Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM

Professional

Both

$780.00

Service Code	HCPCS 12054
Hospital Charge Code	12054
Min. Negotiated Rate	$140.37
Max. Negotiated Rate	$546.00
Rate for Payer: Aetna Commercial	$235.75
Rate for Payer: BCBS Complete	$147.39
Rate for Payer: BCBS Trust/PPO	$212.16
Rate for Payer: Cash Price	$624.00
Rate for Payer: Cash Price	$624.00
Rate for Payer: Mclaren Medicaid	$140.37
Rate for Payer: Meridian Medicaid	$147.39
Rate for Payer: Priority Health Choice Medicaid	$140.37
Rate for Payer: Priority Health Cigna Priority Health	$546.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$268.82
Rate for Payer: Priority Health Narrow Network	$268.82
Rate for Payer: Priority Health SBD	$268.82

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM

Facility

$780.00

Service Code	CPT 12054
Hospital Charge Code	12054
Hospital Revenue Code	521
Min. Negotiated Rate	$491.40
Max. Negotiated Rate	$702.00
Rate for Payer: Aetna Commercial	$663.00
Rate for Payer: Aetna New Business (MI Preferred)	$507.00
Rate for Payer: Cash Price	$624.00
Rate for Payer: Cofinity Commercial	$546.00
Rate for Payer: Cofinity Commercial	$670.80
Rate for Payer: Healthscope Commercial	$702.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$663.00
Rate for Payer: PHP Commercial	$663.00
Rate for Payer: Priority Health Cigna Priority Health	$546.00
Rate for Payer: Priority Health SBD	$491.40

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM

Professional

Both

$616.00

Service Code	HCPCS 12045
Min. Negotiated Rate	$175.09
Max. Negotiated Rate	$431.20
Rate for Payer: Aetna Commercial	$289.67
Rate for Payer: BCBS Complete	$183.84
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: Cash Price	$492.80
Rate for Payer: Cash Price	$492.80
Rate for Payer: Mclaren Medicaid	$175.09
Rate for Payer: Meridian Medicaid	$183.84
Rate for Payer: Priority Health Choice Medicaid	$175.09
Rate for Payer: Priority Health Cigna Priority Health	$431.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$336.65
Rate for Payer: Priority Health Narrow Network	$336.65
Rate for Payer: Priority Health SBD	$336.65

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<

Professional

Both

$410.00

Service Code	HCPCS 12041
Hospital Charge Code	12041
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$2,369.57
Rate for Payer: Aetna Commercial	$155.41
Rate for Payer: BCBS Complete	$97.29
Rate for Payer: BCBS Trust/PPO	$2,369.57
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Mclaren Medicaid	$92.66
Rate for Payer: Meridian Medicaid	$97.29
Rate for Payer: Priority Health Choice Medicaid	$92.66
Rate for Payer: Priority Health Cigna Priority Health	$287.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$177.15
Rate for Payer: Priority Health Narrow Network	$177.15
Rate for Payer: Priority Health SBD	$177.15

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<

Facility

$410.00

Service Code	CPT 12041
Hospital Charge Code	12041
Hospital Revenue Code	521
Min. Negotiated Rate	$142.44
Max. Negotiated Rate	$443.50
Rate for Payer: Aetna Commercial	$348.50
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$266.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$254.30
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cofinity Commercial	$352.60
Rate for Payer: Cofinity Commercial	$287.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$369.00
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$348.50
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$348.50
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$287.00
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health SBD	$258.30
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$156.68
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$142.44
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<

Professional

Both

$410.00

Service Code	HCPCS 12041
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$2,369.57
Rate for Payer: Aetna Commercial	$155.41
Rate for Payer: BCBS Complete	$97.29
Rate for Payer: BCBS Trust/PPO	$2,369.57
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Mclaren Medicaid	$92.66
Rate for Payer: Meridian Medicaid	$97.29
Rate for Payer: Priority Health Choice Medicaid	$92.66
Rate for Payer: Priority Health Cigna Priority Health	$287.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$177.15
Rate for Payer: Priority Health Narrow Network	$177.15
Rate for Payer: Priority Health SBD	$177.15

