|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,033.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$2,621.45 |
| Rate for Payer: Aetna Commercial |
$1,238.27
|
| Rate for Payer: Aetna Medicare |
$961.04
|
| Rate for Payer: BCBS Complete |
$652.39
|
| Rate for Payer: BCBS MAPPO |
$924.08
|
| Rate for Payer: BCBS Trust/PPO |
$746.49
|
| Rate for Payer: BCN Commercial |
$1,403.48
|
| Rate for Payer: BCN Medicare Advantage |
$924.08
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,330.68
|
| Rate for Payer: Cofinity Commercial |
$1,238.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.08
|
| Rate for Payer: Mclaren Medicaid |
$621.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.28
|
| Rate for Payer: Meridian Medicaid |
$652.39
|
| Rate for Payer: Nomi Health Commercial |
$1,108.90
|
| Rate for Payer: PACE SWMI |
$924.08
|
| Rate for Payer: PHP Medicare Advantage |
$924.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,621.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,468.06
|
| Rate for Payer: Priority Health Medicare |
$933.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,468.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$924.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.08
|
| Rate for Payer: UHC Exchange |
$924.08
|
| Rate for Payer: UHC Medicare Advantage |
$924.08
|
| Rate for Payer: UHCCP Medicaid |
$621.32
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,106.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,368.90 |
| Rate for Payer: Aetna Medicare |
$1,053.00
|
| Rate for Payer: BCBS Complete |
$842.40
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,368.90
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$299.48 |
| Max. Negotiated Rate |
$963.95 |
| Rate for Payer: Aetna Commercial |
$589.79
|
| Rate for Payer: Aetna Medicare |
$457.75
|
| Rate for Payer: BCBS Complete |
$314.45
|
| Rate for Payer: BCBS MAPPO |
$440.14
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: BCN Commercial |
$894.28
|
| Rate for Payer: BCN Medicare Advantage |
$440.14
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$633.80
|
| Rate for Payer: Cofinity Commercial |
$589.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.14
|
| Rate for Payer: Mclaren Medicaid |
$299.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.15
|
| Rate for Payer: Meridian Medicaid |
$314.45
|
| Rate for Payer: Nomi Health Commercial |
$528.17
|
| Rate for Payer: PACE SWMI |
$440.14
|
| Rate for Payer: PHP Medicare Advantage |
$440.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.95
|
| Rate for Payer: Priority Health HMO/PPO |
$641.44
|
| Rate for Payer: Priority Health Medicare |
$444.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.14
|
| Rate for Payer: UHC Exchange |
$440.14
|
| Rate for Payer: UHC Medicare Advantage |
$440.14
|
| Rate for Payer: UHCCP Medicaid |
$299.48
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Aetna Medicare |
$370.52
|
| Rate for Payer: BCBS Complete |
$254.51
|
| Rate for Payer: BCBS MAPPO |
$356.27
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$542.92
|
| Rate for Payer: BCN Medicare Advantage |
$356.27
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$513.03
|
| Rate for Payer: Cofinity Commercial |
$477.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.27
|
| Rate for Payer: Mclaren Medicaid |
$242.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.08
|
| Rate for Payer: Meridian Medicaid |
$254.51
|
| Rate for Payer: Nomi Health Commercial |
$427.52
|
| Rate for Payer: PACE SWMI |
$356.27
|
| Rate for Payer: PHP Medicare Advantage |
$356.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO |
$571.96
|
| Rate for Payer: Priority Health Medicare |
$359.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$571.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$356.27
|
| Rate for Payer: UHC Exchange |
$356.27
|
| Rate for Payer: UHC Medicare Advantage |
$356.27
|
| Rate for Payer: UHCCP Medicaid |
$242.39
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$141.86 |
| Max. Negotiated Rate |
$452.22 |
| Rate for Payer: Aetna Commercial |
$280.33
|
| Rate for Payer: Aetna Medicare |
$217.57
|
| Rate for Payer: BCBS Complete |
$148.95
|
| Rate for Payer: BCBS MAPPO |
$209.20
|
| Rate for Payer: BCBS Trust/PPO |
$452.22
|
| Rate for Payer: BCN Commercial |
$317.15
|
| Rate for Payer: BCN Medicare Advantage |
$209.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cofinity Commercial |
$301.25
|
| Rate for Payer: Cofinity Commercial |
$280.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.20
|
| Rate for Payer: Mclaren Medicaid |
$141.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.66
|
| Rate for Payer: Meridian Medicaid |
$148.95
|
| Rate for Payer: Nomi Health Commercial |
$251.04
|
| Rate for Payer: PACE SWMI |
$209.20
|
| Rate for Payer: PHP Medicare Advantage |
$209.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.85
|
| Rate for Payer: Priority Health HMO/PPO |
$352.05
|
| Rate for Payer: Priority Health Medicare |
$211.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.20
|
| Rate for Payer: UHC Exchange |
$209.20
|
| Rate for Payer: UHC Medicare Advantage |
$209.20
|
| Rate for Payer: UHCCP Medicaid |
$141.86
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$747.19 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$299.28
|
| Rate for Payer: BCBS Complete |
$203.30
|
| Rate for Payer: BCBS MAPPO |
$287.77
|
| Rate for Payer: BCBS Trust/PPO |
