|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$366.66 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna Commercial |
$494.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.30
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Advantage |
$407.40
|
| Rate for Payer: Cofinity Commercial |
$500.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.60
|
| Rate for Payer: Healthscope Commercial |
$523.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PHP Commercial |
$494.70
|
| Rate for Payer: Priority Health SBD |
$366.66
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
12044
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.33
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$186.34
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$186.34
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$268.33
|
| Rate for Payer: Cofinity Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.34
|
| Rate for Payer: Healthscope Commercial |
$344.73
|
| Rate for Payer: Healthscope Commercial |
$298.14
|
| Rate for Payer: Mclaren Medicaid |
$121.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.66
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$204.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.60
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PACE SWMI |
$186.34
|
| Rate for Payer: PHP Medicare Advantage |
$186.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$186.34
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: Priority Health Tiered Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$186.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.40
|
| Rate for Payer: UHC Core |
$373.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$186.34
|
| Rate for Payer: UHC Exchange |
$373.40
|
| Rate for Payer: UHC Medicaid |
$121.62
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.35 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$494.70
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$156.35
|
| Rate for Payer: BCN Commercial |
$156.35
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Advantage |
$407.40
|
| Rate for Payer: Cofinity Commercial |
$500.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$523.80
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.70
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$494.70
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$366.66
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.33
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$186.34
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$186.34
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$268.33
|
| Rate for Payer: Cofinity Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.34
|
| Rate for Payer: Healthscope Commercial |
$344.73
|
| Rate for Payer: Healthscope Commercial |
$298.14
|
| Rate for Payer: Mclaren Medicaid |
$121.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.66
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$204.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.60
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PACE SWMI |
$186.34
|
| Rate for Payer: PHP Medicare Advantage |
$186.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$186.34
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: Priority Health Tiered Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$186.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.40
|
| Rate for Payer: UHC Core |
$373.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$186.34
|
| Rate for Payer: UHC Exchange |
$373.40
|
| Rate for Payer: UHC Medicaid |
$121.62
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$293.88
|
| Rate for Payer: Aetna Medicare |
$228.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.81
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS MAPPO |
$219.31
|
| Rate for Payer: BCN Commercial |
$286.67
|
| Rate for Payer: BCN Medicare Advantage |
$219.31
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$315.81
|
| Rate for Payer: Cofinity Commercial |
$293.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.31
|
| Rate for Payer: Healthscope Commercial |
$405.72
|
| Rate for Payer: Healthscope Commercial |
$350.90
|
| Rate for Payer: Mclaren Medicaid |
$143.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.28
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$241.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.42
|
| Rate for Payer: Nomi Health Commercial |
$263.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE SWMI |
$219.31
|
| Rate for Payer: PHP Medicare Advantage |
$219.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$332.72
|
| Rate for Payer: Priority Health Medicare |
$219.31
|
| Rate for Payer: Priority Health SBD |
$332.72
|
| Rate for Payer: Priority Health Tiered Network |
$332.72
|
| Rate for Payer: Railroad Medicare Medicare |
$219.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.71
|
| Rate for Payer: UHC Core |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$219.31
|
| Rate for Payer: UHC Exchange |
$420.71
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$607.75
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.75
|
| 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 |
$307.60
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Advantage |
$500.50
|
| Rate for Payer: Cofinity Commercial |
$614.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$643.50
|
| 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 |
$607.75
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$607.75
|
| 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 |
$450.45
|
| 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 S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$450.45 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Aetna Commercial |
$607.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.75
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Advantage |
$500.50
|
| Rate for Payer: Cofinity Commercial |
$614.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Healthscope Commercial |
