|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$343.50 |
| Rate for Payer: Aetna Commercial |
$194.30
|
| Rate for Payer: Aetna Medicare |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.80
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$145.00
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$145.00
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$194.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.00
|
| Rate for Payer: Healthscope Commercial |
$268.25
|
| Rate for Payer: Healthscope Commercial |
$232.00
|
| Rate for Payer: Mclaren Medicaid |
$95.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.25
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.74
|
| Rate for Payer: Nomi Health Commercial |
$174.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE SWMI |
$145.00
|
| Rate for Payer: PHP Medicare Advantage |
$145.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.45
|
| Rate for Payer: Priority Health Medicare |
$145.00
|
| Rate for Payer: Priority Health SBD |
$232.45
|
| Rate for Payer: Priority Health Tiered Network |
$232.45
|
| Rate for Payer: Railroad Medicare Medicare |
$145.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.58
|
| Rate for Payer: UHC Core |
$292.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.00
|
| Rate for Payer: UHC Exchange |
$292.58
|
| Rate for Payer: UHC Medicaid |
$95.21
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$288.54 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Aetna Commercial |
$389.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.70
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Advantage |
$320.60
|
| Rate for Payer: Cofinity Commercial |
$393.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.40
|
| Rate for Payer: Healthscope Commercial |
$412.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PHP Commercial |
$389.30
|
| Rate for Payer: Priority Health SBD |
$288.54
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$343.50 |
| Rate for Payer: Healthscope Commercial |
$268.25
|
| Rate for Payer: Aetna Commercial |
$194.30
|
| Rate for Payer: Aetna Medicare |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.80
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$145.00
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$145.00
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$194.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.00
|
| Rate for Payer: Healthscope Commercial |
$232.00
|
| Rate for Payer: Mclaren Medicaid |
$95.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.25
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.74
|
| Rate for Payer: Nomi Health Commercial |
$174.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE SWMI |
$145.00
|
| Rate for Payer: PHP Medicare Advantage |
$145.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.45
|
| Rate for Payer: Priority Health Medicare |
$145.00
|
| Rate for Payer: Priority Health SBD |
$232.45
|
| Rate for Payer: Priority Health Tiered Network |
$232.45
|
| Rate for Payer: Railroad Medicare Medicare |
$145.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.58
|
| Rate for Payer: UHC Core |
$292.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.00
|
| Rate for Payer: UHC Exchange |
$292.58
|
| Rate for Payer: UHC Medicaid |
$95.21
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$363.51 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Advantage |
$403.90
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: Priority Health SBD |
$363.51
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Aetna Commercial |
$225.46
|
| Rate for Payer: Aetna Medicare |
$174.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$168.25
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: BCN Medicare Advantage |
$168.25
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$242.28
|
| Rate for Payer: Cofinity Commercial |
$225.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.25
|
| Rate for Payer: Healthscope Commercial |
$311.26
|
| Rate for Payer: Healthscope Commercial |
$269.20
|
| Rate for Payer: Mclaren Medicaid |
$110.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.66
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.62
|
| Rate for Payer: Nomi Health Commercial |
$201.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PACE SWMI |
$168.25
|
| Rate for Payer: PHP Medicare Advantage |
$168.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$274.39
|
| Rate for Payer: Priority Health Medicare |
$168.25
|
| Rate for Payer: Priority Health SBD |
$274.39
|
| Rate for Payer: Priority Health Tiered Network |
$274.39
|
| Rate for Payer: Railroad Medicare Medicare |
$168.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.82
|
| Rate for Payer: UHC Core |
$346.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.25
|
| Rate for Payer: UHC Exchange |
$346.82
|
| Rate for Payer: UHC Medicaid |
$110.12
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Aetna Commercial |
$225.46
|
| Rate for Payer: Aetna Medicare |
$174.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$168.25
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: BCN Medicare Advantage |
$168.25
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$242.28
|
| Rate for Payer: Cofinity Commercial |
$225.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.25
|
| Rate for Payer: Healthscope Commercial |
$311.26
|
| Rate for Payer: Healthscope Commercial |
$269.20
|
| Rate for Payer: Mclaren Medicaid |
$110.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.66
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.62
|
| Rate for Payer: Nomi Health Commercial |
$201.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PACE SWMI |
$168.25
|
| Rate for Payer: PHP Medicare Advantage |
$168.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$274.39
|
| Rate for Payer: Priority Health Medicare |
$168.25
|
| Rate for Payer: Priority Health SBD |
$274.39
|
| Rate for Payer: Priority Health Tiered Network |
$274.39
|
| Rate for Payer: Railroad Medicare Medicare |
$168.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.82
|
| Rate for Payer: UHC Core |
$346.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.25
|
| Rate for Payer: UHC Exchange |
$346.82
|
| Rate for Payer: UHC Medicaid |
$110.12
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$327.81
|
| Rate for Payer: BCN Commercial |
$327.81
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Advantage |
