|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$161.34
|
| Rate for Payer: Aetna Medicare |
$203.00
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.29
|
| Rate for Payer: UHC Medicaid |
$84.99
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.58 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna Commercial |
$345.10
|
| Rate for Payer: Aetna Medicare |
$105.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.88
|
| Rate for Payer: BCBS Complete |
$75.15
|
| Rate for Payer: BCBS MAPPO |
$101.50
|
| Rate for Payer: BCBS Trust/PPO |
$333.77
|
| Rate for Payer: BCN Commercial |
$333.77
|
| Rate for Payer: BCN Medicare Advantage |
$101.50
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$349.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.50
|
| Rate for Payer: Healthscope Commercial |
$365.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.50
|
| Rate for Payer: Mclaren Medicaid |
$71.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.58
|
| Rate for Payer: Meridian Medicaid |
$75.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.10
|
| Rate for Payer: Nomi Health Commercial |
$332.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE Senior Care Partners |
$96.42
|
| Rate for Payer: PACE SWMI |
$101.50
|
| Rate for Payer: PHP Commercial |
$345.10
|
| Rate for Payer: PHP Medicare Advantage |
$101.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.22
|
| Rate for Payer: Priority Health Medicare |
$102.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.58
|
| Rate for Payer: Railroad Medicare Medicare |
$101.50
|
| Rate for Payer: UHC Core |
$339.01
|
| Rate for Payer: UHC Exchange |
$101.50
|
| Rate for Payer: UHC Medicaid |
$71.58
|
| Rate for Payer: UHC Medicare Advantage |
$101.50
|
| Rate for Payer: UHCCP Medicaid |
$71.58
|
| Rate for Payer: VA VA |
$101.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$161.34
|
| Rate for Payer: Aetna Medicare |
$203.00
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.29
|
| Rate for Payer: UHC Medicaid |
$84.99
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$282.58 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna Commercial |
$345.10
|
| Rate for Payer: BCBS Trust/PPO |
$335.32
|
| Rate for Payer: BCN Commercial |
$335.32
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$349.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.80
|
| Rate for Payer: Healthscope Commercial |
$365.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.10
|
| Rate for Payer: Nomi Health Commercial |
$332.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PHP Commercial |
$345.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.58
|
| Rate for Payer: UHC Core |
$339.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Aetna Commercial |
$201.25
|
| Rate for Payer: Aetna Medicare |
$259.00
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCN Commercial |
$225.80
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Mclaren Medicaid |
$105.22
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.07
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$360.53 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: BCBS Trust/PPO |
$427.82
|
| Rate for Payer: BCN Commercial |
$427.82
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Healthscope Commercial |
$466.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: Nomi Health Commercial |
$424.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PHP Commercial |
$440.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.53
|
| Rate for Payer: UHC Core |
$432.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Aetna Commercial |
$201.25
|
| Rate for Payer: Aetna Medicare |
$259.00
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCN Commercial |
$225.80
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Mclaren Medicaid |
$105.22
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.07
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: Aetna Medicare |
$134.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.88
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$129.50
|
| Rate for Payer: BCBS Trust/PPO |
$425.85
|
| Rate for Payer: BCN Commercial |
$425.85
|
| Rate for Payer: BCN Medicare Advantage |
$129.50
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.50
|
| Rate for Payer: Healthscope Commercial |
$466.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.50
|
| Rate for Payer: Mclaren Medicaid |
$91.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.97
|
| Rate for Payer: Meridian Medicaid |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: Nomi Health Commercial |
$424.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PACE Senior Care Partners |
$123.03
|
| Rate for Payer: PACE SWMI |
$129.50
|
| Rate for Payer: PHP Commercial |
$440.30
|
| Rate for Payer: PHP Medicare Advantage |
$129.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.66
|
| Rate for Payer: Priority Health Medicare |
$130.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.53
|
| Rate for Payer: Railroad Medicare Medicare |
$129.50
|
| Rate for Payer: UHC Core |
$432.53
|
| Rate for Payer: UHC Exchange |
$129.50
|
| Rate for Payer: UHC Medicaid |
$91.32
|
| Rate for Payer: UHC Medicare Advantage |
$129.50
|
| Rate for Payer: UHCCP Medicaid |
$91.32
|
| Rate for Payer: VA VA |
$129.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$196.17 |
| Max. Negotiated Rate |
$585.75 |