$643.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PHP Commercial |
$607.75
|
| Rate for Payer: Priority Health SBD |
$450.45
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$293.88
|
| Rate for Payer: Aetna Medicare |
$228.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.81
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS MAPPO |
$219.31
|
| Rate for Payer: BCN Commercial |
$286.67
|
| Rate for Payer: BCN Medicare Advantage |
$219.31
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$315.81
|
| Rate for Payer: Cofinity Commercial |
$293.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.31
|
| Rate for Payer: Healthscope Commercial |
$405.72
|
| Rate for Payer: Healthscope Commercial |
$350.90
|
| Rate for Payer: Mclaren Medicaid |
$143.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.28
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$241.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.42
|
| Rate for Payer: Nomi Health Commercial |
$263.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE SWMI |
$219.31
|
| Rate for Payer: PHP Medicare Advantage |
$219.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$332.72
|
| Rate for Payer: Priority Health Medicare |
$219.31
|
| Rate for Payer: Priority Health SBD |
$332.72
|
| Rate for Payer: Priority Health Tiered Network |
$332.72
|
| Rate for Payer: Railroad Medicare Medicare |
$219.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.71
|
| Rate for Payer: UHC Core |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$219.31
|
| Rate for Payer: UHC Exchange |
$420.71
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
12036
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$760.75
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$280.32
|
| Rate for Payer: BCN Commercial |
$280.32
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Advantage |
$626.50
|
| Rate for Payer: Cofinity Commercial |
$769.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$805.50
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$760.75
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$563.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
12036
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$563.85 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Aetna Commercial |
$760.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.75
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Advantage |
$626.50
|
| Rate for Payer: Cofinity Commercial |
$769.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Healthscope Commercial |
$805.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PHP Commercial |
$760.75
|
| Rate for Payer: Priority Health SBD |
$563.85
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Aetna Commercial |
$355.33
|
| Rate for Payer: Aetna Medicare |
$275.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.84
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCBS MAPPO |
$265.17
|
| Rate for Payer: BCN Commercial |
$335.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.17
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Commercial |
$355.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.17
|
| Rate for Payer: Healthscope Commercial |
$490.56
|
| Rate for Payer: Healthscope Commercial |
$424.27
|
| Rate for Payer: Mclaren Medicaid |
$172.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.43
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$291.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.09
|
| Rate for Payer: Nomi Health Commercial |
$318.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PACE SWMI |
$265.17
|
| Rate for Payer: PHP Medicare Advantage |
$265.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$389.24
|
| Rate for Payer: Priority Health Medicare |
$265.17
|
| Rate for Payer: Priority Health SBD |
$389.24
|
| Rate for Payer: Priority Health Tiered Network |
$389.24
|
| Rate for Payer: Railroad Medicare Medicare |
$265.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.29
|
| Rate for Payer: UHC Core |
$495.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$265.17
|
| Rate for Payer: UHC Exchange |
$495.29
|
| Rate for Payer: UHC Medicaid |
$172.32
|
| Rate for Payer: UHCCP Medicaid |
$172.32
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
12036
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Aetna Commercial |
$355.33
|
| Rate for Payer: Aetna Medicare |
$275.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.84
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCBS MAPPO |
$265.17
|
| Rate for Payer: BCN Commercial |
$335.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.17
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Commercial |
$355.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.17
|
| Rate for Payer: Healthscope Commercial |
$490.56
|
| Rate for Payer: Healthscope Commercial |
$424.27
|
| Rate for Payer: Mclaren Medicaid |
$172.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.43
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$291.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.09
|
| Rate for Payer: Nomi Health Commercial |
$318.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PACE SWMI |
$265.17
|
| Rate for Payer: PHP Medicare Advantage |
$265.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$389.24
|
| Rate for Payer: Priority Health Medicare |
$265.17
|
| Rate for Payer: Priority Health SBD |
$389.24
|
| Rate for Payer: Priority Health Tiered Network |
$389.24
|
| Rate for Payer: Railroad Medicare Medicare |
$265.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.29
|
| Rate for Payer: UHC Core |
$495.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$265.17
|
| Rate for Payer: UHC Exchange |
$495.29
|
| Rate for Payer: UHC Medicaid |
$172.32
|
| Rate for Payer: UHCCP Medicaid |
$172.32
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$172.86
|
| Rate for Payer: Aetna Medicare |
$134.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.76
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$129.00
