|
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 |
$188.73
|
| Rate for Payer: Aetna Medicare |
$146.47
|
| Rate for Payer: BCBS Complete |
$97.29
|
| Rate for Payer: BCBS MAPPO |
$140.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$140.84
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Cofinity Commercial |
$202.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.84
|
| Rate for Payer: Mclaren Medicaid |
$92.66
|
| Rate for Payer: Meridian Medicaid |
$97.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.88
|
| Rate for Payer: PACE SWMI |
$140.84
|
| Rate for Payer: PHP Medicare Advantage |
$140.84
|
| 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 Medicare |
$140.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.84
|
| Rate for Payer: UHC Medicare Advantage |
$145.07
|
|
|
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 |
$188.73
|
| Rate for Payer: Aetna Medicare |
$146.47
|
| Rate for Payer: BCBS Complete |
$97.29
|
| Rate for Payer: BCBS MAPPO |
$140.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$140.84
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Cofinity Commercial |
$202.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.84
|
| Rate for Payer: Mclaren Medicaid |
$92.66
|
| Rate for Payer: Meridian Medicaid |
$97.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.88
|
| Rate for Payer: PACE SWMI |
$140.84
|
| Rate for Payer: PHP Medicare Advantage |
$140.84
|
| 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 Medicare |
$140.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.84
|
| Rate for Payer: UHC Medicare Advantage |
$145.07
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$250.06 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: BCBS Trust/PPO |
$316.85
|
| Rate for Payer: BCN Commercial |
$316.85
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.50
|
| 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 HMO/PPO/Tiered Network |
$356.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.80
|
| Rate for Payer: UHC Core |
$342.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: Aetna Medicare |
$106.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.12
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$102.50
|
| Rate for Payer: BCBS Trust/PPO |
$318.78
|
| Rate for Payer: BCN Commercial |
$318.78
|
| Rate for Payer: BCN Medicare Advantage |
$102.50
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.50
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.50
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.50
|
| Rate for Payer: PACE Senior Care Partners |
$97.38
|
| Rate for Payer: PACE SWMI |
$102.50
|
| Rate for Payer: PHP Commercial |
$348.50
|
| Rate for Payer: PHP Medicare Advantage |
$102.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$356.70
|
| Rate for Payer: Priority Health Medicare |
$102.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.06
|
| Rate for Payer: Railroad Medicare Medicare |
$102.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.80
|
| Rate for Payer: UHC Core |
$342.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.50
|
| Rate for Payer: UHC Medicare Advantage |
$105.58
|
| Rate for Payer: VA VA |
$102.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$122.55 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna Commercial |
$438.60
|
| Rate for Payer: Aetna Medicare |
$134.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.25
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$129.00
|
| Rate for Payer: BCBS Trust/PPO |
$401.19
|
| Rate for Payer: BCN Commercial |
$401.19
|
| Rate for Payer: BCN Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.00
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$438.60
|
| Rate for Payer: PACE Senior Care Partners |
$122.55
|
| Rate for Payer: PACE SWMI |
$129.00
|
| Rate for Payer: PHP Commercial |
$438.60
|
| Rate for Payer: PHP Medicare Advantage |
$129.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.92
|
| Rate for Payer: Priority Health Medicare |
$129.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.71
|
| Rate for Payer: Railroad Medicare Medicare |
$129.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.08
|
| Rate for Payer: UHC Core |
$430.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.00
|
| Rate for Payer: UHC Medicare Advantage |
$132.87
|
| Rate for Payer: VA VA |
$129.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.00
|
|
|
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 |
$454.96 |
| Rate for Payer: Aetna Commercial |
$253.53
|
| Rate for Payer: Aetna Medicare |
$196.77
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS MAPPO |
$189.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$454.96
|
| Rate for Payer: BCN Medicare Advantage |
$189.20
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$253.53
|
| Rate for Payer: Cofinity Commercial |
$272.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.20
|
| Rate for Payer: Mclaren Medicaid |
$124.82
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.66
|
| Rate for Payer: PACE SWMI |
$189.20
|
| Rate for Payer: PHP Medicare Advantage |
$189.20
|
| 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 Medicare |
$189.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.20
|
| Rate for Payer: UHC Medicare Advantage |
$194.88
|
|
|
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 |
$454.96 |
| Rate for Payer: Aetna Commercial |
$253.53
|
| Rate for Payer: Aetna Medicare |
$196.77
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS MAPPO |
$189.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$454.96
|
| Rate for Payer: BCN Medicare Advantage |