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<

Facility

$410.00

Service Code	CPT 12041
Hospital Charge Code	12041
Hospital Revenue Code	521
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$369.00
Rate for Payer: Aetna Commercial	$348.50
Rate for Payer: Aetna New Business (MI Preferred)	$266.50
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cofinity Commercial	$287.00
Rate for Payer: Cofinity Commercial	$352.60
Rate for Payer: Healthscope Commercial	$369.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$348.50
Rate for Payer: PHP Commercial	$348.50
Rate for Payer: Priority Health Cigna Priority Health	$287.00
Rate for Payer: Priority Health SBD	$258.30

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM

Facility

$516.00

Service Code	CPT 12042
Hospital Charge Code	12042
Hospital Revenue Code	521
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$464.40
Rate for Payer: Aetna Commercial	$438.60
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$335.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$249.39
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cofinity Commercial	$361.20
Rate for Payer: Cofinity Commercial	$443.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$464.40
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$438.60
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$438.60
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$361.20
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health SBD	$325.08
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$211.07
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$191.88
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM

Professional

Both

$516.00

Service Code	HCPCS 12042
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$361.20
Rate for Payer: Aetna Commercial	$208.95
Rate for Payer: BCBS Complete	$131.06
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Mclaren Medicaid	$124.82
Rate for Payer: Meridian Medicaid	$131.06
Rate for Payer: Priority Health Choice Medicaid	$124.82
Rate for Payer: Priority Health Cigna Priority Health	$361.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$238.41
Rate for Payer: Priority Health Narrow Network	$238.41
Rate for Payer: Priority Health SBD	$238.41

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM

Facility

$516.00

Service Code	CPT 12042
Hospital Charge Code	12042
Hospital Revenue Code	521
Min. Negotiated Rate	$325.08
Max. Negotiated Rate	$464.40
Rate for Payer: Aetna Commercial	$438.60
Rate for Payer: Aetna New Business (MI Preferred)	$335.40
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cofinity Commercial	$361.20
Rate for Payer: Cofinity Commercial	$443.76
Rate for Payer: Healthscope Commercial	$464.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$438.60
Rate for Payer: PHP Commercial	$438.60
Rate for Payer: Priority Health Cigna Priority Health	$361.20
Rate for Payer: Priority Health SBD	$325.08

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM

Professional

Both

$516.00

Service Code	HCPCS 12042
Hospital Charge Code	12042
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$361.20
Rate for Payer: Aetna Commercial	$208.95
Rate for Payer: BCBS Complete	$131.06
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Mclaren Medicaid	$124.82
Rate for Payer: Meridian Medicaid	$131.06
Rate for Payer: Priority Health Choice Medicaid	$124.82
Rate for Payer: Priority Health Cigna Priority Health	$361.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$238.41
Rate for Payer: Priority Health Narrow Network	$238.41
Rate for Payer: Priority Health SBD	$238.41

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM

Professional

Both

$1,123.00

Service Code	HCPCS 12047
Min. Negotiated Rate	$212.16
Max. Negotiated Rate	$786.10
Rate for Payer: Aetna Commercial	$383.37
Rate for Payer: BCBS Complete	$237.52
Rate for Payer: BCBS Trust/PPO	$212.16
Rate for Payer: Cash Price	$898.40
Rate for Payer: Cash Price	$898.40
Rate for Payer: Mclaren Medicaid	$226.21
Rate for Payer: Meridian Medicaid	$237.52
Rate for Payer: Priority Health Choice Medicaid	$226.21
Rate for Payer: Priority Health Cigna Priority Health	$786.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$433.65
Rate for Payer: Priority Health Narrow Network	$433.65
Rate for Payer: Priority Health SBD	$433.65

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM

Professional

Both

$554.00

Service Code	HCPCS 12044
Hospital Charge Code	12044
Min. Negotiated Rate	$136.75
Max. Negotiated Rate	$387.80
Rate for Payer: Aetna Commercial	$229.21
Rate for Payer: BCBS Complete	$143.59
Rate for Payer: BCBS Trust/PPO	$361.61
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cash Price	$443.20
Rate for Payer: Mclaren Medicaid	$136.75
Rate for Payer: Meridian Medicaid	$143.59
Rate for Payer: Priority Health Choice Medicaid	$136.75
Rate for Payer: Priority Health Cigna Priority Health	$387.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$261.01
Rate for Payer: Priority Health Narrow Network	$261.01
Rate for Payer: Priority Health SBD	$261.01

