|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$547.30 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$757.80
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$816.74
|
| Rate for Payer: ASR Commercial |
$816.74
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$689.51
|
| Rate for Payer: BCN Commercial |
$652.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$791.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$842.00
|
| Rate for Payer: Healthscope Whirlpool |
$816.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$757.80
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: Nomi Health Commercial |
$690.44
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.76
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$590.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$242.22 |
| Rate for Payer: Aetna Commercial |
$106.69
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: BCBS Complete |
$64.64
|
| Rate for Payer: BCBS Trust/PPO |
$242.22
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Meridian Medicaid |
$64.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.04
|
| Rate for Payer: Priority Health Narrow Network |
$130.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.01
|
| Rate for Payer: UHC Exchange |
$79.01
|
| Rate for Payer: UHCCP Medicaid |
$61.56
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$1,975.31 |
| Rate for Payer: Aetna Commercial |
$150.51
|
| Rate for Payer: Aetna Medicare |
$185.00
|
| Rate for Payer: BCBS Complete |
$92.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,975.31
|
| Rate for Payer: BCN Commercial |
$319.60
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Meridian Medicaid |
$92.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.36
|
| Rate for Payer: Priority Health Narrow Network |
$201.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.86
|
| Rate for Payer: UHC Exchange |
$149.86
|
| Rate for Payer: UHCCP Medicaid |
$87.97
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$1,803.09 |
| Rate for Payer: Aetna Commercial |
$57.79
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.09
|
| Rate for Payer: BCN Commercial |
$114.84
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.90
|
| Rate for Payer: Priority Health Narrow Network |
$74.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.60
|
| Rate for Payer: UHC Exchange |
$68.60
|
| Rate for Payer: UHCCP Medicaid |
$33.23
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$311.35 |
| Max. Negotiated Rate |
$479.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: ASR ASR |
$464.63
|
| Rate for Payer: ASR Commercial |
$464.63
|
| Rate for Payer: BCBS Trust/PPO |
$390.34
|
| Rate for Payer: BCN Commercial |
$371.37
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$450.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Healthscope Commercial |
$479.00
|
| Rate for Payer: Healthscope Whirlpool |
$464.63
|
| Rate for Payer: Mclaren Commercial |
$431.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.52
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Aetna Commercial |
$168.37
|
| Rate for Payer: Aetna Medicare |
$239.50
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.50
|
| Rate for Payer: BCN Commercial |
$338.65
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.80
|
| Rate for Payer: Priority Health Narrow Network |
$206.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.91
|
| Rate for Payer: UHC Exchange |
$250.91
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
11043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$311.35 |
| Max. Negotiated Rate |
$929.61 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Medicare |
$599.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: ASR ASR |
$464.63
|
| Rate for Payer: ASR Commercial |
$464.63
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$392.25
|
| Rate for Payer: BCN Commercial |
$371.37
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$450.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$479.00
|
| Rate for Payer: Healthscope Whirlpool |
$464.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$599.75
|
| Rate for Payer: Mclaren Commercial |
$431.10
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$659.72
|
| Rate for Payer: PHP Medicaid |
$321.47
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.84
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$346.27
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$929.61
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP DNSP |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: VA VA |
$599.75
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
11043
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Aetna Commercial |
$168.37
|
| Rate for Payer: Aetna Medicare |
$239.50
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,522.50
|
| Rate for Payer: BCN Commercial |
$338.65
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.80
|
| Rate for Payer: Priority Health Narrow Network |
$206.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.91
|
| Rate for Payer: UHC Exchange |
$250.91
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: Aetna Medicare |
$50.50
|
| Rate for Payer: BCBS Complete |
$36.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,430.00
|
| Rate for Payer: BCN Commercial |
$106.04
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.60
|
| Rate for Payer: Priority Health Narrow Network |
$73.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.36
|
| Rate for Payer: UHC Exchange |
$45.36
|
| Rate for Payer: UHCCP Medicaid |
$34.51
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: Aetna Medicare |
$50.50
|
| Rate for Payer: BCBS Complete |
$36.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,430.00
|
| Rate for Payer: BCN Commercial |
$106.04
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.60
|
| Rate for Payer: Priority Health Narrow Network |
$73.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.36
|
| Rate for Payer: UHC Exchange |
$45.36
|
| Rate for Payer: UHCCP Medicaid |
$34.51
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Medicare |
$50.50
|
| Rate for Payer: ASR ASR |
$97.97
|
| Rate for Payer: ASR Commercial |
$97.97
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS Trust/PPO |
$82.71
|
| Rate for Payer: BCN Commercial |
$78.31
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.97
