|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$141.73 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$378.25
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$141.73
|
| Rate for Payer: BCN Commercial |
$141.73
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$382.70
|
| Rate for Payer: Cofinity Commercial |
$311.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$400.50
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$378.25
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$280.35
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$29,574.00 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$165.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.61
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Healthscope Commercial |
$294.98
|
| Rate for Payer: Healthscope Commercial |
$255.12
|
| Rate for Payer: Mclaren Medicaid |
$108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,574.00
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.37
|
| Rate for Payer: Priority Health Medicare |
$159.45
|
| Rate for Payer: Priority Health Narrow Network |
$229.37
|
| Rate for Payer: Priority Health SBD |
$229.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Exchange |
$233.12
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health SBD |
$352.80
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$34,862.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.61
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Healthscope Commercial |
$348.95
|
| Rate for Payer: Healthscope Commercial |
$301.79
|
| Rate for Payer: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,862.00
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.56
|
| Rate for Payer: Priority Health Medicare |
$188.62
|
| Rate for Payer: Priority Health Narrow Network |
$269.56
|
| Rate for Payer: Priority Health SBD |
$269.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Exchange |
$243.41
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$34,862.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.61
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Healthscope Commercial |
$348.95
|
| Rate for Payer: Healthscope Commercial |
$301.79
|
| Rate for Payer: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,862.00
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.56
|
| Rate for Payer: Priority Health Medicare |
$188.62
|
| Rate for Payer: Priority Health Narrow Network |
$269.56
|
| Rate for Payer: Priority Health SBD |
$269.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Exchange |
$243.41
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$255.93
|
| Rate for Payer: BCN Commercial |
$255.93
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$352.80
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.40
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$37,697.00 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.30
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$203.68
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Commercial |
$272.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$376.81
|
| Rate for Payer: Healthscope Commercial |
$325.89
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,697.00
|
| Rate for Payer: Nomi Health Commercial |
$244.42
|
| Rate for Payer: PACE SWMI |
$203.68
|
| Rate for Payer: PHP Medicare Advantage |
$203.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.77
|
| Rate for Payer: Priority Health Medicare |
$203.68
|
| Rate for Payer: Priority Health Narrow Network |
$290.77
|
| Rate for Payer: Priority Health SBD |
$290.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.68
|
| Rate for Payer: UHC Exchange |
$260.42
|
| Rate for Payer: UHC Medicare Advantage |
$203.68
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.14 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$538.90
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$120.14
|
| Rate for Payer: BCN Commercial |
$120.14
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$545.24
|
| Rate for Payer: Cofinity Commercial |
$443.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$443.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$570.60
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$538.90
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$399.42
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.25
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$37,697.00 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.30
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$203.68
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Commercial |
$272.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$376.81
|
| Rate for Payer: Healthscope Commercial |
$325.89
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,697.00
|
| Rate for Payer: Nomi Health Commercial |
$244.42
|
| Rate for Payer: PACE SWMI |
$203.68
|
| Rate for Payer: PHP Medicare Advantage |
$203.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.77
|
| Rate for Payer: Priority Health Medicare |
$203.68
|
| Rate for Payer: Priority Health Narrow Network |
$290.77
|
| Rate for Payer: Priority Health SBD |
$290.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.68
|
| Rate for Payer: UHC Exchange |
$260.42
|
| Rate for Payer: UHC Medicare Advantage |
$203.68
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$399.42 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Aetna Commercial |
$538.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.10
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$443.80
|
| Rate for Payer: Cofinity Commercial |
$545.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$443.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Healthscope Commercial |
$570.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: PHP Commercial |
$538.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health SBD |
$399.42
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$38,785.00 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.07
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$209.77
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$302.07
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.77
|
| Rate for Payer: Healthscope Commercial |
$388.07
|
| Rate for Payer: Healthscope Commercial |
$335.63
|
| Rate for Payer: Mclaren Medicaid |
$141.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38,785.00
|
| Rate for Payer: Nomi Health Commercial |
$251.72
|
| Rate for Payer: PACE SWMI |
$209.77
|
| Rate for Payer: PHP Medicare Advantage |
$209.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.54
|
| Rate for Payer: Priority Health Medicare |
$209.77
|
| Rate for Payer: Priority Health Narrow Network |
$297.54
|
| Rate for Payer: Priority Health SBD |
$297.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.77
|
| Rate for Payer: UHC Exchange |
$288.52
|
| Rate for Payer: UHC Medicare Advantage |
$209.77
