
|
| Rate for Payer: BCN Commercial |
$296.84
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Commercial |
$359.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$382.87
|
| Rate for Payer: Healthscope Whirlpool |
$371.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$344.58
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Nomi Health Commercial |
$313.95
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.47
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$268.39
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
IP
|
$382.87
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.87 |
| Max. Negotiated Rate |
$382.87 |
| Rate for Payer: Aetna Commercial |
$344.58
|
| Rate for Payer: ASR ASR |
$371.38
|
| Rate for Payer: ASR Commercial |
$371.38
|
| Rate for Payer: BCBS Trust/PPO |
$312.00
|
| Rate for Payer: BCN Commercial |
$296.84
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Commercial |
$359.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$382.87
|
| Rate for Payer: Healthscope Whirlpool |
$371.38
|
| Rate for Payer: Mclaren Commercial |
$344.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Nomi Health Commercial |
$313.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.93
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$504.59
|
| Rate for Payer: ASR Commercial |
$504.59
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$425.99
|
| Rate for Payer: BCN Commercial |
$403.31
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$520.20
|
| Rate for Payer: Healthscope Whirlpool |
$504.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.80
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$364.66
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna Commercial |
$468.18
|
| Rate for Payer: ASR ASR |
$504.59
|
| Rate for Payer: ASR Commercial |
$504.59
|
| Rate for Payer: BCBS Trust/PPO |
$423.91
|
| Rate for Payer: BCN Commercial |
$403.31
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$488.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$520.20
|
| Rate for Payer: Healthscope Whirlpool |
$504.59
|
| Rate for Payer: Mclaren Commercial |
$468.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.78
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$851.15
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.46 |
| Max. Negotiated Rate |
$851.15 |
| Rate for Payer: Aetna Commercial |
$766.03
|
| Rate for Payer: Aetna Medicare |
$425.57
|
| Rate for Payer: ASR ASR |
$825.62
|
| Rate for Payer: ASR Commercial |
$825.62
|
| Rate for Payer: BCBS Complete |
$340.46
|
| Rate for Payer: BCBS Trust/PPO |
$697.01
|
| Rate for Payer: BCN Commercial |
$659.90
|
| Rate for Payer: Cash Price |
$680.92
|
| Rate for Payer: Cofinity Commercial |
$800.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.92
|
| Rate for Payer: Healthscope Commercial |
$851.15
|
| Rate for Payer: Healthscope Whirlpool |
$825.62
|
| Rate for Payer: Mclaren Commercial |
$766.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.48
|
| Rate for Payer: Nomi Health Commercial |
$697.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.78
|
| Rate for Payer: Priority Health Narrow Network |
$596.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.01
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$851.15
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.25 |
| Max. Negotiated Rate |
$851.15 |
| Rate for Payer: Aetna Commercial |
$766.03
|
| Rate for Payer: ASR ASR |
$825.62
|
| Rate for Payer: ASR Commercial |
$825.62
|
| Rate for Payer: BCBS Trust/PPO |
$693.60
|
| Rate for Payer: BCN Commercial |
$659.90
|
| Rate for Payer: Cash Price |
$680.92
|
| Rate for Payer: Cofinity Commercial |
$800.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.92
|
| Rate for Payer: Healthscope Commercial |
$851.15
|
| Rate for Payer: Healthscope Whirlpool |
$825.62
|
| Rate for Payer: Mclaren Commercial |
$766.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.48
|
| Rate for Payer: Nomi Health Commercial |
$697.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.01
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
IP
|
$94.42
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.37 |
| Max. Negotiated Rate |
$94.42 |
| Rate for Payer: Aetna Commercial |
$84.98
|
| Rate for Payer: ASR ASR |
$91.59
|
| Rate for Payer: ASR Commercial |
$91.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.94
|
| Rate for Payer: BCN Commercial |
$73.20
|
| Rate for Payer: Cash Price |
$75.54
|
| Rate for Payer: Cofinity Commercial |
$88.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.54
|
| Rate for Payer: Healthscope Commercial |
$94.42
|
| Rate for Payer: Healthscope Whirlpool |
$91.59
|
| Rate for Payer: Mclaren Commercial |
$84.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.26
|
| Rate for Payer: Nomi Health Commercial |
$77.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.09
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
OP
|
$94.42
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$94.42 |
| Rate for Payer: Aetna Commercial |
$84.98
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$91.59
|
| Rate for Payer: ASR Commercial |
$91.59
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$77.32
|
| Rate for Payer: BCN Commercial |
$73.20
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$75.54
|
| Rate for Payer: Cash Price |
$75.54
|
| Rate for Payer: Cofinity Commercial |
$88.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$94.42
|
| Rate for Payer: Healthscope Whirlpool |
$91.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$84.98
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.26
|
| Rate for Payer: Nomi Health Commercial |