| Rate for Payer: Aetna Commercial |
$356.47
|
| Rate for Payer: Aetna Medicare |
$390.50
|
| Rate for Payer: BCBS Complete |
$205.98
|
| Rate for Payer: BCN Commercial |
$388.38
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Mclaren Medicaid |
$196.17
|
| Rate for Payer: Meridian Medicaid |
$205.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$450.77
|
| Rate for Payer: UHC Medicaid |
$196.17
|
| Rate for Payer: UHCCP Medicaid |
$196.17
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$330.00
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCN Commercial |
$243.08
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$282.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.12
|
| Rate for Payer: UHC Medicaid |
$114.81
|
| Rate for Payer: UHCCP Medicaid |
$114.81
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$459.36 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: BCBS Trust/PPO |
$545.09
|
| Rate for Payer: BCN Commercial |
$545.09
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$495.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.00
|
| Rate for Payer: Nomi Health Commercial |
$541.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PHP Commercial |
$561.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$574.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$459.36
|
| Rate for Payer: UHC Core |
$551.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$495.00
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$330.00
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCN Commercial |
$243.08
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$282.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.12
|
| Rate for Payer: UHC Medicaid |
$114.81
|
| Rate for Payer: UHCCP Medicaid |
$114.81
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$116.36 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Aetna Medicare |
$171.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$206.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$206.25
|
| Rate for Payer: BCBS Complete |
$122.17
|
| Rate for Payer: BCBS MAPPO |
$165.00
|
| Rate for Payer: BCBS Trust/PPO |
$542.59
|
| Rate for Payer: BCN Commercial |
$542.59
|
| Rate for Payer: BCN Medicare Advantage |
$165.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.00
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$495.00
|
| Rate for Payer: Mclaren Medicaid |
$116.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.25
|
| Rate for Payer: Meridian Medicaid |
$122.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.00
|
| Rate for Payer: Nomi Health Commercial |
$541.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PACE Senior Care Partners |
$156.75
|
| Rate for Payer: PACE SWMI |
$165.00
|
| Rate for Payer: PHP Commercial |
$561.00
|
| Rate for Payer: PHP Medicare Advantage |
$165.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$574.20
|
| Rate for Payer: Priority Health Medicare |
$166.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$459.36
|
| Rate for Payer: Railroad Medicare Medicare |
$165.00
|
| Rate for Payer: UHC Core |
$551.10
|
| Rate for Payer: UHC Exchange |
$165.00
|
| Rate for Payer: UHC Medicaid |
$116.36
|
| Rate for Payer: UHC Medicare Advantage |
$165.00
|
| Rate for Payer: UHCCP Medicaid |
$116.36
|
| Rate for Payer: VA VA |
$165.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$495.00
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$313.96 |
| Max. Negotiated Rate |
$788.92 |
| Rate for Payer: Aetna Commercial |
$635.36
|
| Rate for Payer: Aetna Medicare |
$392.50
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: BCN Commercial |
$738.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Mclaren Medicaid |
$313.96
|
| Rate for Payer: Meridian Medicaid |
$329.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$788.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$788.92
|
| Rate for Payer: UHC Medicaid |
$313.96
|
| Rate for Payer: UHCCP Medicaid |
$313.96
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,874.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$3,655.50 |
| Rate for Payer: Aetna Commercial |
$877.19
|
| Rate for Payer: Aetna Medicare |
$2,437.00
|
| Rate for Payer: BCBS Complete |
$542.36
|
| Rate for Payer: BCN Commercial |
$1,275.83
|
| Rate for Payer: Cash Price |
$3,899.20
|
| Rate for Payer: Cash Price |
$3,899.20
|
| Rate for Payer: Mclaren Medicaid |
$516.53
|
| Rate for Payer: Meridian Medicaid |
$542.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,655.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,372.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,372.00
|
| Rate for Payer: UHC Medicaid |
$516.53
|
| Rate for Payer: UHCCP Medicaid |
$516.53
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$345.86 |
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: Aetna Medicare |
$179.00
|
| Rate for Payer: BCBS Complete |
$112.95
|
| Rate for Payer: BCN Commercial |
$283.85
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Mclaren Medicaid |
$107.57
|
| Rate for Payer: Meridian Medicaid |
$112.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$345.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.86
|
| Rate for Payer: UHC Medicaid |
$107.57
|
| Rate for Payer: UHCCP Medicaid |
$107.57
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$569.25 |
| Rate for Payer: Aetna Commercial |
$339.34
|
| Rate for Payer: Aetna Medicare |