|
| Rate for Payer: Mclaren Commercial |
$90.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: Nomi Health Commercial |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.50
|
| Rate for Payer: Priority Health Narrow Network |
$70.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.88
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: ASR ASR |
$97.97
|
| Rate for Payer: ASR Commercial |
$97.97
|
| Rate for Payer: BCBS Trust/PPO |
$82.30
|
| Rate for Payer: BCN Commercial |
$78.31
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.97
|
| Rate for Payer: Mclaren Commercial |
$90.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: Nomi Health Commercial |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.88
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$57.48 |
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$38.48
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.96
|
| Rate for Payer: Priority Health Narrow Network |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.37
|
| Rate for Payer: UHC Exchange |
$17.37
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 11721
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Aetna Commercial |
$25.22
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,712.50
|
| Rate for Payer: BCN Commercial |
$51.83
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.60
|
| Rate for Payer: Priority Health Narrow Network |
$31.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.46
|
| Rate for Payer: UHC Exchange |
$29.46
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
|
PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$839.47 |
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: Aetna Medicare |
$60.00
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS Trust/PPO |
$839.47
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.95
|
| Rate for Payer: Priority Health Narrow Network |
$48.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.14
|
| Rate for Payer: UHC Exchange |
$31.14
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
|
|
PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$514.04 |
| Rate for Payer: Aetna Commercial |
$27.86
|
| Rate for Payer: Aetna Medicare |
$69.50
|
| Rate for Payer: BCBS Complete |
$16.11
|
| Rate for Payer: BCBS Trust/PPO |
$514.04
|
| Rate for Payer: BCN Commercial |
$65.48
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Meridian Medicaid |
$16.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.51
|
| Rate for Payer: Priority Health Narrow Network |
$34.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.14
|
| Rate for Payer: UHC Exchange |
$42.14
|
| Rate for Payer: UHCCP Medicaid |
$15.34
|
|
|
PR DEBRIDEMENT, SKIN, PARTIAL THICKNESS
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 11040
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$219.05 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: ASR ASR |
$326.89
|
| Rate for Payer: ASR Commercial |
$326.89
|
| Rate for Payer: BCBS Trust/PPO |
$274.62
|
| Rate for Payer: BCN Commercial |
$261.28
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$316.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Healthscope Commercial |
$337.00
|
| Rate for Payer: Healthscope Whirlpool |
$326.89
|
| Rate for Payer: Mclaren Commercial |
$303.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: Nomi Health Commercial |
$276.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.56
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
11042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$65.33
|
| Rate for Payer: Aetna Medicare |
$168.50
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.72
|
| Rate for Payer: Priority Health Narrow Network |
$81.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.23
|
| Rate for Payer: UHC Exchange |
$47.23
|
| Rate for Payer: UHCCP Medicaid |
$38.77
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
11042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$326.89
|
| Rate for Payer: ASR Commercial |
$326.89
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$275.97
|
| Rate for Payer: BCN Commercial |
$261.28
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$316.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$337.00
|
| Rate for Payer: Healthscope Whirlpool |
$326.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$303.30
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.45
|
| Rate for Payer: Nomi Health Commercial |
$276.34
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.84
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$346.27
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$65.33
|
| Rate for Payer: Aetna Medicare |
$168.50
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.72
|
| Rate for Payer: Priority Health Narrow Network |
$81.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.23
|
| Rate for Payer: UHC Exchange |
$47.23
|
| Rate for Payer: UHCCP Medicaid |
$38.77
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: ASR Commercial |
$67.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.04
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: ASR ASR |
$67.90
|
| Rate for Payer: ASR Commercial |
$67.90
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.32
|
| Rate for Payer: BCN Commercial |
$54.27
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$65.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$70.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.90
|
| Rate for Payer: Mclaren Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Nomi Health Commercial |
$57.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.33
|
| Rate for Payer: Priority Health Narrow Network |
$49.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.60
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$111.72 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$111.72
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Narrow Network |
$33.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.53
|
| Rate for Payer: UHC Exchange |
$21.53
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$111.72 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$111.72
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Narrow Network |
$33.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.53
|
| Rate for Payer: UHC Exchange |
$21.53
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