$77.42
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.73
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$66.19
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
OP
|
$114.46
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Aetna Commercial |
$103.01
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$111.03
|
| Rate for Payer: ASR Commercial |
$111.03
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$93.73
|
| Rate for Payer: BCN Commercial |
$88.74
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cofinity Commercial |
$107.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$114.46
|
| Rate for Payer: Healthscope Whirlpool |
$111.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$103.01
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.29
|
| Rate for Payer: Nomi Health Commercial |
$93.86
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.29
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$80.24
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
IP
|
$114.46
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Aetna Commercial |
$103.01
|
| Rate for Payer: ASR ASR |
$111.03
|
| Rate for Payer: ASR Commercial |
$111.03
|
| Rate for Payer: BCBS Trust/PPO |
$93.27
|
| Rate for Payer: BCN Commercial |
$88.74
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cofinity Commercial |
$107.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.57
|
| Rate for Payer: Healthscope Commercial |
$114.46
|
| Rate for Payer: Healthscope Whirlpool |
$111.03
|
| Rate for Payer: Mclaren Commercial |
$103.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.29
|
| Rate for Payer: Nomi Health Commercial |
$93.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.72
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$1,113.39
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.70 |
| Max. Negotiated Rate |
$1,113.39 |
| Rate for Payer: Aetna Commercial |
$1,002.05
|
| Rate for Payer: ASR ASR |
$1,079.99
|
| Rate for Payer: ASR Commercial |
$1,079.99
|
| Rate for Payer: BCBS Trust/PPO |
$907.30
|
| Rate for Payer: BCN Commercial |
$863.21
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cofinity Commercial |
$1,046.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$890.71
|
| Rate for Payer: Healthscope Commercial |
$1,113.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,079.99
|
| Rate for Payer: Mclaren Commercial |
$1,002.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.38
|
| Rate for Payer: Nomi Health Commercial |
$912.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$979.78
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,113.39
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,113.39 |
| Rate for Payer: Aetna Commercial |
$1,002.05
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$1,079.99
|
| Rate for Payer: ASR Commercial |
$1,079.99
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$911.76
|
| Rate for Payer: BCN Commercial |
$863.21
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cofinity Commercial |
$1,046.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$890.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$1,113.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,079.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$1,002.05
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.38
|
| Rate for Payer: Nomi Health Commercial |
$912.98
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$975.55
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$780.49
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$979.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,887.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,887.00 |
| Rate for Payer: Aetna Commercial |
$1,698.30
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$1,830.39
|
| Rate for Payer: ASR Commercial |
$1,830.39
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.26
|
| Rate for Payer: BCN Commercial |
$1,462.99
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,773.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,887.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,830.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$1,698.30
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.95
|
| Rate for Payer: Nomi Health Commercial |
$1,547.34
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,653.39
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,322.79
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,660.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,887.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,226.55 |
| Max. Negotiated Rate |
$1,887.00 |
| Rate for Payer: Aetna Commercial |
$1,698.30
|
| Rate for Payer: ASR ASR |
$1,830.39
|
| Rate for Payer: ASR Commercial |
$1,830.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,537.72
|
| Rate for Payer: BCN Commercial |
$1,462.99
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,773.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.60
|
| Rate for Payer: Healthscope Commercial |
$1,887.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,830.39
|
| Rate for Payer: Mclaren Commercial |
$1,698.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.95
|
| Rate for Payer: Nomi Health Commercial |
$1,547.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,660.56
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,672.00
|
| Rate for Payer: ASR ASR |
$3,957.60
|
| Rate for Payer: ASR Commercial |
$3,957.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,324.79
|
| Rate for Payer: BCN Commercial |
$3,163.22
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$3,835.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Healthscope Commercial |