$379.50
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCN Commercial |
$389.42
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Mclaren Medicaid |
$145.27
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.49
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$1,775.25 |
| Rate for Payer: Aetna Commercial |
$948.56
|
| Rate for Payer: Aetna Medicare |
$1,183.50
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCN Commercial |
$1,099.54
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Mclaren Medicaid |
$431.54
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,775.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,175.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,175.38
|
| Rate for Payer: UHC Medicaid |
$431.54
|
| Rate for Payer: UHCCP Medicaid |
$431.54
|
|
|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$1,012.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna Commercial |
$469.82
|
| Rate for Payer: Aetna Medicare |
$506.00
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCN Commercial |
$552.26
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Mclaren Medicaid |
$230.89
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$759.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$672.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$672.89
|
| Rate for Payer: UHC Medicaid |
$230.89
|
| Rate for Payer: UHCCP Medicaid |
$230.89
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$590.37 |
| Rate for Payer: Aetna Commercial |
$408.20
|
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$234.16
|
| Rate for Payer: BCN Commercial |
$484.54
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Mclaren Medicaid |
$223.01
|
| Rate for Payer: Meridian Medicaid |
$234.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$590.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.37
|
| Rate for Payer: UHC Medicaid |
$223.01
|
| Rate for Payer: UHCCP Medicaid |
$223.01
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$410.45 |
| Max. Negotiated Rate |
$1,242.03 |
| Rate for Payer: Aetna Commercial |
$918.82
|
| Rate for Payer: Aetna Medicare |
$619.50
|
| Rate for Payer: BCBS Complete |
$430.97
|
| Rate for Payer: BCN Commercial |
$1,019.37
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Mclaren Medicaid |
$410.45
|
| Rate for Payer: Meridian Medicaid |
$430.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,242.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,242.03
|
| Rate for Payer: UHC Medicaid |
$410.45
|
| Rate for Payer: UHCCP Medicaid |
$410.45
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,427.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$1,820.25 |
| Rate for Payer: Aetna Commercial |
$1,220.47
|
| Rate for Payer: Aetna Medicare |
$1,213.50
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCN Commercial |
$1,410.28
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Mclaren Medicaid |
$584.90
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,820.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,328.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,328.06
|
| Rate for Payer: UHC Medicaid |
$584.90
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$430.26 |
| Max. Negotiated Rate |
$1,775.25 |
| Rate for Payer: Aetna Commercial |
$942.95
|
| Rate for Payer: Aetna Medicare |
$1,183.50
|
| Rate for Payer: BCBS Complete |
$451.77
|
| Rate for Payer: BCN Commercial |
$1,089.09
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Mclaren Medicaid |
$430.26
|
| Rate for Payer: Meridian Medicaid |
$451.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,775.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,164.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,164.20
|
| Rate for Payer: UHC Medicaid |
$430.26
|
| Rate for Payer: UHCCP Medicaid |
$430.26
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,592.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$843.91 |
| Max. Negotiated Rate |
$3,444.00 |
| Rate for Payer: Aetna Commercial |
$1,689.72
|
| Rate for Payer: Aetna Medicare |
$2,296.00
|
| Rate for Payer: BCBS Complete |
$886.11
|
| Rate for Payer: BCN Commercial |
$2,210.70
|
| Rate for Payer: Cash Price |
$3,673.60
|
| Rate for Payer: Cash Price |
$3,673.60
|
| Rate for Payer: Mclaren Medicaid |
$843.91
|
| Rate for Payer: Meridian Medicaid |
$886.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,444.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,337.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,337.29
|
| Rate for Payer: UHC Medicaid |
$843.91
|
| Rate for Payer: UHCCP Medicaid |
$843.91
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$5,245.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,065.21 |
| Max. Negotiated Rate |
$3,933.75 |
| Rate for Payer: Aetna Commercial |
$2,146.84
|
| Rate for Payer: Aetna Medicare |
$2,622.50
|
| Rate for Payer: BCBS Complete |
$1,118.47
|
| Rate for Payer: BCN Commercial |
$2,806.46
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Mclaren Medicaid |
$1,065.21
|
| Rate for Payer: Meridian Medicaid |
$1,118.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,933.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,065.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,967.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,967.18
|
| Rate for Payer: UHC Medicaid |
$1,065.21
|
| Rate for Payer: UHCCP Medicaid |
$1,065.21
|
|