$189.20
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$272.45
|
| Rate for Payer: Cofinity Commercial |
$253.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.20
|
| Rate for Payer: Mclaren Medicaid |
$124.82
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.66
|
| Rate for Payer: PACE SWMI |
$189.20
|
| Rate for Payer: PHP Medicare Advantage |
$189.20
|
| 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 Medicare |
$189.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.20
|
| Rate for Payer: UHC Medicare Advantage |
$194.88
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$314.71 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna Commercial |
$438.60
|
| Rate for Payer: BCBS Trust/PPO |
$398.76
|
| Rate for Payer: BCN Commercial |
$398.76
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.00
|
| 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 HMO/PPO/Tiered Network |
$448.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.08
|
| Rate for Payer: UHC Core |
$430.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.00
|
|
|
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 |
$804.85 |
| Rate for Payer: Aetna Commercial |
$465.80
|
| Rate for Payer: Aetna Medicare |
$361.51
|
| Rate for Payer: BCBS Complete |
$237.52
|
| Rate for Payer: BCBS MAPPO |
$347.61
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$804.85
|
| Rate for Payer: BCN Medicare Advantage |
$347.61
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cofinity Commercial |
$500.56
|
| Rate for Payer: Cofinity Commercial |
$465.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.61
|
| Rate for Payer: Mclaren Medicaid |
$226.21
|
| Rate for Payer: Meridian Medicaid |
$237.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$364.99
|
| Rate for Payer: PACE SWMI |
$347.61
|
| Rate for Payer: PHP Medicare Advantage |
$347.61
|
| 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 Medicare |
$347.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$433.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.61
|
| Rate for Payer: UHC Medicare Advantage |
$358.04
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$131.58 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$470.90
|
| Rate for Payer: Aetna Medicare |
$144.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.12
|
| Rate for Payer: BCBS Complete |
$432.60
|
| Rate for Payer: BCBS MAPPO |
$138.50
|
| Rate for Payer: BCBS Trust/PPO |
$430.74
|
| Rate for Payer: BCN Commercial |
$430.74
|
| Rate for Payer: BCN Medicare Advantage |
$138.50
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$476.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.50
|
| Rate for Payer: Healthscope Commercial |
$498.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.50
|
| Rate for Payer: Mclaren Medicaid |
$412.00
|
| Rate for Payer: Meridian Medicaid |
$432.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$470.90
|
| Rate for Payer: PACE Senior Care Partners |
$131.58
|
| Rate for Payer: PACE SWMI |
$138.50
|
| Rate for Payer: PHP Commercial |
$470.90
|
| Rate for Payer: PHP Medicare Advantage |
$138.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.98
|
| Rate for Payer: Priority Health Medicare |
$138.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.88
|
| Rate for Payer: Railroad Medicare Medicare |
$138.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.52
|
| Rate for Payer: UHC Core |
$462.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.50
|
| Rate for Payer: UHC Medicare Advantage |
$142.66
|
| Rate for Payer: VA VA |
$138.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.50
|
|
|
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 |
$560.51 |
| Rate for Payer: Aetna Commercial |
$278.87
|
| Rate for Payer: Aetna Medicare |
$216.43
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$208.11
|
| Rate for Payer: BCBS Trust/PPO |
$361.61
|
| Rate for Payer: BCN Commercial |
$560.51
|
| Rate for Payer: BCN Medicare Advantage |
$208.11
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$299.68
|
| Rate for Payer: Cofinity Commercial |
$278.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.11
|
| Rate for Payer: Mclaren Medicaid |
$136.75
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.52
|
| Rate for Payer: PACE SWMI |
$208.11
|
| Rate for Payer: PHP Medicare Advantage |
$208.11
|
| 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 Medicare |
$208.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.11
|
| Rate for Payer: UHC Medicare Advantage |
$214.35
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$337.88 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$470.90
|
| Rate for Payer: BCBS Trust/PPO |
$428.13
|
| Rate for Payer: BCN Commercial |
$428.13
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$476.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.20
|
| Rate for Payer: Healthscope Commercial |
$498.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.50
|
| 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 HMO/PPO/Tiered Network |
$481.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.52
|
| Rate for Payer: UHC Core |
$462.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.50
|
|
|
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 |
$560.51 |
| Rate for Payer: Aetna Commercial |
$278.87
|
| Rate for Payer: Aetna Medicare |
$216.43
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$208.11
|
| Rate for Payer: BCBS Trust/PPO |
$361.61
|
| Rate for Payer: BCN Commercial |
$560.51
|
| Rate for Payer: BCN Medicare Advantage |
$208.11
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$299.68
|
| Rate for Payer: Cofinity Commercial |
