|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$861.90 |
| Rate for Payer: Aetna Commercial |
$627.51
|
| Rate for Payer: Aetna Medicare |
$487.02
|
| Rate for Payer: BCBS Complete |
$530.40
|
| Rate for Payer: BCBS MAPPO |
$468.29
|
| Rate for Payer: BCN Medicare Advantage |
$468.29
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$674.34
|
| Rate for Payer: Cofinity Commercial |
$627.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.70
|
| Rate for Payer: Nomi Health Commercial |
$561.95
|
| Rate for Payer: PACE SWMI |
$468.29
|
| Rate for Payer: PHP Medicare Advantage |
$468.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.90
|
| Rate for Payer: Priority Health Medicare |
$472.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.29
|
| Rate for Payer: UHC Exchange |
$468.29
|
| Rate for Payer: UHC Medicare Advantage |
$468.29
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,686.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$3,074.40 |
| Max. Negotiated Rate |
$5,642.31 |
| Rate for Payer: Aetna Commercial |
$5,250.48
|
| Rate for Payer: Aetna Medicare |
$4,075.00
|
| Rate for Payer: BCBS Complete |
$3,074.40
|
| Rate for Payer: BCBS MAPPO |
$3,918.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,918.27
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cofinity Commercial |
$5,642.31
|
| Rate for Payer: Cofinity Commercial |
$5,250.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,918.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,114.18
|
| Rate for Payer: Nomi Health Commercial |
$4,701.92
|
| Rate for Payer: PACE SWMI |
$3,918.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,918.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,995.90
|
| Rate for Payer: Priority Health Medicare |
$3,957.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,918.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,918.27
|
| Rate for Payer: UHC Exchange |
$3,918.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,918.27
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,838.80 |
| Max. Negotiated Rate |
$3,379.67 |
| Rate for Payer: Aetna Commercial |
$3,144.97
|
| Rate for Payer: Aetna Medicare |
$2,440.87
|
| Rate for Payer: BCBS Complete |
$1,838.80
|
| Rate for Payer: BCBS MAPPO |
$2,346.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,346.99
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cofinity Commercial |
$3,379.67
|
| Rate for Payer: Cofinity Commercial |
$3,144.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,346.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,464.34
|
| Rate for Payer: Nomi Health Commercial |
$2,816.39
|
| Rate for Payer: PACE SWMI |
$2,346.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,346.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health Medicare |
$2,370.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,346.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,346.99
|
| Rate for Payer: UHC Exchange |
$2,346.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,346.99
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$490.80 |
| Max. Negotiated Rate |
$988.04 |
| Rate for Payer: Aetna Commercial |
$919.43
|
| Rate for Payer: Aetna Medicare |
$713.59
|
| Rate for Payer: BCBS Complete |
$490.80
|
| Rate for Payer: BCBS MAPPO |
$686.14
|
| Rate for Payer: BCN Medicare Advantage |
$686.14
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cofinity Commercial |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$919.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.45
|
| Rate for Payer: Nomi Health Commercial |
$823.37
|
| Rate for Payer: PACE SWMI |
$686.14
|
| Rate for Payer: PHP Medicare Advantage |
$686.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.55
|
| Rate for Payer: Priority Health Medicare |
$693.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.14
|
| Rate for Payer: UHC Exchange |
$686.14
|
| Rate for Payer: UHC Medicare Advantage |
$686.14
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$263.21 |
| Max. Negotiated Rate |
$603.20 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$263.21
|
| Rate for Payer: BCN Medicare Advantage |
$263.21
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$379.02
|
| Rate for Payer: Cofinity Commercial |
$352.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.37
|
| Rate for Payer: Nomi Health Commercial |
$315.85
|
| Rate for Payer: PACE SWMI |
$263.21
|
| Rate for Payer: PHP Medicare Advantage |
$263.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$265.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.21
|
| Rate for Payer: UHC Exchange |
$263.21
|
| Rate for Payer: UHC Medicare Advantage |
$263.21
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$316.36 |
| Max. Negotiated Rate |
$800.80 |
| Rate for Payer: Aetna Commercial |
$423.92
|
| Rate for Payer: Aetna Medicare |
$329.01
|
| Rate for Payer: BCBS Complete |
$492.80
|
| Rate for Payer: BCBS MAPPO |
$316.36
|
| Rate for Payer: BCN Medicare Advantage |
$316.36
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$455.56
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.18
|
| Rate for Payer: Nomi Health Commercial |
$379.63
|
| Rate for Payer: PACE SWMI |
$316.36
|
| Rate for Payer: PHP Medicare Advantage |
$316.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health Medicare |
$319.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.36
|
| Rate for Payer: UHC Exchange |
$316.36
|
| Rate for Payer: UHC Medicare Advantage |
$316.36
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$229.33 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Aetna Commercial |
$307.30
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$229.33
|
| Rate for Payer: BCN Medicare Advantage |
$229.33
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$330.24
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.80
|
| Rate for Payer: Nomi Health Commercial |
$275.20
|
| Rate for Payer: PACE SWMI |
$229.33
|
| Rate for Payer: PHP Medicare Advantage |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$231.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.33
|
| Rate for Payer: UHC Exchange |
$229.33
|
| Rate for Payer: UHC Medicare Advantage |
$229.33
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$382.44
|
| Rate for Payer: Aetna Medicare |
$296.82
|
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: BCBS MAPPO |
$285.40
|
| Rate for Payer: BCN Medicare Advantage |
$285.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$410.98
|
| Rate for Payer: Cofinity Commercial |
$382.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.67
|
| Rate for Payer: Nomi Health Commercial |
$342.48
|
| Rate for Payer: PACE SWMI |
$285.40
|
| Rate for Payer: PHP Medicare Advantage |
$285.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health Medicare |
$288.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.40
|
| Rate for Payer: UHC Exchange |
$285.40
|
| Rate for Payer: UHC Medicare Advantage |
$285.40
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$118.59 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$158.91
|
| Rate for Payer: Aetna Medicare |
$123.33
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$118.59
|
| Rate for Payer: BCN Medicare Advantage |
$118.59
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.52
|
| Rate for Payer: Nomi Health Commercial |
$142.31
|
| Rate for Payer: PACE SWMI |
$118.59
|