$364.91
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: BCN Medicare Advantage |
$287.77
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cofinity Commercial |
$414.39
|
| Rate for Payer: Cofinity Commercial |
$385.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.77
|
| Rate for Payer: Mclaren Medicaid |
$193.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.16
|
| Rate for Payer: Meridian Medicaid |
$203.30
|
| Rate for Payer: Nomi Health Commercial |
$345.32
|
| Rate for Payer: PACE SWMI |
$287.77
|
| Rate for Payer: PHP Medicare Advantage |
$287.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.05
|
| Rate for Payer: Priority Health HMO/PPO |
$408.62
|
| Rate for Payer: Priority Health Medicare |
$290.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.77
|
| Rate for Payer: UHC Exchange |
$287.77
|
| Rate for Payer: UHC Medicare Advantage |
$287.77
|
| Rate for Payer: UHCCP Medicaid |
$193.62
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Aetna Commercial |
$378.25
|
| Rate for Payer: BCBS Trust/PPO |
$363.25
|
| Rate for Payer: BCN Commercial |
$343.90
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$382.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Healthscope Commercial |
$400.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: Nomi Health Commercial |
$364.90
|
| Rate for Payer: PHP Commercial |
$378.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO |
$387.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.60
|
| Rate for Payer: UHC Core |
$371.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$165.83
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Mclaren Medicaid |
$108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO |
$229.37
|
| Rate for Payer: Priority Health Medicare |
$161.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Exchange |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$165.83
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Mclaren Medicaid |
$108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO |
$229.37
|
| Rate for Payer: Priority Health Medicare |
$161.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Exchange |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.69 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Aetna Commercial |
$378.25
|
| Rate for Payer: Aetna Medicare |
$115.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.06
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$111.25
|
| Rate for Payer: BCBS Trust/PPO |
$365.83
|
| Rate for Payer: BCN Commercial |
$345.99
|
| Rate for Payer: BCN Medicare Advantage |
$111.25
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$382.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.25
|
| Rate for Payer: Healthscope Commercial |
$400.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.75
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.81
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: Nomi Health Commercial |
$364.90
|
| Rate for Payer: PACE Senior Care Partners |
$105.69
|
| Rate for Payer: PACE SWMI |
$111.25
|
| Rate for Payer: PHP Commercial |
$378.25
|
| Rate for Payer: PHP Medicare Advantage |
$111.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO |
$387.15
|
| Rate for Payer: Priority Health Medicare |
$112.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.15
|
| Rate for Payer: Railroad Medicare Medicare |
$111.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.60
|
| Rate for Payer: UHC Core |
$371.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.25
|
| Rate for Payer: UHC Exchange |
$111.25
|
| Rate for Payer: UHC Medicare Advantage |
$111.25
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$111.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO |
$269.56
|
| Rate for Payer: Priority Health Medicare |
$190.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Exchange |
$188.62
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna Medicare |
$145.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.00
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$140.00
|
| Rate for Payer: BCBS Trust/PPO |
$460.38
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: BCN Medicare Advantage |
$140.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.00
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.00
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$459.20
|
| Rate for Payer: PACE Senior Care Partners |
$133.00
|
| Rate for Payer: PACE SWMI |
$140.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: PHP Medicare Advantage |
$140.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO |
$487.20
|
| Rate for Payer: Priority Health Medicare |
$141.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$375.20
|
| Rate for Payer: Railroad Medicare Medicare |
$140.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.80
|
| Rate for Payer: UHC Core |
$467.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.00
|
| Rate for Payer: UHC Exchange |
$140.00
|
| Rate for Payer: UHC Medicare Advantage |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$140.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO |
$269.56
|
| Rate for Payer: Priority Health Medicare |
$190.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Exchange |
$188.62
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: BCBS Trust/PPO |
$457.13
|
| Rate for Payer: BCN Commercial |
$432.77
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$459.20