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: BCN Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$238.65
|
| Rate for Payer: Healthscope Commercial |
$206.40
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.45
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.99
|
| Rate for Payer: Nomi Health Commercial |
$154.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE SWMI |
$129.00
|
| Rate for Payer: PHP Medicare Advantage |
$129.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$129.00
|
| Rate for Payer: Priority Health SBD |
$208.29
|
| Rate for Payer: Priority Health Tiered Network |
$208.29
|
| Rate for Payer: Railroad Medicare Medicare |
$129.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.57
|
| Rate for Payer: UHC Core |
$262.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.00
|
| Rate for Payer: UHC Exchange |
$262.57
|
| Rate for Payer: UHC Medicaid |
$84.99
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$255.78 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna Commercial |
$345.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.90
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Advantage |
$284.20
|
| Rate for Payer: Cofinity Commercial |
$349.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.80
|
| Rate for Payer: Healthscope Commercial |
$365.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PHP Commercial |
$345.10
|
| Rate for Payer: Priority Health SBD |
$255.78
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$345.10
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.90
|
| 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 |
$307.60
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Advantage |
$284.20
|
| Rate for Payer: Cofinity Commercial |
$349.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$365.40
|
| 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 |
$345.10
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$345.10
|
| 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 |
$255.78
|
| 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 S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$172.86
|
| Rate for Payer: Aetna Medicare |
$134.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.76
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$129.00
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: BCN Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$238.65
|
| Rate for Payer: Healthscope Commercial |
$206.40
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.45
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.99
|
| Rate for Payer: Nomi Health Commercial |
$154.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE SWMI |
$129.00
|
| Rate for Payer: PHP Medicare Advantage |
$129.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$129.00
|
| Rate for Payer: Priority Health SBD |
$208.29
|
| Rate for Payer: Priority Health Tiered Network |
$208.29
|
| Rate for Payer: Railroad Medicare Medicare |
$129.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.57
|
| Rate for Payer: UHC Core |
$262.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.00
|
| Rate for Payer: UHC Exchange |
$262.57
|
| Rate for Payer: UHC Medicaid |
$84.99
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Aetna Commercial |
$213.96
|
| Rate for Payer: Aetna Medicare |
$166.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.92
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS MAPPO |
$159.67
|
| Rate for Payer: BCN Commercial |
$225.80
|
| Rate for Payer: BCN Medicare Advantage |
$159.67
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$229.92
|
| Rate for Payer: Cofinity Commercial |
$213.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.67
|
| Rate for Payer: Healthscope Commercial |
$295.39
|
| Rate for Payer: Healthscope Commercial |
$255.47
|
| Rate for Payer: Mclaren Medicaid |
$105.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.65
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.01
|
| Rate for Payer: Nomi Health Commercial |
$191.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PACE SWMI |
$159.67
|
| Rate for Payer: PHP Medicare Advantage |
$159.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$262.07
|
| Rate for Payer: Priority Health Medicare |
$159.67
|
| Rate for Payer: Priority Health SBD |
$262.07
|
| Rate for Payer: Priority Health Tiered Network |
$262.07
|
| Rate for Payer: Railroad Medicare Medicare |
$159.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.60
|
| Rate for Payer: UHC Core |
$328.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.67
|
| Rate for Payer: UHC Exchange |
$328.60
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Aetna Commercial |
$213.96
|
| Rate for Payer: Aetna Medicare |
$166.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.92
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS MAPPO |
$159.67
|
| Rate for Payer: BCN Commercial |
$225.80
|
| Rate for Payer: BCN Medicare Advantage |
$159.67
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$229.92
|
| Rate for Payer: Cofinity Commercial |
$213.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.67
|
| Rate for Payer: Healthscope Commercial |
$295.39
|
| Rate for Payer: Healthscope Commercial |
$255.47
|
| Rate for Payer: Mclaren Medicaid |
$105.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.65
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.01
|
| Rate for Payer: Nomi Health Commercial |
$191.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PACE SWMI |
$159.67
|
| Rate for Payer: PHP Medicare Advantage |
$159.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$262.07
|
| Rate for Payer: Priority Health Medicare |
$159.67
|
| Rate for Payer: Priority Health SBD |
$262.07
|
| Rate for Payer: Priority Health Tiered Network |
$262.07
|
| Rate for Payer: Railroad Medicare Medicare |
$159.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.60
|
| Rate for Payer: UHC Core |
$328.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.67
|
| Rate for Payer: UHC Exchange |
$328.60
