|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$937.55 |
| Rate for Payer: Aetna Commercial |
$785.45
|
| Rate for Payer: Aetna Medicare |
$609.61
|
| Rate for Payer: BCBS Complete |
$409.50
|
| Rate for Payer: BCBS MAPPO |
$586.16
|
| Rate for Payer: BCBS Trust/PPO |
$154.79
|
| Rate for Payer: BCN Commercial |
$897.21
|
| Rate for Payer: BCN Medicare Advantage |
$586.16
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$785.45
|
| Rate for Payer: Cofinity Commercial |
$844.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.16
|
| Rate for Payer: Mclaren Medicaid |
$390.00
|
| Rate for Payer: Meridian Medicaid |
$409.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$615.47
|
| Rate for Payer: PACE SWMI |
$586.16
|
| Rate for Payer: PHP Medicare Advantage |
$586.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$937.55
|
| Rate for Payer: Priority Health Medicare |
$586.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$937.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.16
|
| Rate for Payer: UHC Medicare Advantage |
$603.74
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$221.09 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$454.54
|
| Rate for Payer: Aetna Medicare |
$352.78
|
| Rate for Payer: BCBS Complete |
$232.14
|
| Rate for Payer: BCBS MAPPO |
$339.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: BCN Commercial |
$789.70
|
| Rate for Payer: BCN Medicare Advantage |
$339.21
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cofinity Commercial |
$488.46
|
| Rate for Payer: Cofinity Commercial |
$454.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.21
|
| Rate for Payer: Mclaren Medicaid |
$221.09
|
| Rate for Payer: Meridian Medicaid |
$232.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.17
|
| Rate for Payer: PACE SWMI |
$339.21
|
| Rate for Payer: PHP Medicare Advantage |
$339.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$531.59
|
| Rate for Payer: Priority Health Medicare |
$339.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.21
|
| Rate for Payer: UHC Medicare Advantage |
$349.39
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$3,954.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$614.51 |
| Max. Negotiated Rate |
$2,767.80 |
| Rate for Payer: Aetna Commercial |
$1,266.33
|
| Rate for Payer: Aetna Medicare |
$982.82
|
| Rate for Payer: BCBS Complete |
$645.24
|
| Rate for Payer: BCBS MAPPO |
$945.02
|
| Rate for Payer: BCBS Trust/PPO |
$746.49
|
| Rate for Payer: BCN Commercial |
$1,403.48
|
| Rate for Payer: BCN Medicare Advantage |
$945.02
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,360.83
|
| Rate for Payer: Cofinity Commercial |
$1,266.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.02
|
| Rate for Payer: Mclaren Medicaid |
$614.51
|
| Rate for Payer: Meridian Medicaid |
$645.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$992.27
|
| Rate for Payer: PACE SWMI |
$945.02
|
| Rate for Payer: PHP Medicare Advantage |
$945.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,767.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,466.59
|
| Rate for Payer: Priority Health Medicare |
$945.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,466.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.02
|
| Rate for Payer: UHC Medicare Advantage |
$973.37
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,065.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$826.00 |
| Max. Negotiated Rate |
$1,445.50 |
| Rate for Payer: BCBS Complete |
$826.00
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.50
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$294.79 |
| Max. Negotiated Rate |
$1,017.80 |
| Rate for Payer: Aetna Commercial |
$602.34
|
| Rate for Payer: Aetna Medicare |
$467.49
|
| Rate for Payer: BCBS Complete |
$309.53
|
| Rate for Payer: BCBS MAPPO |
$449.51
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: BCN Commercial |
$894.28
|
| Rate for Payer: BCN Medicare Advantage |
$449.51
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$647.29
|
| Rate for Payer: Cofinity Commercial |
$602.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.51
|
| Rate for Payer: Mclaren Medicaid |
$294.79
|
| Rate for Payer: Meridian Medicaid |
$309.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$471.99
|
| Rate for Payer: PACE SWMI |
$449.51
|
| Rate for Payer: PHP Medicare Advantage |
$449.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.15
|
| Rate for Payer: Priority Health Medicare |
$449.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$637.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.51
|
| Rate for Payer: UHC Medicare Advantage |
$463.00
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Aetna Commercial |
$485.75
|
| Rate for Payer: Aetna Medicare |
$377.00
|
| Rate for Payer: BCBS Complete |
$251.38
|
| Rate for Payer: BCBS MAPPO |
$362.50
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$542.92
|
| Rate for Payer: BCN Medicare Advantage |
$362.50
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$522.00
|
| Rate for Payer: Cofinity Commercial |
$485.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.50
|
| Rate for Payer: Mclaren Medicaid |
$239.41
|
| Rate for Payer: Meridian Medicaid |
$251.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$380.62
|
| Rate for Payer: PACE SWMI |
$362.50
|
| Rate for Payer: PHP Medicare Advantage |
$362.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.34
|
| Rate for Payer: Priority Health Medicare |
$362.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$567.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.50
|