$278.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.11
|
| Rate for Payer: Mclaren Medicaid |
$136.75
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.52
|
| Rate for Payer: PACE SWMI |
$208.11
|
| Rate for Payer: PHP Medicare Advantage |
$208.11
|
| 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 Medicare |
$208.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.11
|
| Rate for Payer: UHC Medicare Advantage |
$214.35
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$578.00
|
| Rate for Payer: Aetna Medicare |
$176.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.50
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$528.70
|
| Rate for Payer: BCN Commercial |
$528.70
|
| Rate for Payer: BCN Medicare Advantage |
$170.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cofinity Commercial |
$584.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.00
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.00
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$578.00
|
| Rate for Payer: PACE Senior Care Partners |
$161.50
|
| Rate for Payer: PACE SWMI |
$170.00
|
| Rate for Payer: PHP Commercial |
$578.00
|
| Rate for Payer: PHP Medicare Advantage |
$170.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$591.60
|
| Rate for Payer: Priority Health Medicare |
$170.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.73
|
| Rate for Payer: Railroad Medicare Medicare |
$170.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.40
|
| Rate for Payer: UHC Core |
$567.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.00
|
| Rate for Payer: UHC Medicare Advantage |
$175.10
|
| Rate for Payer: VA VA |
$170.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.00
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$414.73 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$578.00
|
| Rate for Payer: BCBS Trust/PPO |
$525.50
|
| Rate for Payer: BCN Commercial |
$525.50
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cofinity Commercial |
$584.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.00
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.00
|
| 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 HMO/PPO/Tiered Network |
$591.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.40
|
| Rate for Payer: UHC Core |
$567.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.00
|
|
|
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 |
$315.96
|
| Rate for Payer: Aetna Medicare |
$245.22
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS MAPPO |
$235.79
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$459.81
|
| Rate for Payer: BCN Medicare Advantage |
$235.79
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cofinity Commercial |
$339.54
|
| Rate for Payer: Cofinity Commercial |
$315.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.79
|
| Rate for Payer: Mclaren Medicaid |
$154.21
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$247.58
|
| Rate for Payer: PACE SWMI |
$235.79
|
| Rate for Payer: PHP Medicare Advantage |
$235.79
|
| 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 Medicare |
$235.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.79
|
| Rate for Payer: UHC Medicare Advantage |
$242.86
|
|
|
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 |
$315.96
|
| Rate for Payer: Aetna Medicare |
$245.22
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS MAPPO |
$235.79
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$459.81
|
| Rate for Payer: BCN Medicare Advantage |
$235.79
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cofinity Commercial |
$339.54
|
| Rate for Payer: Cofinity Commercial |
$315.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.79
|
| Rate for Payer: Mclaren Medicaid |
$154.21
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$247.58
|
| Rate for Payer: PACE SWMI |
$235.79
|
| Rate for Payer: PHP Medicare Advantage |
$235.79
|
| 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 Medicare |
$235.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.79
|
| Rate for Payer: UHC Medicare Advantage |
$242.86
|
|
|
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 |
$370.05
|
| Rate for Payer: Aetna Medicare |
$287.21
|
| Rate for Payer: BCBS Complete |
$189.43
|
| Rate for Payer: BCBS MAPPO |
$276.16
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$510.07
|
| Rate for Payer: BCN Medicare Advantage |
$276.16
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Commercial |
$397.67
|
| Rate for Payer: Cofinity Commercial |
$370.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.16
|
| Rate for Payer: Mclaren Medicaid |
$180.41
|
| Rate for Payer: Meridian Medicaid |
$189.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$289.97
|
| Rate for Payer: PACE SWMI |
$276.16
|
| Rate for Payer: PHP Medicare Advantage |
$276.16
|
| 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 Medicare |
$276.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.16
|
| Rate for Payer: UHC Medicare Advantage |
$284.44
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.68 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Aetna Commercial |
$328.10
|
| Rate for Payer: Aetna Medicare |
$100.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.62
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$96.50
|
| Rate for Payer: BCBS Trust/PPO |
$300.12
|
| Rate for Payer: BCN Commercial |
$300.12
|
| Rate for Payer: BCN Medicare Advantage |
$96.50
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.50
|
| Rate for Payer: Healthscope Commercial |
$347.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.50