$403.90
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$363.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$119.28 |
| Max. Negotiated Rate |
$489.75 |
| Rate for Payer: Aetna Commercial |
$244.63
|
| Rate for Payer: Aetna Medicare |
$189.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.89
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$182.56
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$182.56
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Commercial |
$262.89
|
| Rate for Payer: Cofinity Commercial |
$244.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.56
|
| Rate for Payer: Healthscope Commercial |
$337.74
|
| Rate for Payer: Healthscope Commercial |
$292.10
|
| Rate for Payer: Mclaren Medicaid |
$119.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.69
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.97
|
| Rate for Payer: Nomi Health Commercial |
$219.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PACE SWMI |
$182.56
|
| Rate for Payer: PHP Medicare Advantage |
$182.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$182.56
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: Priority Health Tiered Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$182.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.32
|
| Rate for Payer: UHC Core |
$375.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.56
|
| Rate for Payer: UHC Exchange |
$375.32
|
| Rate for Payer: UHC Medicaid |
$119.28
|
| Rate for Payer: UHCCP Medicaid |
$119.28
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$153.88 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$555.05
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$153.88
|
| Rate for Payer: BCN Commercial |
$153.88
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Advantage |
$457.10
|
| Rate for Payer: Cofinity Commercial |
$561.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$522.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$587.70
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.05
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$555.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$411.39
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$411.39 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Aetna Commercial |
$555.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.45
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Advantage |
$457.10
|
| Rate for Payer: Cofinity Commercial |
$561.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$522.40
|
| Rate for Payer: Healthscope Commercial |
$587.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PHP Commercial |
$555.05
|
| Rate for Payer: Priority Health SBD |
$411.39
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$119.28 |
| Max. Negotiated Rate |
$489.75 |
| Rate for Payer: Aetna Commercial |
$244.63
|
| Rate for Payer: Aetna Medicare |
$189.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.89
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$182.56
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$182.56
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Commercial |
$262.89
|
| Rate for Payer: Cofinity Commercial |
$244.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.56
|
| Rate for Payer: Healthscope Commercial |
$337.74
|
| Rate for Payer: Healthscope Commercial |
$292.10
|
| Rate for Payer: Mclaren Medicaid |
$119.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.69
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.97
|
| Rate for Payer: Nomi Health Commercial |
$219.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PACE SWMI |
$182.56
|
| Rate for Payer: PHP Medicare Advantage |
$182.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$182.56
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: Priority Health Tiered Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$182.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.32
|
| Rate for Payer: UHC Core |
$375.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.56
|
| Rate for Payer: UHC Exchange |
$375.32
|
| Rate for Payer: UHC Medicaid |
$119.28
|
| Rate for Payer: UHCCP Medicaid |
$119.28
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$259.30
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.65
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCBS MAPPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$330.16
|
| Rate for Payer: BCN Medicare Advantage |
$193.51
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$278.65
|
| Rate for Payer: Cofinity Commercial |
$259.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.51
|
| Rate for Payer: Healthscope Commercial |
$357.99
|
| Rate for Payer: Healthscope Commercial |
$309.62
|
| Rate for Payer: Mclaren Medicaid |
$125.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.19
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$212.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.85
|
| Rate for Payer: Nomi Health Commercial |
$232.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PACE SWMI |
$193.51
|
| Rate for Payer: PHP Medicare Advantage |
$193.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.19
|
| Rate for Payer: Priority Health Medicare |
$193.51
|
| Rate for Payer: Priority Health SBD |
$302.19
|
| Rate for Payer: Priority Health Tiered Network |
$302.19
|
| Rate for Payer: Railroad Medicare Medicare |
$193.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.38
|
| Rate for Payer: UHC Core |
$386.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$193.51
|
| Rate for Payer: UHC Exchange |
$386.38
|
| Rate for Payer: UHC Medicaid |
$125.67
|
| Rate for Payer: UHCCP Medicaid |
$125.67
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$697.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Advantage |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$705.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.00
|
| Rate for Payer: Healthscope Commercial |
$738.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$697.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PHP Commercial |
$697.00
|
| Rate for Payer: Priority Health SBD |
$516.60
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$259.30
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.65
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCBS MAPPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$330.16
|
| Rate for Payer: BCN Medicare Advantage |
$193.51