$4,080.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,957.60
|
| Rate for Payer: Mclaren Commercial |
$3,672.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: Nomi Health Commercial |
$3,345.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,590.40
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$3,672.00
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$3,957.60
|
| Rate for Payer: ASR Commercial |
$3,957.60
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,341.11
|
| Rate for Payer: BCN Commercial |
$3,163.22
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$3,835.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$4,080.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,957.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$3,672.00
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: Nomi Health Commercial |
$3,345.60
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,574.90
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,860.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,590.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$509.07
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.63 |
| Max. Negotiated Rate |
$509.07 |
| Rate for Payer: Aetna Commercial |
$458.16
|
| Rate for Payer: Aetna Medicare |
$254.53
|
| Rate for Payer: ASR ASR |
$493.80
|
| Rate for Payer: ASR Commercial |
$493.80
|
| Rate for Payer: BCBS Complete |
$203.63
|
| Rate for Payer: BCBS Trust/PPO |
$416.88
|
| Rate for Payer: BCN Commercial |
$394.68
|
| Rate for Payer: Cash Price |
$407.26
|
| Rate for Payer: Cofinity Commercial |
$478.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.26
|
| Rate for Payer: Healthscope Commercial |
$509.07
|
| Rate for Payer: Healthscope Whirlpool |
$493.80
|
| Rate for Payer: Mclaren Commercial |
$458.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.71
|
| Rate for Payer: Nomi Health Commercial |
$417.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.05
|
| Rate for Payer: Priority Health Narrow Network |
$356.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.98
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$509.07
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.90 |
| Max. Negotiated Rate |
$509.07 |
| Rate for Payer: Aetna Commercial |
$458.16
|
| Rate for Payer: ASR ASR |
$493.80
|
| Rate for Payer: ASR Commercial |
$493.80
|
| Rate for Payer: BCBS Trust/PPO |
$414.84
|
| Rate for Payer: BCN Commercial |
$394.68
|
| Rate for Payer: Cash Price |
$407.26
|
| Rate for Payer: Cofinity Commercial |
$478.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.26
|
| Rate for Payer: Healthscope Commercial |
$509.07
|
| Rate for Payer: Healthscope Whirlpool |
$493.80
|
| Rate for Payer: Mclaren Commercial |
$458.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.71
|
| Rate for Payer: Nomi Health Commercial |
$417.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.98
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$645.08
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$645.08 |
| Rate for Payer: Aetna Commercial |
$580.57
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$625.73
|
| Rate for Payer: ASR Commercial |
$625.73
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$528.26
|
| Rate for Payer: BCN Commercial |
$500.13
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cofinity Commercial |
$606.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$645.08
|
| Rate for Payer: Healthscope Whirlpool |
$625.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$580.57
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.32
|
| Rate for Payer: Nomi Health Commercial |
$528.97
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.22
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$452.20
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$567.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$645.08
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.30 |
| Max. Negotiated Rate |
$645.08 |
| Rate for Payer: Aetna Commercial |
$580.57
|
| Rate for Payer: ASR ASR |
$625.73
|
| Rate for Payer: ASR Commercial |
$625.73
|
| Rate for Payer: BCBS Trust/PPO |
$525.68
|
| Rate for Payer: BCN Commercial |
$500.13
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cofinity Commercial |
$606.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.06
|
| Rate for Payer: Healthscope Commercial |
$645.08
|
| Rate for Payer: Healthscope Whirlpool |
$625.73
|
| Rate for Payer: Mclaren Commercial |
$580.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.32
|
| Rate for Payer: Nomi Health Commercial |
$528.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$567.67
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: ASR ASR |
$36.43
|
| Rate for Payer: ASR Commercial |
$36.43
|
| Rate for Payer: BCBS Trust/PPO |
$30.61
|
| Rate for Payer: BCN Commercial |
$29.12
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$37.56
|
| Rate for Payer: Healthscope Whirlpool |
$36.43
|
| Rate for Payer: Mclaren Commercial |
$33.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.05
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: ASR ASR |
$36.43
|
| Rate for Payer: ASR Commercial |
$36.43
|
| Rate for Payer: BCBS Complete |
$15.02
|
| Rate for Payer: BCBS Trust/PPO |
$30.76
|
| Rate for Payer: BCN Commercial |
$29.12
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$37.56
|
| Rate for Payer: Healthscope Whirlpool |
$36.43
|
| Rate for Payer: Mclaren Commercial |
$33.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.91
|
| Rate for Payer: Priority Health Narrow Network |
$26.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.05
|
|