| Rate for Payer: PHP Medicare Advantage |
$118.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$119.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.59
|
| Rate for Payer: UHC Exchange |
$118.59
|
| Rate for Payer: UHC Medicare Advantage |
$118.59
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$355.55 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$225.58
|
| Rate for Payer: BCBS Complete |
$218.80
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCN Medicare Advantage |
$216.90
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$290.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.75
|
| Rate for Payer: Nomi Health Commercial |
$260.28
|
| Rate for Payer: PACE SWMI |
$216.90
|
| Rate for Payer: PHP Medicare Advantage |
$216.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.90
|
| Rate for Payer: UHC Exchange |
$216.90
|
| Rate for Payer: UHC Medicare Advantage |
$216.90
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$246.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Exchange |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$246.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Exchange |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$583.70 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: BCBS Trust/PPO |
$733.04
|
| Rate for Payer: BCN Commercial |
$693.97
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$673.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$736.36
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO |
$781.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$601.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.24
|
| Rate for Payer: UHC Core |
$749.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$213.28 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$233.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$280.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$280.62
|
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: BCBS MAPPO |
$224.50
|
| Rate for Payer: BCBS Trust/PPO |
$738.25
|
| Rate for Payer: BCN Commercial |
$698.20
|
| Rate for Payer: BCN Medicare Advantage |
$224.50
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.50
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$673.50
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.72
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$736.36
|
| Rate for Payer: PACE Senior Care Partners |
$213.28
|
| Rate for Payer: PACE SWMI |
$224.50
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: PHP Medicare Advantage |
$224.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO |
$781.26
|
| Rate for Payer: Priority Health Medicare |
$226.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$601.66
|
| Rate for Payer: Railroad Medicare Medicare |
$224.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.24
|
| Rate for Payer: UHC Core |
$749.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.50
|
| Rate for Payer: UHC Exchange |
$224.50
|
| Rate for Payer: UHC Medicare Advantage |
$224.50
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
| Rate for Payer: VA VA |
$224.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Exchange |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna Medicare |
$73.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.81
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$231.01
|
| Rate for Payer: BCN Commercial |
$218.48
|
| Rate for Payer: BCN Medicare Advantage |
$70.25
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: PACE Senior Care Partners |
$66.74
|
| Rate for Payer: PACE SWMI |
$70.25
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: PHP Medicare Advantage |
$70.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$244.47
|
| Rate for Payer: Priority Health Medicare |
$70.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.27
|
| Rate for Payer: Railroad Medicare Medicare |
$70.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.25
|
| Rate for Payer: UHC Exchange |
$70.25
|
| Rate for Payer: UHC Medicare Advantage |
$70.25
|
| Rate for Payer: VA VA |
$70.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.65 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: BCBS Trust/PPO |
$229.38
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$230.42
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$244.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Exchange |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$189.93 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$254.51
|
| Rate for Payer: Aetna Medicare |
$197.53
|
| Rate for Payer: BCBS Complete |
$220.80
|
| Rate for Payer: BCBS MAPPO |
$189.93
|
| Rate for Payer: BCN Medicare Advantage |
$189.93
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.43
|
| Rate for Payer: Nomi Health Commercial |
$227.92
|
| Rate for Payer: PACE SWMI |
$189.93
|
| Rate for Payer: PHP Medicare Advantage |
$189.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health Medicare |
$191.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.93
|
| Rate for Payer: UHC Exchange |
$189.93
|
| Rate for Payer: UHC Medicare Advantage |
$189.93
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$432.90 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: BCBS Trust/PPO |
$543.66
|
| Rate for Payer: BCN Commercial |
$514.68
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO |
$579.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.08
|
| Rate for Payer: UHC Core |
$556.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.50
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$234.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Exchange |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$234.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Exchange |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$158.18 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Medicare |
$173.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.12
|
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: BCBS MAPPO |
$166.50
|
| Rate for Payer: BCBS Trust/PPO |
$547.52
|
| Rate for Payer: BCN Commercial |
$517.82
|
| Rate for Payer: BCN Medicare Advantage |
$166.50
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.50
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.50
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.82
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: PACE Senior Care Partners |
$158.18
|
| Rate for Payer: PACE SWMI |
$166.50
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: PHP Medicare Advantage |
$166.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO |
$579.42
|
| Rate for Payer: Priority Health Medicare |
$168.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.22
|
| Rate for Payer: Railroad Medicare Medicare |
$166.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.08
|
| Rate for Payer: UHC Core |
$556.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.50
|
| Rate for Payer: UHC Exchange |
$166.50
|
| Rate for Payer: UHC Medicare Advantage |
$166.50
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
| Rate for Payer: VA VA |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.50
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$69.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Exchange |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$69.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Exchange |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
|