| Rate for Payer: UHC Medicare Advantage |
$373.38
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$452.22 |
| Rate for Payer: Aetna Commercial |
$284.88
|
| Rate for Payer: Aetna Medicare |
$221.10
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS MAPPO |
$212.60
|
| Rate for Payer: BCBS Trust/PPO |
$452.22
|
| Rate for Payer: BCN Commercial |
$317.15
|
| Rate for Payer: BCN Medicare Advantage |
$212.60
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cofinity Commercial |
$306.14
|
| Rate for Payer: Cofinity Commercial |
$284.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.60
|
| Rate for Payer: Mclaren Medicaid |
$140.79
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$223.23
|
| Rate for Payer: PACE SWMI |
$212.60
|
| Rate for Payer: PHP Medicare Advantage |
$212.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.70
|
| Rate for Payer: Priority Health Medicare |
$212.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.60
|
| Rate for Payer: UHC Medicare Advantage |
$218.98
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$192.77 |
| Max. Negotiated Rate |
$747.19 |
| Rate for Payer: Aetna Commercial |
$394.16
|
| Rate for Payer: Aetna Medicare |
$305.92
|
| Rate for Payer: BCBS Complete |
$202.41
|
| Rate for Payer: BCBS MAPPO |
$294.15
|
| Rate for Payer: BCBS Trust/PPO |
$364.91
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: BCN Medicare Advantage |
$294.15
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cofinity Commercial |
$394.16
|
| Rate for Payer: Cofinity Commercial |
$423.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.15
|
| Rate for Payer: Mclaren Medicaid |
$192.77
|
| Rate for Payer: Meridian Medicaid |
$202.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$308.86
|
| Rate for Payer: PACE SWMI |
$294.15
|
| Rate for Payer: PHP Medicare Advantage |
$294.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.47
|
| Rate for Payer: Priority Health Medicare |
$294.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.15
|
| Rate for Payer: UHC Medicare Advantage |
$302.97
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$220.16
|
| Rate for Payer: Aetna Medicare |
$170.87
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$164.30
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$164.30
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Cofinity Commercial |
$236.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.30
|
| Rate for Payer: Mclaren Medicaid |
$108.20
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.52
|
| Rate for Payer: PACE SWMI |
$164.30
|
| Rate for Payer: PHP Medicare Advantage |
$164.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.16
|
| Rate for Payer: Priority Health Medicare |
$164.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.30
|
| Rate for Payer: UHC Medicare Advantage |
$169.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$220.16
|
| Rate for Payer: Aetna Medicare |
$170.87
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$164.30
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$164.30
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$236.59
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.30
|
| Rate for Payer: Mclaren Medicaid |
$108.20
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.52
|
| Rate for Payer: PACE SWMI |
$164.30
|
| Rate for Payer: PHP Medicare Advantage |
$164.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.16
|
| Rate for Payer: Priority Health Medicare |
$164.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.30
|
| Rate for Payer: UHC Medicare Advantage |
$169.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$392.40 |
| Rate for Payer: Aetna Commercial |
$370.60
|
| Rate for Payer: Aetna Medicare |
$113.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.25
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$109.00
|
| Rate for Payer: BCBS Trust/PPO |
$338.99
|
| Rate for Payer: BCN Commercial |
$338.99
|
| Rate for Payer: BCN Medicare Advantage |
$109.00
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$374.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.00
|
| Rate for Payer: Healthscope Commercial |
$392.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.00
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.60
|
| Rate for Payer: PACE Senior Care Partners |
$103.55
|
| Rate for Payer: PACE SWMI |
$109.00
|
| Rate for Payer: PHP Commercial |
$370.60
|
| Rate for Payer: PHP Medicare Advantage |
$109.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.32
|
| Rate for Payer: Priority Health Medicare |
$109.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.92
|
| Rate for Payer: Railroad Medicare Medicare |
$109.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.68
|
| Rate for Payer: UHC Core |
$364.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.00
|
| Rate for Payer: UHC Medicare Advantage |
$112.27
|
| Rate for Payer: VA VA |
$109.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$265.92 |
| Max. Negotiated Rate |
$392.40 |
| Rate for Payer: Aetna Commercial |
$370.60
|
| Rate for Payer: BCBS Trust/PPO |
$336.94
|
| Rate for Payer: BCN Commercial |
$336.94
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$374.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.80
|
| Rate for Payer: Healthscope Commercial |
$392.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.60
|
| Rate for Payer: PHP Commercial |
$370.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.68
|
| Rate for Payer: UHC Core |
$364.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$259.53
|
| Rate for Payer: Aetna Medicare |
$201.43
|
| Rate for Payer: BCBS Complete |