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$326.34 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.70
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Advantage |
$362.60
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Healthscope Commercial |
$466.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PHP Commercial |
$440.30
|
| Rate for Payer: Priority Health SBD |
$326.34
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.70
|
| 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 |
$412.19
|
| Rate for Payer: BCN Commercial |
$412.19
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Advantage |
$362.60
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$466.20
|
| 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 |
$440.30
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$440.30
|
| 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 |
$326.34
|
| 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 S/A/T/E >30.0 CM
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$196.17 |
| Max. Negotiated Rate |
$585.75 |
| Rate for Payer: Aetna Commercial |
$405.70
|
| Rate for Payer: Aetna Medicare |
$314.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.97
|
| Rate for Payer: BCBS Complete |
$205.98
|
| Rate for Payer: BCBS MAPPO |
$302.76
|
| Rate for Payer: BCN Commercial |
$388.38
|
| Rate for Payer: BCN Medicare Advantage |
$302.76
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cofinity Commercial |
$435.97
|
| Rate for Payer: Cofinity Commercial |
$405.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.76
|
| Rate for Payer: Healthscope Commercial |
$560.11
|
| Rate for Payer: Healthscope Commercial |
$484.42
|
| Rate for Payer: Mclaren Medicaid |
$196.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.90
|
| Rate for Payer: Meridian Medicaid |
$205.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.54
|
| Rate for Payer: Nomi Health Commercial |
$363.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.75
|
| Rate for Payer: PACE SWMI |
$302.76
|
| Rate for Payer: PHP Medicare Advantage |
$302.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$450.77
|
| Rate for Payer: Priority Health Medicare |
$302.76
|
| Rate for Payer: Priority Health SBD |
$450.77
|
| Rate for Payer: Priority Health Tiered Network |
$450.77
|
| Rate for Payer: Railroad Medicare Medicare |
$302.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.65
|
| Rate for Payer: UHC Core |
$579.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$302.76
|
| Rate for Payer: UHC Exchange |
$579.65
|
| Rate for Payer: UHC Medicaid |
$196.17
|
| Rate for Payer: UHCCP Medicaid |
$196.17
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$235.32
|
| Rate for Payer: Aetna Medicare |
$182.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$175.61
|
| Rate for Payer: BCN Commercial |
$243.08
|
| Rate for Payer: BCN Medicare Advantage |
$175.61
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Cofinity Commercial |
$235.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.61
|
| Rate for Payer: Healthscope Commercial |
$324.88
|
| Rate for Payer: Healthscope Commercial |
$280.98
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.39
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.12
|
| Rate for Payer: Nomi Health Commercial |
$210.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PACE SWMI |
$175.61
|
| Rate for Payer: PHP Medicare Advantage |
$175.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$282.12
|
| Rate for Payer: Priority Health Medicare |
$175.61
|
| Rate for Payer: Priority Health SBD |
$282.12
|
| Rate for Payer: Priority Health Tiered Network |
$282.12
|
| Rate for Payer: Railroad Medicare Medicare |
$175.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.59
|
| Rate for Payer: UHC Core |
$357.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.61
|
| Rate for Payer: UHC Exchange |
$357.59
|
| Rate for Payer: UHC Medicaid |
$114.81
|
| Rate for Payer: UHCCP Medicaid |
$114.81
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$235.32
|
| Rate for Payer: Aetna Medicare |
$182.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$175.61
|
| Rate for Payer: BCN Commercial |
$243.08
|
| Rate for Payer: BCN Medicare Advantage |
$175.61
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Cofinity Commercial |
$235.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.61
|
| Rate for Payer: Healthscope Commercial |
$324.88
|
| Rate for Payer: Healthscope Commercial |
$280.98
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.39
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.12
|
| Rate for Payer: Nomi Health Commercial |
$210.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PACE SWMI |
$175.61
|
| Rate for Payer: PHP Medicare Advantage |
$175.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$282.12
|
| Rate for Payer: Priority Health Medicare |
$175.61
|
| Rate for Payer: Priority Health SBD |
$282.12
|
| Rate for Payer: Priority Health Tiered Network |
$282.12
|
| Rate for Payer: Railroad Medicare Medicare |
$175.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.59
|
| Rate for Payer: UHC Core |
$357.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.61
|
| Rate for Payer: UHC Exchange |
$357.59
|
| Rate for Payer: UHC Medicaid |
$114.81
|
| Rate for Payer: UHCCP Medicaid |
$114.81
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Advantage |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PHP Commercial |
$561.00
|
| Rate for Payer: Priority Health SBD |
$415.80
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.00
|
| 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 |
$412.47
|
| Rate for Payer: BCN Commercial |
$412.47
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Advantage |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| 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 |
$561.00
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$561.00
|
| 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 |
$415.80
|
| 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
|
|
