|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$163.08 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Aetna Commercial |
$786.25
|
| Rate for Payer: Aetna Medicare |
$240.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.06
|
| Rate for Payer: BCBS Complete |
$171.22
|
| Rate for Payer: BCBS MAPPO |
$231.25
|
| Rate for Payer: BCBS Trust/PPO |
$760.44
|
| Rate for Payer: BCN Commercial |
$760.44
|
| Rate for Payer: BCN Medicare Advantage |
$231.25
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$795.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.25
|
| Rate for Payer: Healthscope Commercial |
$832.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.75
|
| Rate for Payer: Mclaren Medicaid |
$163.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.81
|
| Rate for Payer: Meridian Medicaid |
$171.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$254.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.25
|
| Rate for Payer: Nomi Health Commercial |
$758.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PACE Senior Care Partners |
$219.69
|
| Rate for Payer: PACE SWMI |
$231.25
|
| Rate for Payer: PHP Commercial |
$786.25
|
| Rate for Payer: PHP Medicare Advantage |
$231.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$804.75
|
| Rate for Payer: Priority Health Medicare |
$233.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.80
|
| Rate for Payer: Railroad Medicare Medicare |
$231.25
|
| Rate for Payer: UHC Core |
$772.38
|
| Rate for Payer: UHC Exchange |
$231.25
|
| Rate for Payer: UHC Medicaid |
$163.08
|
| Rate for Payer: UHC Medicare Advantage |
$231.25
|
| Rate for Payer: UHCCP Medicaid |
$163.08
|
| Rate for Payer: VA VA |
$231.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Aetna Commercial |
$277.38
|
| Rate for Payer: Aetna Medicare |
$462.50
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.24
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$643.80 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Aetna Commercial |
$786.25
|
| Rate for Payer: BCBS Trust/PPO |
$763.96
|
| Rate for Payer: BCN Commercial |
$763.96
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$795.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.00
|
| Rate for Payer: Healthscope Commercial |
$832.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.25
|
| Rate for Payer: Nomi Health Commercial |
$758.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: PHP Commercial |
$786.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$804.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.80
|
| Rate for Payer: UHC Core |
$772.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Aetna Commercial |
$277.38
|
| Rate for Payer: Aetna Medicare |
$462.50
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCN Commercial |
$385.94
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.24
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$90.06
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Mclaren Medicaid |
$43.24
|
| Rate for Payer: Meridian Medicaid |
$45.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.67
|
| Rate for Payer: UHC Medicaid |
$43.24
|
| Rate for Payer: UHCCP Medicaid |
$43.24
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$90.06
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCN Commercial |
$122.01
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Mclaren Medicaid |
$43.24
|
| Rate for Payer: Meridian Medicaid |
$45.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.67
|
| Rate for Payer: UHC Medicaid |
$43.24
|
| Rate for Payer: UHCCP Medicaid |
$43.24
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$201.14 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$245.65
|
| Rate for Payer: BCBS Trust/PPO |
$238.69
|
| Rate for Payer: BCN Commercial |
$238.69
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$248.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.20
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.65
|
| Rate for Payer: Nomi Health Commercial |
$236.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PHP Commercial |
$245.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$251.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.14
|
| Rate for Payer: UHC Core |
$241.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.95 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$245.65
|
| Rate for Payer: Aetna Medicare |
$75.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.31
|
| Rate for Payer: BCBS Complete |
$53.49
|
| Rate for Payer: BCBS MAPPO |
$72.25
|
| Rate for Payer: BCBS Trust/PPO |
$237.59
|
| Rate for Payer: BCN Commercial |
$237.59
|
| Rate for Payer: BCN Medicare Advantage |
$72.25
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$248.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.25
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.75
|
| Rate for Payer: Mclaren Medicaid |
$50.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.86
|
| Rate for Payer: Meridian Medicaid |
$53.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.65
|
| Rate for Payer: Nomi Health Commercial |
$236.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE Senior Care Partners |