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$278.65
|
| Rate for Payer: Cofinity Commercial |
$259.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.51
|
| Rate for Payer: Healthscope Commercial |
$357.99
|
| Rate for Payer: Healthscope Commercial |
$309.62
|
| Rate for Payer: Mclaren Medicaid |
$125.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.19
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$212.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.85
|
| Rate for Payer: Nomi Health Commercial |
$232.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PACE SWMI |
$193.51
|
| Rate for Payer: PHP Medicare Advantage |
$193.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.19
|
| Rate for Payer: Priority Health Medicare |
$193.51
|
| Rate for Payer: Priority Health SBD |
$302.19
|
| Rate for Payer: Priority Health Tiered Network |
$302.19
|
| Rate for Payer: Railroad Medicare Medicare |
$193.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.38
|
| Rate for Payer: UHC Core |
$386.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$193.51
|
| Rate for Payer: UHC Exchange |
$386.38
|
| Rate for Payer: UHC Medicaid |
$125.67
|
| Rate for Payer: UHCCP Medicaid |
$125.67
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$697.00
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$223.11
|
| Rate for Payer: BCN Commercial |
$223.11
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Advantage |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$705.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$738.00
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$697.00
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$697.00
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$516.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$485.25 |
| Rate for Payer: Aetna Commercial |
$349.57
|
| Rate for Payer: Aetna Medicare |
$271.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.65
|
| Rate for Payer: BCBS Complete |
$179.81
|
| Rate for Payer: BCBS MAPPO |
$260.87
|
| Rate for Payer: BCN Commercial |
$409.84
|
| Rate for Payer: BCN Medicare Advantage |
$260.87
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cofinity Commercial |
$375.65
|
| Rate for Payer: Cofinity Commercial |
$349.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.87
|
| Rate for Payer: Healthscope Commercial |
$482.61
|
| Rate for Payer: Healthscope Commercial |
$417.39
|
| Rate for Payer: Mclaren Medicaid |
$171.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.91
|
| Rate for Payer: Meridian Medicaid |
$179.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.20
|
| Rate for Payer: Nomi Health Commercial |
$313.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.25
|
| Rate for Payer: PACE SWMI |
$260.87
|
| Rate for Payer: PHP Medicare Advantage |
$260.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$375.11
|
| Rate for Payer: Priority Health Medicare |
$260.87
|
| Rate for Payer: Priority Health SBD |
$375.11
|
| Rate for Payer: Priority Health Tiered Network |
$375.11
|
| Rate for Payer: Railroad Medicare Medicare |
$260.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$469.26
|
| Rate for Payer: UHC Core |
$469.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$260.87
|
| Rate for Payer: UHC Exchange |
$469.26
|
| Rate for Payer: UHC Medicaid |
$171.25
|
| Rate for Payer: UHCCP Medicaid |
$171.25
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Aetna Commercial |
$168.55
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.12
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS MAPPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$219.11
|
| Rate for Payer: BCN Medicare Advantage |
$125.78
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$181.12
|
| Rate for Payer: Cofinity Commercial |
$168.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.78
|
| Rate for Payer: Healthscope Commercial |
$232.69
|
| Rate for Payer: Healthscope Commercial |
$201.25
|
| Rate for Payer: Mclaren Medicaid |
$82.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.07
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.51
|
| Rate for Payer: Nomi Health Commercial |
$150.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PACE SWMI |
$125.78
|
| Rate for Payer: PHP Medicare Advantage |
$125.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$200.54
|
| Rate for Payer: Priority Health Medicare |
$125.78
|
| Rate for Payer: Priority Health SBD |
$200.54
|
| Rate for Payer: Priority Health Tiered Network |
$200.54
|
| Rate for Payer: Railroad Medicare Medicare |
$125.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.10
|
| Rate for Payer: UHC Core |
$255.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.78
|
| Rate for Payer: UHC Exchange |
$255.10
|
| Rate for Payer: UHC Medicaid |
$82.43
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$366.35
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$335.41
|
| Rate for Payer: BCN Commercial |
$335.41
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Advantage |
$301.70
|
| Rate for Payer: Cofinity Commercial |
$370.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$387.90
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.35
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$366.35
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$271.53
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Aetna Commercial |
$168.55
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.12
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS MAPPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$219.11
|
| Rate for Payer: BCN Medicare Advantage |
$125.78
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$181.12
|
| Rate for Payer: Cofinity Commercial |
$168.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.78
|
| Rate for Payer: Healthscope Commercial |
$232.69
|
| Rate for Payer: Healthscope Commercial |
$201.25
|
| Rate for Payer: Mclaren Medicaid |
$82.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.07
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.51
|
| Rate for Payer: Nomi Health Commercial |
$150.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PACE SWMI |
$125.78
|
| Rate for Payer: PHP Medicare Advantage |
$125.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$200.54
|
| Rate for Payer: Priority Health Medicare |
$125.78
|
| Rate for Payer: Priority Health SBD |
$200.54
|
| Rate for Payer: Priority Health Tiered Network |