$133.52
|
| Rate for Payer: BCBS MAPPO |
$193.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$193.68
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Commercial |
$259.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.68
|
| Rate for Payer: Mclaren Medicaid |
$127.16
|
| Rate for Payer: Meridian Medicaid |
$133.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.36
|
| Rate for Payer: PACE SWMI |
$193.68
|
| Rate for Payer: PHP Medicare Advantage |
$193.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.74
|
| Rate for Payer: Priority Health Medicare |
$193.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.68
|
| Rate for Payer: UHC Medicare Advantage |
$199.49
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$259.53
|
| Rate for Payer: Aetna Medicare |
$201.43
|
| Rate for Payer: BCBS Complete |
$133.52
|
| Rate for Payer: BCBS MAPPO |
$193.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$193.68
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Commercial |
$259.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.68
|
| Rate for Payer: Mclaren Medicaid |
$127.16
|
| Rate for Payer: Meridian Medicaid |
$133.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.36
|
| Rate for Payer: PACE SWMI |
$193.68
|
| Rate for Payer: PHP Medicare Advantage |
$193.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.74
|
| Rate for Payer: Priority Health Medicare |
$193.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.68
|
| Rate for Payer: UHC Medicare Advantage |
$199.49
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$334.84 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Aetna Commercial |
$466.65
|
| Rate for Payer: BCBS Trust/PPO |
$424.27
|
| Rate for Payer: BCN Commercial |
$424.27
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$472.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.20
|
| Rate for Payer: Healthscope Commercial |
$494.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.65
|
| Rate for Payer: PHP Commercial |
$466.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.12
|
| Rate for Payer: UHC Core |
$458.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.39 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Aetna Commercial |
$466.65
|
| Rate for Payer: Aetna Medicare |
$142.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.56
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$137.25
|
| Rate for Payer: BCBS Trust/PPO |
$426.85
|
| Rate for Payer: BCN Commercial |
$426.85
|
| Rate for Payer: BCN Medicare Advantage |
$137.25
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$472.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.25
|
| Rate for Payer: Healthscope Commercial |
$494.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.75
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.65
|
| Rate for Payer: PACE Senior Care Partners |
$130.39
|
| Rate for Payer: PACE SWMI |
$137.25
|
| Rate for Payer: PHP Commercial |
$466.65
|
| Rate for Payer: PHP Medicare Advantage |
$137.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.63
|
| Rate for Payer: Priority Health Medicare |
$137.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.84
|
| Rate for Payer: Railroad Medicare Medicare |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.12
|
| Rate for Payer: UHC Core |
$458.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.25
|
| Rate for Payer: UHC Medicare Advantage |
$141.37
|
| Rate for Payer: VA VA |
$137.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$280.64
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$209.43
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$209.43
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$280.64
|
| Rate for Payer: Cofinity Commercial |
$301.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.43
|
| Rate for Payer: Mclaren Medicaid |
$137.17
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$219.90
|
| Rate for Payer: PACE SWMI |
$209.43
|
| Rate for Payer: PHP Medicare Advantage |
$209.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Medicare |
$209.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.43
|
| Rate for Payer: UHC Medicare Advantage |
$215.71
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$280.64
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$209.43
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$209.43
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$301.58
|
| Rate for Payer: Cofinity Commercial |
$280.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.43
|
| Rate for Payer: Mclaren Medicaid |
$137.17
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$219.90
|
| Rate for Payer: PACE SWMI |
$209.43
|
| Rate for Payer: PHP Medicare Advantage |
$209.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Medicare |
$209.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.43
|
| Rate for Payer: UHC Medicare Advantage |
$215.71
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$379.36 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: BCBS Trust/PPO |
$480.68
|
| Rate for Payer: BCN Commercial |
$480.68
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.70
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.36
|
| Rate for Payer: UHC Core |
$519.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$147.72 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna Medicare |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$194.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$194.38
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$155.50
|
| Rate for Payer: BCBS Trust/PPO |
$483.60
|
| Rate for Payer: BCN Commercial |