$68.64
|
| Rate for Payer: PACE SWMI |
$72.25
|
| Rate for Payer: PHP Commercial |
$245.65
|
| Rate for Payer: PHP Medicare Advantage |
$72.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$251.43
|
| Rate for Payer: Priority Health Medicare |
$72.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.14
|
| Rate for Payer: Railroad Medicare Medicare |
$72.25
|
| Rate for Payer: UHC Core |
$241.31
|
| Rate for Payer: UHC Exchange |
$72.25
|
| Rate for Payer: UHC Medicaid |
$50.95
|
| Rate for Payer: UHC Medicare Advantage |
$72.25
|
| Rate for Payer: UHCCP Medicaid |
$50.95
|
| Rate for Payer: VA VA |
$72.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.75
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$426.75 |
| Rate for Payer: Aetna Commercial |
$215.74
|
| Rate for Payer: Aetna Medicare |
$284.50
|
| Rate for Payer: BCBS Complete |
$114.73
|
| Rate for Payer: BCN Commercial |
$300.78
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Mclaren Medicaid |
$109.27
|
| Rate for Payer: Meridian Medicaid |
$114.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$426.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.29
|
| Rate for Payer: UHC Medicaid |
$109.27
|
| Rate for Payer: UHCCP Medicaid |
$109.27
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Aetna Commercial |
$267.18
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Mclaren Medicaid |
$133.98
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$337.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.27
|
| Rate for Payer: UHC Medicaid |
$133.98
|
| Rate for Payer: UHCCP Medicaid |
$133.98
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Aetna Commercial |
$267.18
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Mclaren Medicaid |
$133.98
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$337.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.27
|
| Rate for Payer: UHC Medicaid |
$133.98
|
| Rate for Payer: UHCCP Medicaid |
$133.98
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$477.46 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: BCBS Trust/PPO |
$566.57
|
| Rate for Payer: BCN Commercial |
$566.57
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$562.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$596.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.46
|
| Rate for Payer: UHC Core |
$572.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna Medicare |
$178.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.38
|
| Rate for Payer: BCBS Complete |
$126.98
|
| Rate for Payer: BCBS MAPPO |
$171.50
|
| Rate for Payer: BCBS Trust/PPO |
$563.96
|
| Rate for Payer: BCN Commercial |
$563.96
|
| Rate for Payer: BCN Medicare Advantage |
$171.50
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Mclaren Medicaid |
$120.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.07
|
| Rate for Payer: Meridian Medicaid |
$126.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$562.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE Senior Care Partners |
$162.93
|
| Rate for Payer: PACE SWMI |
$171.50
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: PHP Medicare Advantage |
$171.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$596.82
|
| Rate for Payer: Priority Health Medicare |
$173.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.46
|
| Rate for Payer: Railroad Medicare Medicare |
$171.50
|
| Rate for Payer: UHC Core |
$572.81
|
| Rate for Payer: UHC Exchange |
$171.50
|
| Rate for Payer: UHC Medicaid |
$120.94
|
| Rate for Payer: UHC Medicare Advantage |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$120.94
|
| Rate for Payer: VA VA |
$171.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.54
|
| Rate for Payer: UHC Medicaid |
$38.13
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: Aetna Medicare |
$107.50
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.54
|
| Rate for Payer: UHC Medicaid |
$38.13
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Medicare |
$55.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.19
|
| Rate for Payer: BCBS Complete |
$39.80
|
| Rate for Payer: BCBS MAPPO |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$176.75
|
| Rate for Payer: BCN Commercial |
$176.75
|
| Rate for Payer: BCN Medicare Advantage |
$53.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Mclaren Medicaid |
$37.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.44
|
| Rate for Payer: Meridian Medicaid |
$39.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE Senior Care Partners |
$51.06
|
| Rate for Payer: PACE SWMI |
$53.75
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: PHP Medicare Advantage |
$53.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.05
|
| Rate for Payer: Priority Health Medicare |
$54.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.64
|
| Rate for Payer: Railroad Medicare Medicare |
$53.75
|
| Rate for Payer: UHC Core |
$179.53
|
| Rate for Payer: UHC Exchange |
$53.75
|
| Rate for Payer: UHC Medicaid |
$37.90
|
| Rate for Payer: UHC Medicare Advantage |
$53.75
|
| Rate for Payer: UHCCP Medicaid |
$37.90
|
| Rate for Payer: VA VA |
