|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$697.00
|
| Rate for Payer: Aetna Medicare |
$213.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.25
|
| Rate for Payer: BCBS Complete |
$151.78
|
| Rate for Payer: BCBS MAPPO |
$205.00
|
| Rate for Payer: BCBS Trust/PPO |
$674.12
|
| Rate for Payer: BCN Commercial |
$674.12
|
| Rate for Payer: BCN Medicare Advantage |
$205.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$705.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.00
|
| Rate for Payer: Healthscope Commercial |
$738.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.00
|
| Rate for Payer: Mclaren Medicaid |
$144.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.25
|
| Rate for Payer: Meridian Medicaid |
$151.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$697.00
|
| Rate for Payer: Nomi Health Commercial |
$672.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PACE Senior Care Partners |
$194.75
|
| Rate for Payer: PACE SWMI |
$205.00
|
| Rate for Payer: PHP Commercial |
$697.00
|
| Rate for Payer: PHP Medicare Advantage |
$205.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.40
|
| Rate for Payer: Priority Health Medicare |
$207.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.72
|
| Rate for Payer: Railroad Medicare Medicare |
$205.00
|
| Rate for Payer: UHC Core |
$684.70
|
| Rate for Payer: UHC Exchange |
$205.00
|
| Rate for Payer: UHC Medicaid |
$144.57
|
| Rate for Payer: UHC Medicare Advantage |
$205.00
|
| Rate for Payer: UHCCP Medicaid |
$144.57
|
| Rate for Payer: VA VA |
$205.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$235.75
|
| Rate for Payer: Aetna Medicare |
$410.00
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCN Commercial |
$330.16
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Mclaren Medicaid |
$125.67
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.19
|
| Rate for Payer: UHC Medicaid |
$125.67
|
| Rate for Payer: UHCCP Medicaid |
$125.67
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$235.75
|
| Rate for Payer: Aetna Medicare |
$410.00
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCN Commercial |
$330.16
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Mclaren Medicaid |
$125.67
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.19
|
| Rate for Payer: UHC Medicaid |
$125.67
|
| Rate for Payer: UHCCP Medicaid |
$125.67
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$485.25 |
| Rate for Payer: Aetna Commercial |
$289.67
|
| Rate for Payer: Aetna Medicare |
$323.50
|
| Rate for Payer: BCBS Complete |
$179.81
|
| Rate for Payer: BCN Commercial |
$409.84
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Mclaren Medicaid |
$171.25
|
| Rate for Payer: Meridian Medicaid |
$179.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$375.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$375.11
|
| Rate for Payer: UHC Medicaid |
$171.25
|
| Rate for Payer: UHCCP Medicaid |
$171.25
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Aetna Commercial |
$366.35
|
| Rate for Payer: Aetna Medicare |
$112.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.69
|
| Rate for Payer: BCBS Complete |
$79.78
|
| Rate for Payer: BCBS MAPPO |
$107.75
|
| Rate for Payer: BCBS Trust/PPO |
$354.33
|
| Rate for Payer: BCN Commercial |
$354.33
|
| Rate for Payer: BCN Medicare Advantage |
$107.75
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$370.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.75
|
| Rate for Payer: Healthscope Commercial |
$387.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.25
|
| Rate for Payer: Mclaren Medicaid |
$75.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.14
|
| Rate for Payer: Meridian Medicaid |
$79.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.35
|
| Rate for Payer: Nomi Health Commercial |
$353.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PACE Senior Care Partners |
$102.36
|
| Rate for Payer: PACE SWMI |
$107.75
|
| Rate for Payer: PHP Commercial |
$366.35
|
| Rate for Payer: PHP Medicare Advantage |
$107.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.97
|
| Rate for Payer: Priority Health Medicare |
$108.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.98
|
| Rate for Payer: Railroad Medicare Medicare |
$107.75
|
| Rate for Payer: UHC Core |
$359.88
|
| Rate for Payer: UHC Exchange |
$107.75
|
| Rate for Payer: UHC Medicaid |
$75.99
|
| Rate for Payer: UHC Medicare Advantage |
$107.75
|
| Rate for Payer: UHCCP Medicaid |
$75.99
|
| Rate for Payer: VA VA |
$107.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.25
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: Aetna Medicare |
$215.50
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCN Commercial |
$219.11
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Mclaren Medicaid |
$82.43
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$200.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.54
|
| Rate for Payer: UHC Medicaid |
$82.43
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$299.98 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Aetna Commercial |
$366.35
|
| Rate for Payer: BCBS Trust/PPO |
$355.96
|
| Rate for Payer: BCN Commercial |
$355.96
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$370.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.80
|
| Rate for Payer: Healthscope Commercial |
$387.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.35
|
| Rate for Payer: Nomi Health Commercial |
$353.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PHP Commercial |
$366.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.98
|
| Rate for Payer: UHC Core |
$359.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.25
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: Aetna Medicare |
$215.50
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCN Commercial |
$219.11
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Mclaren Medicaid |
$82.43
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$200.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.54
|
| Rate for Payer: UHC Medicaid |
$82.43
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna Commercial |
$460.70
|
| Rate for Payer: Aetna Medicare |
$140.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.38
|
| Rate for Payer: BCBS Complete |