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$501.48 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna Commercial |
$676.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.40
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$557.20
|
| Rate for Payer: Cofinity Commercial |
$684.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Healthscope Commercial |
$716.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: PHP Commercial |
$676.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health SBD |
$501.48
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$676.60
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$174.19
|
| Rate for Payer: BCN Commercial |
$174.19
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$557.20
|
| Rate for Payer: Cofinity Commercial |
$684.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$557.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$716.40
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: Nomi Health Commercial |
$1,174.35
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$676.60
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$501.48
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.36
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$38,785.00 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.07
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$209.77
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$302.07
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.77
|
| Rate for Payer: Healthscope Commercial |
$388.07
|
| Rate for Payer: Healthscope Commercial |
$335.63
|
| Rate for Payer: Mclaren Medicaid |
$141.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38,785.00
|
| Rate for Payer: Nomi Health Commercial |
$251.72
|
| Rate for Payer: PACE SWMI |
$209.77
|
| Rate for Payer: PHP Medicare Advantage |
$209.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.54
|
| Rate for Payer: Priority Health Medicare |
$209.77
|
| Rate for Payer: Priority Health Narrow Network |
$297.54
|
| Rate for Payer: Priority Health SBD |
$297.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.77
|
| Rate for Payer: UHC Exchange |
$288.52
|
| Rate for Payer: UHC Medicare Advantage |
$209.77
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$48,220.00 |
| Rate for Payer: Aetna Commercial |
$346.94
|
| Rate for Payer: Aetna Medicare |
$269.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.83
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS MAPPO |
$258.91
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$609.87
|
| Rate for Payer: BCN Medicare Advantage |
$258.91
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cofinity Commercial |
$372.83
|
| Rate for Payer: Cofinity Commercial |
$346.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.91
|
| Rate for Payer: Healthscope Commercial |
$478.98
|
| Rate for Payer: Healthscope Commercial |
$414.26
|
| Rate for Payer: Mclaren Medicaid |
$175.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.86
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,220.00
|
| Rate for Payer: Nomi Health Commercial |
$310.69
|
| Rate for Payer: PACE SWMI |
$258.91
|
| Rate for Payer: PHP Medicare Advantage |
$258.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.14
|
| Rate for Payer: Priority Health Medicare |
$258.91
|
| Rate for Payer: Priority Health Narrow Network |
$371.14
|
| Rate for Payer: Priority Health SBD |
$371.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.91
|
| Rate for Payer: UHC Exchange |
$305.14
|
| Rate for Payer: UHC Medicare Advantage |
$258.91
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$151.92 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$355.30
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$261.86
|
| Rate for Payer: BCN Commercial |
$261.86
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$359.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$376.20
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.30
|
| Rate for Payer: Nomi Health Commercial |
$1,174.35
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$355.30
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$263.34
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.92
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$25,351.00 |
| Rate for Payer: Aetna Commercial |
$184.91
|
| Rate for Payer: Aetna Medicare |
$143.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.71
|
| Rate for Payer: BCBS Complete |
$98.41
|
| Rate for Payer: BCBS MAPPO |
$137.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$137.99
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$198.71
|
| Rate for Payer: Cofinity Commercial |
$184.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.99
|
| Rate for Payer: Healthscope Commercial |
$255.28
|
| Rate for Payer: Healthscope Commercial |
$220.78
|
| Rate for Payer: Mclaren Medicaid |
$93.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.89
|
| Rate for Payer: Meridian Medicaid |
$98.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,351.00
|
| Rate for Payer: Nomi Health Commercial |
$165.59
|
| Rate for Payer: PACE SWMI |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$137.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.41
|
| Rate for Payer: Priority Health Medicare |
$137.99
|
| Rate for Payer: Priority Health Narrow Network |
$196.41
|
| Rate for Payer: Priority Health SBD |
$196.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.99
|
| Rate for Payer: UHC Exchange |
$199.86
|
| Rate for Payer: UHC Medicare Advantage |
$137.99
|
| Rate for Payer: UHCCP Medicaid |
$93.72
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna Commercial |
$355.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.70
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$359.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.40
|
| Rate for Payer: Healthscope Commercial |
$376.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.30
|
| Rate for Payer: PHP Commercial |
$355.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health SBD |
$263.34
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$25,351.00 |
| Rate for Payer: Aetna Commercial |
$184.91
|
| Rate for Payer: Aetna Medicare |
$143.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.71
|
| Rate for Payer: BCBS Complete |
$98.41
|
| Rate for Payer: BCBS MAPPO |
$137.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$137.99
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$198.71
|
| Rate for Payer: Cofinity Commercial |
$184.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.99
|
| Rate for Payer: Healthscope Commercial |
$255.28
|
| Rate for Payer: Healthscope Commercial |
$220.78
|
| Rate for Payer: Mclaren Medicaid |
$93.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.89
|
| Rate for Payer: Meridian Medicaid |
$98.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,351.00
|
| Rate for Payer: Nomi Health Commercial |