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM

Facility

$554.00

Service Code	CPT 12044
Hospital Charge Code	12044
Hospital Revenue Code	521
Min. Negotiated Rate	$349.02
Max. Negotiated Rate	$498.60
Rate for Payer: Aetna Commercial	$470.90
Rate for Payer: Aetna New Business (MI Preferred)	$360.10
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cofinity Commercial	$387.80
Rate for Payer: Cofinity Commercial	$476.44
Rate for Payer: Healthscope Commercial	$498.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$470.90
Rate for Payer: PHP Commercial	$470.90
Rate for Payer: Priority Health Cigna Priority Health	$387.80
Rate for Payer: Priority Health SBD	$349.02

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM

Facility

$554.00

Service Code	CPT 12044
Hospital Charge Code	12044
Hospital Revenue Code	521
Min. Negotiated Rate	$118.54
Max. Negotiated Rate	$1,757.43
Rate for Payer: Aetna Commercial	$470.90
Rate for Payer: Aetna Medicare	$581.18
Rate for Payer: Aetna New Business (MI Preferred)	$360.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$698.54
Rate for Payer: Amish Plain Church Group Commercial	$698.54
Rate for Payer: BCBS Complete	$320.99
Rate for Payer: BCBS MAPPO	$558.83
Rate for Payer: BCBS Trust/PPO	$118.54
Rate for Payer: BCN Medicare Advantage	$558.83
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cofinity Commercial	$476.44
Rate for Payer: Cofinity Commercial	$387.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$558.83
Rate for Payer: Healthscope Commercial	$498.60
Rate for Payer: Mclaren Medicaid	$305.68
Rate for Payer: Mclaren Medicare	$558.83
Rate for Payer: Meridian Medicaid	$320.99
Rate for Payer: Meridian Wellcare - Medicare Advantage	$586.77
Rate for Payer: MI Amish Medical Board Commercial	$642.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$470.90
Rate for Payer: PACE Medicare	$530.89
Rate for Payer: PACE SWMI	$558.83
Rate for Payer: PHP Commercial	$470.90
Rate for Payer: PHP Medicare Advantage	$558.83
Rate for Payer: Priority Health Choice Medicaid	$305.68
Rate for Payer: Priority Health Cigna Priority Health	$387.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,757.43
Rate for Payer: Priority Health Medicare	$558.83
Rate for Payer: Priority Health Narrow Network	$1,405.94
Rate for Payer: Priority Health SBD	$349.02
Rate for Payer: Railroad Medicare Medicare	$558.83
Rate for Payer: UHC All Payor (Choice/PPO)	$231.24
Rate for Payer: UHC Dual Complete DSNP	$558.83
Rate for Payer: UHC Exchange	$210.22
Rate for Payer: UHC Medicare Advantage	$575.59
Rate for Payer: VA VA	$558.83

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM

Professional

Both

$554.00

Service Code	HCPCS 12044
Min. Negotiated Rate	$136.75
Max. Negotiated Rate	$387.80
Rate for Payer: Aetna Commercial	$229.21
Rate for Payer: BCBS Complete	$143.59
Rate for Payer: BCBS Trust/PPO	$361.61
Rate for Payer: Cash Price	$443.20
Rate for Payer: Cash Price	$443.20
Rate for Payer: Mclaren Medicaid	$136.75
Rate for Payer: Meridian Medicaid	$143.59
Rate for Payer: Priority Health Choice Medicaid	$136.75
Rate for Payer: Priority Health Cigna Priority Health	$387.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$261.01
Rate for Payer: Priority Health Narrow Network	$261.01
Rate for Payer: Priority Health SBD	$261.01

PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM

Professional

Both

$680.00

Service Code	HCPCS 12035
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$476.00
Rate for Payer: Aetna Commercial	$260.49
Rate for Payer: BCBS Complete	$161.92
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Mclaren Medicaid	$154.21
Rate for Payer: Meridian Medicaid	$161.92
Rate for Payer: Priority Health Choice Medicaid	$154.21
Rate for Payer: Priority Health Cigna Priority Health	$476.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$295.13
Rate for Payer: Priority Health Narrow Network	$295.13
Rate for Payer: Priority Health SBD	$295.13

PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM

Facility

$680.00

Service Code	CPT 12035
Hospital Charge Code	12035
Hospital Revenue Code	521
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna Commercial	$578.00
Rate for Payer: Aetna New Business (MI Preferred)	$442.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cofinity Commercial	$476.00
Rate for Payer: Cofinity Commercial	$584.80
Rate for Payer: Healthscope Commercial	$612.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$578.00
Rate for Payer: PHP Commercial	$578.00
Rate for Payer: Priority Health Cigna Priority Health	$476.00
Rate for Payer: Priority Health SBD	$428.40

PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM

Professional

Both

$680.00

Service Code	HCPCS 12035
Hospital Charge Code	12035
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$476.00
Rate for Payer: Aetna Commercial	$260.49
Rate for Payer: BCBS Complete	$161.92
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Mclaren Medicaid	$154.21
Rate for Payer: Meridian Medicaid	$161.92
Rate for Payer: Priority Health Choice Medicaid	$154.21
Rate for Payer: Priority Health Cigna Priority Health	$476.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$295.13
Rate for Payer: Priority Health Narrow Network	$295.13
Rate for Payer: Priority Health SBD	$295.13

PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM

Facility

$680.00

Service Code	CPT 12035
Hospital Charge Code	12035
Hospital Revenue Code	521
Min. Negotiated Rate	$194.08
Max. Negotiated Rate	$612.00
Rate for Payer: Aetna Commercial	$578.00
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$442.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$233.21
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cofinity Commercial	$476.00
Rate for Payer: Cofinity Commercial	$584.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$612.00
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$578.00
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$578.00
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$476.00
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health SBD	$428.40
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$260.78
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$237.07
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM

Professional

Both

$852.00

Service Code	HCPCS 12036
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$596.40
Rate for Payer: Aetna Commercial	$306.51
Rate for Payer: BCBS Complete	$189.43
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Mclaren Medicaid	$180.41
Rate for Payer: Meridian Medicaid	$189.43
Rate for Payer: Priority Health Choice Medicaid	$180.41
Rate for Payer: Priority Health Cigna Priority Health	$596.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$344.44
Rate for Payer: Priority Health Narrow Network	$344.44
Rate for Payer: Priority Health SBD	$344.44

PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<

Facility

$386.00

Service Code	CPT 12031
Hospital Charge Code	12031
Hospital Revenue Code	521
Min. Negotiated Rate	$243.18
Max. Negotiated Rate	$347.40
Rate for Payer: Aetna Commercial	$328.10
Rate for Payer: Aetna New Business (MI Preferred)	$250.90
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cofinity Commercial	$270.20
Rate for Payer: Cofinity Commercial	$331.96
Rate for Payer: Healthscope Commercial	$347.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$328.10
Rate for Payer: PHP Commercial	$328.10
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health SBD	$243.18

PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<

Professional

Both

$386.00

Service Code	HCPCS 12031
Hospital Charge Code	12031
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$270.20
Rate for Payer: Aetna Commercial	$161.34
Rate for Payer: BCBS Complete	$101.54
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Mclaren Medicaid	$96.70
Rate for Payer: Meridian Medicaid	$101.54
Rate for Payer: Priority Health Choice Medicaid	$96.70
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$185.38
Rate for Payer: Priority Health Narrow Network	$185.38
Rate for Payer: Priority Health SBD	$185.38

PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<

Facility

$386.00

Service Code	CPT 12031
Hospital Charge Code	12031
Hospital Revenue Code	521
Min. Negotiated Rate	$148.66
Max. Negotiated Rate	$443.50
Rate for Payer: Aetna Commercial	$328.10
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$250.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$233.21
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cofinity Commercial	$270.20
Rate for Payer: Cofinity Commercial	$331.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$347.40
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$328.10
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$328.10
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health SBD	$243.18
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$163.53
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$148.66
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<

Professional

Both

$386.00

Service Code	HCPCS 12031
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$270.20
Rate for Payer: Aetna Commercial	$161.34
Rate for Payer: BCBS Complete	$101.54
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Mclaren Medicaid	$96.70
Rate for Payer: Meridian Medicaid	$101.54
Rate for Payer: Priority Health Choice Medicaid	$96.70
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$185.38
Rate for Payer: Priority Health Narrow Network	$185.38
Rate for Payer: Priority Health SBD	$185.38

Know your out-of-pocket cost for care.

All Charges