$100.32
|
| Rate for Payer: BCBS MAPPO |
$135.50
|
| Rate for Payer: BCBS Trust/PPO |
$445.58
|
| Rate for Payer: BCN Commercial |
$445.58
|
| Rate for Payer: BCN Medicare Advantage |
$135.50
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Commercial |
$466.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.50
|
| Rate for Payer: Healthscope Commercial |
$487.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.50
|
| Rate for Payer: Mclaren Medicaid |
$95.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.28
|
| Rate for Payer: Meridian Medicaid |
$100.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.70
|
| Rate for Payer: Nomi Health Commercial |
$444.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: PACE Senior Care Partners |
$128.72
|
| Rate for Payer: PACE SWMI |
$135.50
|
| Rate for Payer: PHP Commercial |
$460.70
|
| Rate for Payer: PHP Medicare Advantage |
$135.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$471.54
|
| Rate for Payer: Priority Health Medicare |
$136.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$377.23
|
| Rate for Payer: Railroad Medicare Medicare |
$135.50
|
| Rate for Payer: UHC Core |
$452.57
|
| Rate for Payer: UHC Exchange |
$135.50
|
| Rate for Payer: UHC Medicaid |
$95.55
|
| Rate for Payer: UHC Medicare Advantage |
$135.50
|
| Rate for Payer: UHCCP Medicaid |
$95.55
|
| Rate for Payer: VA VA |
$135.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$377.23 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna Commercial |
$460.70
|
| Rate for Payer: BCBS Trust/PPO |
$447.64
|
| Rate for Payer: BCN Commercial |
$447.64
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Commercial |
$466.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.60
|
| Rate for Payer: Healthscope Commercial |
$487.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.70
|
| Rate for Payer: Nomi Health Commercial |
$444.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: PHP Commercial |
$460.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$471.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$377.23
|
| Rate for Payer: UHC Core |
$452.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
12042
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Aetna Commercial |
$208.95
|
| Rate for Payer: Aetna Medicare |
$271.00
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCN Commercial |
$294.31
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Mclaren Medicaid |
$107.35
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.37
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Aetna Commercial |
$208.95
|
| Rate for Payer: Aetna Medicare |
$271.00
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCN Commercial |
$294.31
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Mclaren Medicaid |
$107.35
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.37
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$884.25 |
| Rate for Payer: Aetna Commercial |
$383.37
|
| Rate for Payer: Aetna Medicare |
$589.50
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCN Commercial |
$531.85
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Mclaren Medicaid |
$220.46
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$486.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.77
|
| Rate for Payer: UHC Medicaid |
$220.46
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$405.07 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna Commercial |
$494.70
|
| Rate for Payer: BCBS Trust/PPO |
$480.67
|
| Rate for Payer: BCN Commercial |
$480.67
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$500.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.60
|
| Rate for Payer: Healthscope Commercial |
$523.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.70
|
| Rate for Payer: Nomi Health Commercial |
$477.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PHP Commercial |
$494.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$506.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.07
|
| Rate for Payer: UHC Core |
$485.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.61 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Aetna Commercial |
$494.70
|
| Rate for Payer: Aetna Medicare |
$151.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.88
|
| Rate for Payer: BCBS Complete |
$107.73
|
| Rate for Payer: BCBS MAPPO |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$478.46
|
| Rate for Payer: BCN Commercial |
$478.46
|
| Rate for Payer: BCN Medicare Advantage |
$145.50
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$500.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.50
|
| Rate for Payer: Healthscope Commercial |
$523.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.50
|
| Rate for Payer: Mclaren Medicaid |
$102.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.78
|
| Rate for Payer: Meridian Medicaid |
$107.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.70
|
| Rate for Payer: Nomi Health Commercial |
$477.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PACE Senior Care Partners |
$138.22
|
| Rate for Payer: PACE SWMI |
$145.50
|
| Rate for Payer: PHP Commercial |
$494.70
|
| Rate for Payer: PHP Medicare Advantage |
$145.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$506.34
|
| Rate for Payer: Priority Health Medicare |
$146.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.07
|
| Rate for Payer: Railroad Medicare Medicare |
$145.50
|
| Rate for Payer: UHC Core |
$485.97
|
| Rate for Payer: UHC Exchange |
$145.50
|
| Rate for Payer: UHC Medicaid |
$102.61
|
| Rate for Payer: UHC Medicare Advantage |
$145.50
|
| Rate for Payer: UHCCP Medicaid |
$102.61
|
| Rate for Payer: VA VA |
$145.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
12044
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$229.21
|
| Rate for Payer: Aetna Medicare |
$291.00
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Mclaren Medicaid |
$121.62
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.80
|
| Rate for Payer: UHC Medicaid |
$121.62
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$229.21
|
| Rate for Payer: Aetna Medicare |
$291.00
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Mclaren Medicaid |
$121.62
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.80
|