$200.54
|
| Rate for Payer: Railroad Medicare Medicare |
$125.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.10
|
| Rate for Payer: UHC Core |
$255.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.78
|
| Rate for Payer: UHC Exchange |
$255.10
|
| Rate for Payer: UHC Medicaid |
$82.43
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Aetna Commercial |
$366.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.15
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Advantage |
$301.70
|
| Rate for Payer: Cofinity Commercial |
$370.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.80
|
| Rate for Payer: Healthscope Commercial |
$387.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PHP Commercial |
$366.35
|
| Rate for Payer: Priority Health SBD |
$271.53
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$460.70
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$328.94
|
| Rate for Payer: BCN Commercial |
$328.94
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Advantage |
$379.40
|
| Rate for Payer: Cofinity Commercial |
$466.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$487.80
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.70
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$460.70
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$341.46
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Aetna Commercial |
$219.44
|
| Rate for Payer: Aetna Medicare |
$170.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.81
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS MAPPO |
$163.76
|
| Rate for Payer: BCN Commercial |
$294.31
|
| Rate for Payer: BCN Medicare Advantage |
$163.76
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Commercial |
$235.81
|
| Rate for Payer: Cofinity Commercial |
$219.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.76
|
| Rate for Payer: Healthscope Commercial |
$302.96
|
| Rate for Payer: Healthscope Commercial |
$262.02
|
| Rate for Payer: Mclaren Medicaid |
$107.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.95
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.56
|
| Rate for Payer: Nomi Health Commercial |
$196.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: PACE SWMI |
$163.76
|
| Rate for Payer: PHP Medicare Advantage |
$163.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$269.37
|
| Rate for Payer: Priority Health Medicare |
$163.76
|
| Rate for Payer: Priority Health SBD |
$269.37
|
| Rate for Payer: Priority Health Tiered Network |
$269.37
|
| Rate for Payer: Railroad Medicare Medicare |
$163.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.59
|
| Rate for Payer: UHC Core |
$340.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.76
|
| Rate for Payer: UHC Exchange |
$340.59
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
12042
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Aetna Commercial |
$219.44
|
| Rate for Payer: Aetna Medicare |
$170.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.81
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS MAPPO |
$163.76
|
| Rate for Payer: BCN Commercial |
$294.31
|
| Rate for Payer: BCN Medicare Advantage |
$163.76
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Commercial |
$235.81
|
| Rate for Payer: Cofinity Commercial |
$219.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.76
|
| Rate for Payer: Healthscope Commercial |
$302.96
|
| Rate for Payer: Healthscope Commercial |
$262.02
|
| Rate for Payer: Mclaren Medicaid |
$107.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.95
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.56
|
| Rate for Payer: Nomi Health Commercial |
$196.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: PACE SWMI |
$163.76
|
| Rate for Payer: PHP Medicare Advantage |
$163.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$269.37
|
| Rate for Payer: Priority Health Medicare |
$163.76
|
| Rate for Payer: Priority Health SBD |
$269.37
|
| Rate for Payer: Priority Health Tiered Network |
$269.37
|
| Rate for Payer: Railroad Medicare Medicare |
$163.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.59
|
| Rate for Payer: UHC Core |
$340.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.76
|
| Rate for Payer: UHC Exchange |
$340.59
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$341.46 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna Commercial |
$460.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.30
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Advantage |
$379.40
|
| Rate for Payer: Cofinity Commercial |
$466.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.60
|
| Rate for Payer: Healthscope Commercial |
$487.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: PHP Commercial |
$460.70
|
| Rate for Payer: Priority Health SBD |
$341.46
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$884.25 |
| Rate for Payer: Aetna Commercial |
$454.22
|
| Rate for Payer: Aetna Medicare |
$352.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.12
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCBS MAPPO |
$338.97
|
| Rate for Payer: BCN Commercial |
$531.85
|
| Rate for Payer: BCN Medicare Advantage |
$338.97
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cofinity Commercial |
$488.12
|
| Rate for Payer: Cofinity Commercial |
$454.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.97
|
| Rate for Payer: Healthscope Commercial |
$627.09
|
| Rate for Payer: Healthscope Commercial |
$542.35
|
| Rate for Payer: Mclaren Medicaid |
$220.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.92
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$372.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.70
|
| Rate for Payer: Nomi Health Commercial |
$406.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.25
|
| Rate for Payer: PACE SWMI |
$338.97
|
| Rate for Payer: PHP Medicare Advantage |
$338.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$486.77
|
| Rate for Payer: Priority Health Medicare |
$338.97
|
| Rate for Payer: Priority Health SBD |
$486.77
|
| Rate for Payer: Priority Health Tiered Network |
$486.77
|
| Rate for Payer: Railroad Medicare Medicare |
$338.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.86
|
| Rate for Payer: UHC Core |
$614.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$338.97
|
| Rate for Payer: UHC Exchange |
$614.86
|
| Rate for Payer: UHC Medicaid |
$220.46
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
|