$53.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$149.64 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: BCBS Trust/PPO |
$177.57
|
| Rate for Payer: BCN Commercial |
$177.57
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$176.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.64
|
| Rate for Payer: UHC Core |
$179.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Aetna Commercial |
$148.88
|
| Rate for Payer: Aetna Medicare |
$243.50
|
| Rate for Payer: BCBS Complete |
$76.04
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Mclaren Medicaid |
$72.42
|
| Rate for Payer: Meridian Medicaid |
$76.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$186.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.87
|
| Rate for Payer: UHC Medicaid |
$72.42
|
| Rate for Payer: UHCCP Medicaid |
$72.42
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$561.04 |
| Max. Negotiated Rate |
$3,262.50 |
| Rate for Payer: Aetna Commercial |
$1,296.30
|
| Rate for Payer: Aetna Medicare |
$2,175.00
|
| Rate for Payer: BCBS Complete |
$589.09
|
| Rate for Payer: BCN Commercial |
$1,413.27
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Mclaren Medicaid |
$561.04
|
| Rate for Payer: Meridian Medicaid |
$589.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,262.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,519.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,519.79
|
| Rate for Payer: UHC Medicaid |
$561.04
|
| Rate for Payer: UHCCP Medicaid |
$561.04
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$568.28 |
| Max. Negotiated Rate |
$1,565.57 |
| Rate for Payer: Aetna Commercial |
$1,288.90
|
| Rate for Payer: Aetna Medicare |
$1,005.00
|
| Rate for Payer: BCBS Complete |
$596.69
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Mclaren Medicaid |
$568.28
|
| Rate for Payer: Meridian Medicaid |
$596.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,507.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,565.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,565.57
|
| Rate for Payer: UHC Medicaid |
$568.28
|
| Rate for Payer: UHCCP Medicaid |
$568.28
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$366.15 |
| Max. Negotiated Rate |
$1,675.50 |
| Rate for Payer: Aetna Commercial |
$797.98
|
| Rate for Payer: Aetna Medicare |
$1,117.00
|
| Rate for Payer: BCBS Complete |
$384.46
|
| Rate for Payer: BCN Commercial |
$929.73
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Mclaren Medicaid |
$366.15
|
| Rate for Payer: Meridian Medicaid |
$384.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,675.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$993.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$993.86
|
| Rate for Payer: UHC Medicaid |
$366.15
|
| Rate for Payer: UHCCP Medicaid |
$366.15
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$250.06 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna Commercial |
$590.68
|
| Rate for Payer: Aetna Medicare |
$644.00
|
| Rate for Payer: BCBS Complete |
$262.56
|
| Rate for Payer: BCN Commercial |
$676.75
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Mclaren Medicaid |
$250.06
|
| Rate for Payer: Meridian Medicaid |
$262.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$792.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$792.72
|
| Rate for Payer: UHC Medicaid |
$250.06
|
| Rate for Payer: UHCCP Medicaid |
$250.06
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$459.65 |
| Max. Negotiated Rate |
$1,593.75 |
| Rate for Payer: Aetna Commercial |
$969.79
|
| Rate for Payer: Aetna Medicare |
$1,062.50
|
| Rate for Payer: BCBS Complete |
$482.63
|
| Rate for Payer: BCN Commercial |
$1,217.06
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Mclaren Medicaid |
$459.65
|
| Rate for Payer: Meridian Medicaid |
$482.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,593.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,232.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,232.63
|
| Rate for Payer: UHC Medicaid |
$459.65
|
| Rate for Payer: UHCCP Medicaid |
$459.65
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$291.17 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna Commercial |
$599.11
|
| Rate for Payer: Aetna Medicare |
$788.00
|
| Rate for Payer: BCBS Complete |
$305.73
|
| Rate for Payer: BCN Commercial |
$761.91
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Mclaren Medicaid |
$291.17
|
| Rate for Payer: Meridian Medicaid |
$305.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$771.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$771.65
|
| Rate for Payer: UHC Medicaid |
$291.17
|
| Rate for Payer: UHCCP Medicaid |
$291.17
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$544.81 |
| Rate for Payer: Aetna Commercial |
$400.74
|
| Rate for Payer: Aetna Medicare |
$347.00
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCN Commercial |
$465.12
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Mclaren Medicaid |
$176.36
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$544.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$544.81
|
| Rate for Payer: UHC Medicaid |
$176.36
|
| Rate for Payer: UHCCP Medicaid |
$176.36
|
|