| Rate for Payer: UHC Medicaid |
$121.62
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$260.49
|
| Rate for Payer: Aetna Medicare |
$357.50
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCN Commercial |
$286.67
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Mclaren Medicaid |
$143.14
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.72
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$497.64 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Aetna Commercial |
$607.75
|
| Rate for Payer: BCBS Trust/PPO |
$590.52
|
| Rate for Payer: BCN Commercial |
$590.52
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$614.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Healthscope Commercial |
$643.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Nomi Health Commercial |
$586.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PHP Commercial |
$607.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$622.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.64
|
| Rate for Payer: UHC Core |
$597.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$260.49
|
| Rate for Payer: Aetna Medicare |
$357.50
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCN Commercial |
$286.67
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Mclaren Medicaid |
$143.14
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.72
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$126.05 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Aetna Commercial |
$607.75
|
| Rate for Payer: Aetna Medicare |
$185.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.44
|
| Rate for Payer: BCBS Complete |
$132.35
|
| Rate for Payer: BCBS MAPPO |
$178.75
|
| Rate for Payer: BCBS Trust/PPO |
$587.80
|
| Rate for Payer: BCN Commercial |
$587.80
|
| Rate for Payer: BCN Medicare Advantage |
$178.75
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$614.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.75
|
| Rate for Payer: Healthscope Commercial |
$643.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.25
|
| Rate for Payer: Mclaren Medicaid |
$126.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.69
|
| Rate for Payer: Meridian Medicaid |
$132.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Nomi Health Commercial |
$586.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE Senior Care Partners |
$169.81
|
| Rate for Payer: PACE SWMI |
$178.75
|
| Rate for Payer: PHP Commercial |
$607.75
|
| Rate for Payer: PHP Medicare Advantage |
$178.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$622.05
|
| Rate for Payer: Priority Health Medicare |
$180.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.64
|
| Rate for Payer: Railroad Medicare Medicare |
$178.75
|
| Rate for Payer: UHC Core |
$597.02
|
| Rate for Payer: UHC Exchange |
$178.75
|
| Rate for Payer: UHC Medicaid |
$126.05
|
| Rate for Payer: UHC Medicare Advantage |
$178.75
|
| Rate for Payer: UHCCP Medicaid |
$126.05
|
| Rate for Payer: VA VA |
$178.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
12036
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$622.92 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Aetna Commercial |
$760.75
|
| Rate for Payer: BCBS Trust/PPO |
$739.18
|
| Rate for Payer: BCN Commercial |
$739.18
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$769.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Healthscope Commercial |
$805.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: Nomi Health Commercial |
$733.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PHP Commercial |
$760.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$778.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.92
|
| Rate for Payer: UHC Core |
$747.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
12036
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Aetna Commercial |
$306.51
|
| Rate for Payer: Aetna Medicare |
$447.50
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCN Commercial |
$335.37
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Mclaren Medicaid |
$172.32
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.24
|
| Rate for Payer: UHC Medicaid |
$172.32
|
| Rate for Payer: UHCCP Medicaid |
$172.32
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
12036
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Aetna Commercial |
$760.75
|
| Rate for Payer: Aetna Medicare |
$232.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.69
|
| Rate for Payer: BCBS Complete |
$165.66
|
| Rate for Payer: BCBS MAPPO |
$223.75
|
| Rate for Payer: BCBS Trust/PPO |
$735.78
|
| Rate for Payer: BCN Commercial |
$735.78
|
| Rate for Payer: BCN Medicare Advantage |
$223.75
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$769.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.75
|
| Rate for Payer: Healthscope Commercial |
$805.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.25
|
| Rate for Payer: Mclaren Medicaid |
$157.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.94
|
| Rate for Payer: Meridian Medicaid |
$165.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$246.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: Nomi Health Commercial |
$733.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PACE Senior Care Partners |
$212.56
|
| Rate for Payer: PACE SWMI |
$223.75
|
| Rate for Payer: PHP Commercial |
$760.75
|
| Rate for Payer: PHP Medicare Advantage |
$223.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$778.65
|
| Rate for Payer: Priority Health Medicare |
$225.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.92
|
| Rate for Payer: Railroad Medicare Medicare |
$223.75
|
| Rate for Payer: UHC Core |
$747.33
|
| Rate for Payer: UHC Exchange |
$223.75
|
| Rate for Payer: UHC Medicaid |
$157.79
|
| Rate for Payer: UHC Medicare Advantage |
$223.75
|
| Rate for Payer: UHCCP Medicaid |
$157.79
|
| Rate for Payer: VA VA |
$223.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Aetna Commercial |
$306.51
|
| Rate for Payer: Aetna Medicare |
$447.50
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCN Commercial |
$335.37
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Mclaren Medicaid |
$172.32
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.24
|
| Rate for Payer: UHC Medicaid |
$172.32
|
| Rate for Payer: UHCCP Medicaid |
$172.32
|
|