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$101.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.10
|
| Rate for Payer: PACE Senior Care Partners |
$91.68
|
| Rate for Payer: PACE SWMI |
$96.50
|
| Rate for Payer: PHP Commercial |
$328.10
|
| Rate for Payer: PHP Medicare Advantage |
$96.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.82
|
| Rate for Payer: Priority Health Medicare |
$96.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.42
|
| Rate for Payer: Railroad Medicare Medicare |
$96.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.68
|
| Rate for Payer: UHC Core |
$322.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.50
|
| Rate for Payer: UHC Medicare Advantage |
$99.40
|
| Rate for Payer: VA VA |
$96.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$235.42 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Aetna Commercial |
$328.10
|
| Rate for Payer: BCBS Trust/PPO |
$298.30
|
| Rate for Payer: BCN Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.80
|
| Rate for Payer: Healthscope Commercial |
$347.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.50
|
| 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 HMO/PPO/Tiered Network |
$335.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.68
|
| Rate for Payer: UHC Core |
$322.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.50
|
|
|
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 |
$310.99 |
| Rate for Payer: Aetna Commercial |
$196.52
|
| Rate for Payer: Aetna Medicare |
$152.53
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$146.66
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$310.99
|
| Rate for Payer: BCN Medicare Advantage |
$146.66
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$196.52
|
| Rate for Payer: Cofinity Commercial |
$211.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.66
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.99
|
| Rate for Payer: PACE SWMI |
$146.66
|
| Rate for Payer: PHP Medicare Advantage |
$146.66
|
| 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 Medicare |
$146.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.66
|
| Rate for Payer: UHC Medicare Advantage |
$151.06
|
|
|
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 |
$310.99 |
| Rate for Payer: Aetna Commercial |
$196.52
|
| Rate for Payer: Aetna Medicare |
$152.53
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$146.66
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$310.99
|
| Rate for Payer: BCN Medicare Advantage |
$146.66
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$196.52
|
| Rate for Payer: Cofinity Commercial |
$211.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.66
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.99
|
| Rate for Payer: PACE SWMI |
$146.66
|
| Rate for Payer: PHP Medicare Advantage |
$146.66
|
| 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 Medicare |
$146.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.66
|
| Rate for Payer: UHC Medicare Advantage |
$151.06
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$300.68 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna Commercial |
$419.05
|
| Rate for Payer: BCBS Trust/PPO |
$380.99
|
| Rate for Payer: BCN Commercial |
$380.99
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cofinity Commercial |
$423.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.40
|
| Rate for Payer: Healthscope Commercial |
$443.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.05
|
| Rate for Payer: PHP Commercial |
$419.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.84
|
| Rate for Payer: UHC Core |
$411.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.75
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$358.50 |
| Rate for Payer: Aetna Commercial |
$245.68
|
| Rate for Payer: Aetna Medicare |
$190.67
|
| Rate for Payer: BCBS Complete |
$127.48
|
| Rate for Payer: BCBS MAPPO |
$183.34
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$358.50
|
| Rate for Payer: BCN Medicare Advantage |
$183.34
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cofinity Commercial |
$245.68
|
| Rate for Payer: Cofinity Commercial |
$264.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.34
|
| Rate for Payer: Mclaren Medicaid |
$121.41
|
| Rate for Payer: Meridian Medicaid |
$127.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$192.51
|
| Rate for Payer: PACE SWMI |
$183.34
|
| Rate for Payer: PHP Medicare Advantage |
$183.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.82
|
| Rate for Payer: Priority Health Medicare |
$183.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.34
|
| Rate for Payer: UHC Medicare Advantage |
$188.84
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$358.50 |
| Rate for Payer: Aetna Commercial |
$245.68
|
| Rate for Payer: Aetna Medicare |
$190.67
|
| Rate for Payer: BCBS Complete |
$127.48
|
| Rate for Payer: BCBS MAPPO |
$183.34
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$358.50
|
| Rate for Payer: BCN Medicare Advantage |
$183.34
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Cofinity Commercial |
$245.68
|
| Rate for Payer: Cofinity Commercial |
$264.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.34
|
| Rate for Payer: Mclaren Medicaid |
$121.41
|
| Rate for Payer: Meridian Medicaid |
$127.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$192.51
|
| Rate for Payer: PACE SWMI |
$183.34
|
| Rate for Payer: PHP Medicare Advantage |
$183.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.82
|
| Rate for Payer: Priority Health Medicare |
$183.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.34
|
| Rate for Payer: UHC Medicare Advantage |
$188.84
|
|