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO |
$487.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$375.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.80
|
| Rate for Payer: UHC Core |
$467.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$412.10 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Aetna Commercial |
$538.90
|
| Rate for Payer: BCBS Trust/PPO |
$517.53
|
| Rate for Payer: BCN Commercial |
$489.96
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$545.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Healthscope Commercial |
$570.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: Nomi Health Commercial |
$519.88
|
| Rate for Payer: PHP Commercial |
$538.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO |
$551.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$424.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.92
|
| Rate for Payer: UHC Core |
$529.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$203.68
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Commercial |
$272.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.68
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Nomi Health Commercial |
$244.42
|
| Rate for Payer: PACE SWMI |
$203.68
|
| Rate for Payer: PHP Medicare Advantage |
$203.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO |
$290.77
|
| Rate for Payer: Priority Health Medicare |
$205.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.68
|
| Rate for Payer: UHC Exchange |
$203.68
|
| Rate for Payer: UHC Medicare Advantage |
$203.68
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$203.68
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Commercial |
$272.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.68
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Nomi Health Commercial |
$244.42
|
| Rate for Payer: PACE SWMI |
$203.68
|
| Rate for Payer: PHP Medicare Advantage |
$203.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO |
$290.77
|
| Rate for Payer: Priority Health Medicare |
$205.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.68
|
| Rate for Payer: UHC Exchange |
$203.68
|
| Rate for Payer: UHC Medicare Advantage |
$203.68
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.58 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Aetna Commercial |
$538.90
|
| Rate for Payer: Aetna Medicare |
$164.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$198.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$198.12
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$158.50
|
| Rate for Payer: BCBS Trust/PPO |
$521.21
|
| Rate for Payer: BCN Commercial |
$492.94
|
| Rate for Payer: BCN Medicare Advantage |
$158.50
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$545.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.50
|
| Rate for Payer: Healthscope Commercial |
$570.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.50
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.42
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: Nomi Health Commercial |
$519.88
|
| Rate for Payer: PACE Senior Care Partners |
$150.58
|
| Rate for Payer: PACE SWMI |
$158.50
|
| Rate for Payer: PHP Commercial |
$538.90
|
| Rate for Payer: PHP Medicare Advantage |
$158.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO |
$551.58
|
| Rate for Payer: Priority Health Medicare |
$160.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$424.78
|
| Rate for Payer: Railroad Medicare Medicare |
$158.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.92
|
| Rate for Payer: UHC Core |
$529.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.50
|
| Rate for Payer: UHC Exchange |
$158.50
|
| Rate for Payer: UHC Medicare Advantage |
$158.50
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$158.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$189.05 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna Commercial |
$676.60
|
| Rate for Payer: Aetna Medicare |
$206.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.75
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$199.00
|
| Rate for Payer: BCBS Trust/PPO |
$654.39
|
| Rate for Payer: BCN Commercial |
$618.89
|
| Rate for Payer: BCN Medicare Advantage |
$199.00
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$684.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.00
|
| Rate for Payer: Healthscope Commercial |
$716.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.00
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.95
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: Nomi Health Commercial |
$652.72
|
| Rate for Payer: PACE Senior Care Partners |
$189.05
|
| Rate for Payer: PACE SWMI |
$199.00
|
| Rate for Payer: PHP Commercial |
$676.60
|
| Rate for Payer: PHP Medicare Advantage |
$199.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO |
$692.52
|
| Rate for Payer: Priority Health Medicare |
$200.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.32
|
| Rate for Payer: Railroad Medicare Medicare |
$199.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.48
|
| Rate for Payer: UHC Core |
$664.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.00
|
| Rate for Payer: UHC Exchange |
$199.00
|
| Rate for Payer: UHC Medicare Advantage |
$199.00
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$199.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$209.77
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$302.07
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.77