$165.59
|
| Rate for Payer: PACE SWMI |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$137.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.41
|
| Rate for Payer: Priority Health Medicare |
$137.99
|
| Rate for Payer: Priority Health Narrow Network |
$196.41
|
| Rate for Payer: Priority Health SBD |
$196.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.99
|
| Rate for Payer: UHC Exchange |
$199.86
|
| Rate for Payer: UHC Medicare Advantage |
$137.99
|
| Rate for Payer: UHCCP Medicaid |
$93.72
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
12042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$34,056.00 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.37
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$184.98
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$454.96
|
| Rate for Payer: BCN Medicare Advantage |
$184.98
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$266.37
|
| Rate for Payer: Cofinity Commercial |
$247.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.98
|
| Rate for Payer: Healthscope Commercial |
$342.21
|
| Rate for Payer: Healthscope Commercial |
$295.97
|
| Rate for Payer: Mclaren Medicaid |
$125.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.23
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,056.00
|
| Rate for Payer: Nomi Health Commercial |
$221.98
|
| Rate for Payer: PACE SWMI |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$184.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.58
|
| Rate for Payer: Priority Health Medicare |
$184.98
|
| Rate for Payer: Priority Health Narrow Network |
$264.58
|
| Rate for Payer: Priority Health SBD |
$264.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.98
|
| Rate for Payer: UHC Exchange |
$243.80
|
| Rate for Payer: UHC Medicare Advantage |
$184.98
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$447.10
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$256.81
|
| Rate for Payer: BCN Commercial |
$256.81
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$452.36
|
| Rate for Payer: Cofinity Commercial |
$368.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$473.40
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.10
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$447.10
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$331.38
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.35
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$34,056.00 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.37
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$184.98
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$454.96
|
| Rate for Payer: BCN Medicare Advantage |
$184.98
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$266.37
|
| Rate for Payer: Cofinity Commercial |
$247.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.98
|
| Rate for Payer: Healthscope Commercial |
$342.21
|
| Rate for Payer: Healthscope Commercial |
$295.97
|
| Rate for Payer: Mclaren Medicaid |
$125.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.23
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,056.00
|
| Rate for Payer: Nomi Health Commercial |
$221.98
|
| Rate for Payer: PACE SWMI |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$184.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.58
|
| Rate for Payer: Priority Health Medicare |
$184.98
|
| Rate for Payer: Priority Health Narrow Network |
$264.58
|
| Rate for Payer: Priority Health SBD |
$264.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.98
|
| Rate for Payer: UHC Exchange |
$243.80
|
| Rate for Payer: UHC Medicare Advantage |
$184.98
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Aetna Commercial |
$447.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.90
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$368.20
|
| Rate for Payer: Cofinity Commercial |
$452.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.80
|
| Rate for Payer: Healthscope Commercial |
$473.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.10
|
| Rate for Payer: PHP Commercial |
$447.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health SBD |
$331.38
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$62,570.00 |
| Rate for Payer: Aetna Commercial |
$455.12
|
| Rate for Payer: Aetna Medicare |
$353.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.08
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: BCBS MAPPO |
$339.64
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$804.85
|
| Rate for Payer: BCN Medicare Advantage |
$339.64
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$489.08
|
| Rate for Payer: Cofinity Commercial |
$455.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.64
|
| Rate for Payer: Healthscope Commercial |
$628.33
|
| Rate for Payer: Healthscope Commercial |
$543.42
|
| Rate for Payer: Mclaren Medicaid |
$227.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.62
|
| Rate for Payer: Meridian Medicaid |
$238.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62,570.00
|
| Rate for Payer: Nomi Health Commercial |
$407.57
|
| Rate for Payer: PACE SWMI |
$339.64
|
| Rate for Payer: PHP Medicare Advantage |
$339.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.51
|
| Rate for Payer: Priority Health Medicare |
$339.64
|
| Rate for Payer: Priority Health Narrow Network |
$479.51
|
| Rate for Payer: Priority Health SBD |
$479.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.64
|
| Rate for Payer: UHC Exchange |
$457.13
|
| Rate for Payer: UHC Medicare Advantage |
$339.64
|
| Rate for Payer: UHCCP Medicaid |
$227.48
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$37,460.00 |
| Rate for Payer: Aetna Commercial |
$274.03
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.48
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$204.50
|
| Rate for Payer: BCBS Trust/PPO |
$361.61
|
| Rate for Payer: BCN Commercial |
$560.51
|
| Rate for Payer: BCN Medicare Advantage |
$204.50
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$294.48
|
| Rate for Payer: Cofinity Commercial |
$274.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.50
|
| Rate for Payer: Healthscope Commercial |
$378.32
|
| Rate for Payer: Healthscope Commercial |
$327.20
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.72
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,460.00
|
| Rate for Payer: Nomi Health Commercial |
$245.40
|
| Rate for Payer: PACE SWMI |
$204.50
|
| Rate for Payer: PHP Medicare Advantage |
$204.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.88
|
| Rate for Payer: Priority Health Medicare |
$204.50
|
| Rate for Payer: Priority Health Narrow Network |
$289.88
|
| Rate for Payer: Priority Health SBD |
$289.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.50
|
| Rate for Payer: UHC Exchange |
$262.40
|
| Rate for Payer: UHC Medicare Advantage |
$204.50
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