$483.60
|
| Rate for Payer: BCN Medicare Advantage |
$155.50
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$163.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.70
|
| Rate for Payer: PACE Senior Care Partners |
$147.72
|
| Rate for Payer: PACE SWMI |
$155.50
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: PHP Medicare Advantage |
$155.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.14
|
| Rate for Payer: Priority Health Medicare |
$155.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.36
|
| Rate for Payer: Railroad Medicare Medicare |
$155.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.36
|
| Rate for Payer: UHC Core |
$519.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.50
|
| Rate for Payer: UHC Medicare Advantage |
$160.16
|
| Rate for Payer: VA VA |
$155.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$475.72 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna Commercial |
$663.00
|
| Rate for Payer: BCBS Trust/PPO |
$602.78
|
| Rate for Payer: BCN Commercial |
$602.78
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$670.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.00
|
| Rate for Payer: Healthscope Commercial |
$702.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.00
|
| 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 HMO/PPO/Tiered Network |
$678.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$475.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.40
|
| Rate for Payer: UHC Core |
$651.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.00
|
|
|
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 |
$566.38 |
| Rate for Payer: Aetna Commercial |
$288.73
|
| Rate for Payer: Aetna Medicare |
$224.09
|
| Rate for Payer: BCBS Complete |
$147.39
|
| Rate for Payer: BCBS MAPPO |
$215.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$215.47
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$310.28
|
| Rate for Payer: Cofinity Commercial |
$288.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.47
|
| Rate for Payer: Mclaren Medicaid |
$140.37
|
| Rate for Payer: Meridian Medicaid |
$147.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.24
|
| Rate for Payer: PACE SWMI |
$215.47
|
| Rate for Payer: PHP Medicare Advantage |
$215.47
|
| 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 Medicare |
$215.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.47
|
| Rate for Payer: UHC Medicare Advantage |
$221.93
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna Commercial |
$663.00
|
| Rate for Payer: Aetna Medicare |
$202.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.75
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$195.00
|
| Rate for Payer: BCBS Trust/PPO |
$606.45
|
| Rate for Payer: BCN Commercial |
$606.45
|
| Rate for Payer: BCN Medicare Advantage |
$195.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$670.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.00
|
| Rate for Payer: Healthscope Commercial |
$702.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.00
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.00
|
| Rate for Payer: PACE Senior Care Partners |
$185.25
|
| Rate for Payer: PACE SWMI |
$195.00
|
| Rate for Payer: PHP Commercial |
$663.00
|
| Rate for Payer: PHP Medicare Advantage |
$195.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.60
|
| Rate for Payer: Priority Health Medicare |
$195.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$475.72
|
| Rate for Payer: Railroad Medicare Medicare |
$195.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.40
|
| Rate for Payer: UHC Core |
$651.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.00
|
| Rate for Payer: UHC Medicare Advantage |
$200.85
|
| Rate for Payer: VA VA |
$195.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$140.37 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Aetna Commercial |
$288.73
|
| Rate for Payer: Aetna Medicare |
$224.09
|
| Rate for Payer: BCBS Complete |
$147.39
|
| Rate for Payer: BCBS MAPPO |
$215.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$215.47
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$310.28
|
| Rate for Payer: Cofinity Commercial |
$288.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.47
|
| Rate for Payer: Mclaren Medicaid |
$140.37
|
| Rate for Payer: Meridian Medicaid |
$147.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.24
|
| Rate for Payer: PACE SWMI |
$215.47
|
| Rate for Payer: PHP Medicare Advantage |
$215.47
|
| 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 Medicare |
$215.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.47
|
| Rate for Payer: UHC Medicare Advantage |
$221.93
|
|
|
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 |
$609.87 |
| Rate for Payer: Aetna Commercial |
$358.97
|
| Rate for Payer: Aetna Medicare |
$278.61
|
| Rate for Payer: BCBS Complete |
$183.84
|
| Rate for Payer: BCBS MAPPO |
$267.89
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$609.87
|
| Rate for Payer: BCN Medicare Advantage |
$267.89
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$358.97
|
| Rate for Payer: Cofinity Commercial |
$385.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.89
|
| Rate for Payer: Mclaren Medicaid |
$175.09
|
| Rate for Payer: Meridian Medicaid |
$183.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$281.28
|
| Rate for Payer: PACE SWMI |
$267.89
|
| Rate for Payer: PHP Medicare Advantage |
$267.89
|
| 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 Medicare |
$267.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.89
|
| Rate for Payer: UHC Medicare Advantage |
$275.93
|
|