|
| Rate for Payer: Mclaren Medicaid |
$141.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Nomi Health Commercial |
$251.72
|
| Rate for Payer: PACE SWMI |
$209.77
|
| Rate for Payer: PHP Medicare Advantage |
$209.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Medicare |
$211.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.77
|
| Rate for Payer: UHC Exchange |
$209.77
|
| Rate for Payer: UHC Medicare Advantage |
$209.77
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$209.77
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$302.07
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.77
|
| Rate for Payer: Mclaren Medicaid |
$141.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Nomi Health Commercial |
$251.72
|
| Rate for Payer: PACE SWMI |
$209.77
|
| Rate for Payer: PHP Medicare Advantage |
$209.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Medicare |
$211.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.77
|
| Rate for Payer: UHC Exchange |
$209.77
|
| Rate for Payer: UHC Medicare Advantage |
$209.77
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$517.40 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Aetna Commercial |
$676.60
|
| Rate for Payer: BCBS Trust/PPO |
$649.77
|
| Rate for Payer: BCN Commercial |
$615.15
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$684.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Healthscope Commercial |
$716.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: Nomi Health Commercial |
$652.72
|
| Rate for Payer: PHP Commercial |
$676.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO |
$692.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.48
|
| Rate for Payer: UHC Core |
$664.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.00
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$609.87 |
| Rate for Payer: Aetna Commercial |
$346.94
|
| Rate for Payer: Aetna Medicare |
$269.27
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS MAPPO |
$258.91
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$609.87
|
| Rate for Payer: BCN Medicare Advantage |
$258.91
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cofinity Commercial |
$372.83
|
| Rate for Payer: Cofinity Commercial |
$346.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.91
|
| Rate for Payer: Mclaren Medicaid |
$175.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.86
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Nomi Health Commercial |
$310.69
|
| Rate for Payer: PACE SWMI |
$258.91
|
| Rate for Payer: PHP Medicare Advantage |
$258.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.20
|
| Rate for Payer: Priority Health HMO/PPO |
$371.14
|
| Rate for Payer: Priority Health Medicare |
$261.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.91
|
| Rate for Payer: UHC Exchange |
$258.91
|
| Rate for Payer: UHC Medicare Advantage |
$258.91
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$99.28 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna Commercial |
$355.30
|
| Rate for Payer: Aetna Medicare |
$108.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.62
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$104.50
|
| Rate for Payer: BCBS Trust/PPO |
$343.64
|
| Rate for Payer: BCN Commercial |
$325.00
|
| Rate for Payer: BCN Medicare Advantage |
$104.50
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$359.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.50
|
| Rate for Payer: Healthscope Commercial |
$376.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.50
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.72
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.30
|
| Rate for Payer: Nomi Health Commercial |
$342.76
|
| Rate for Payer: PACE Senior Care Partners |
$99.28
|
| Rate for Payer: PACE SWMI |
$104.50
|
| Rate for Payer: PHP Commercial |
$355.30
|
| Rate for Payer: PHP Medicare Advantage |
$104.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO |
$363.66
|
| Rate for Payer: Priority Health Medicare |
$105.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.06
|
| Rate for Payer: Railroad Medicare Medicare |
$104.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.84
|
| Rate for Payer: UHC Core |
$349.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.50
|
| Rate for Payer: UHC Exchange |
$104.50
|
| Rate for Payer: UHC Medicare Advantage |
$104.50
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$104.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$184.91
|
| Rate for Payer: Aetna Medicare |
$143.51
|
| Rate for Payer: BCBS Complete |
$98.41
|
| Rate for Payer: BCBS MAPPO |
$137.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$137.99
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$198.71
|
| Rate for Payer: Cofinity Commercial |
$184.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.99
|
| Rate for Payer: Mclaren Medicaid |
$93.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.89
|
| Rate for Payer: Meridian Medicaid |
$98.41
|
| Rate for Payer: Nomi Health Commercial |
$165.59
|
| Rate for Payer: PACE SWMI |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$137.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO |
$196.41
|
| Rate for Payer: Priority Health Medicare |
$139.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.99
|
| Rate for Payer: UHC Exchange |
$137.99
|
| Rate for Payer: UHC Medicare Advantage |
$137.99
|
| Rate for Payer: UHCCP Medicaid |
$93.72
|
|
