|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$271.70 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna Commercial |
$355.30
|
| Rate for Payer: BCBS Trust/PPO |
$341.21
|
| Rate for Payer: BCN Commercial |
$323.03
|
| 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: Healthscope Commercial |
$376.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.30
|
| Rate for Payer: Nomi Health Commercial |
$342.76
|
| Rate for Payer: PHP Commercial |
$355.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO |
$363.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.84
|
| Rate for Payer: UHC Core |
$349.03
|
| 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
|
| Hospital Charge Code |
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
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$124.92 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Aetna Commercial |
$447.10
|
| Rate for Payer: Aetna Medicare |
$136.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.38
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$131.50
|
| Rate for Payer: BCBS Trust/PPO |
$432.42
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: BCN Medicare Advantage |
$131.50
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$452.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.50
|
| Rate for Payer: Healthscope Commercial |
$473.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.50
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.08
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.10
|
| Rate for Payer: Nomi Health Commercial |
$431.32
|
| Rate for Payer: PACE Senior Care Partners |
$124.92
|
| Rate for Payer: PACE SWMI |
$131.50
|
| Rate for Payer: PHP Commercial |
$447.10
|
| Rate for Payer: PHP Medicare Advantage |
$131.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO |
$457.62
|
| Rate for Payer: Priority Health Medicare |
$132.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.42
|
| Rate for Payer: Railroad Medicare Medicare |
$131.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.88
|
| Rate for Payer: UHC Core |
$439.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.50
|
| Rate for Payer: UHC Exchange |
$131.50
|
| Rate for Payer: UHC Medicare Advantage |
$131.50
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$131.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$454.96 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$184.98
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$454.96
|
| Rate for Payer: BCN Medicare Advantage |
$184.98
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$266.37
|
| Rate for Payer: Cofinity Commercial |
$247.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.98
|
| Rate for Payer: Mclaren Medicaid |
$125.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.23
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Nomi Health Commercial |
$221.98
|
| Rate for Payer: PACE SWMI |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$184.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO |
$264.58
|
| Rate for Payer: Priority Health Medicare |
$186.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.98
|
| Rate for Payer: UHC Exchange |
$184.98
|
| Rate for Payer: UHC Medicare Advantage |
$184.98
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$341.90 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Aetna Commercial |
$447.10
|
| Rate for Payer: BCBS Trust/PPO |
$429.37
|
| Rate for Payer: BCN Commercial |
$406.49
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$452.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.80
|
| Rate for Payer: Healthscope Commercial |
$473.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.10
|
| Rate for Payer: Nomi Health Commercial |
$431.32
|
| Rate for Payer: PHP Commercial |
$447.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO |
$457.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.88
|
| Rate for Payer: UHC Core |
$439.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
12042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$454.96 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$184.98
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$454.96
|
| Rate for Payer: BCN Medicare Advantage |
$184.98
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$266.37
|
| Rate for Payer: Cofinity Commercial |
$247.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.98
|
| Rate for Payer: Mclaren Medicaid |
$125.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.23
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Nomi Health Commercial |
$221.98
|
| Rate for Payer: PACE SWMI |
$184.98
|
| Rate for Payer: PHP Medicare Advantage |
$184.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health HMO/PPO |
$264.58
|
| Rate for Payer: Priority Health Medicare |
$186.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.98
|
| Rate for Payer: UHC Exchange |
$184.98
|
| Rate for Payer: UHC Medicare Advantage |
$184.98
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$804.85 |
| Rate for Payer: Aetna Commercial |
$455.12
|
| Rate for Payer: Aetna Medicare |
$353.23
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: BCBS MAPPO |
$339.64
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$804.85
|
| Rate for Payer: BCN Medicare Advantage |
$339.64
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$489.08
|
| Rate for Payer: Cofinity Commercial |
$455.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.64
|
| Rate for Payer: Mclaren Medicaid |
$227.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.62
|
| Rate for Payer: Meridian Medicaid |
$238.85
|
| Rate for Payer: Nomi Health Commercial |
$407.57
|
| Rate for Payer: PACE SWMI |
$339.64
|
| Rate for Payer: PHP Medicare Advantage |
$339.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health HMO/PPO |
$479.51
|
| Rate for Payer: Priority Health Medicare |
$343.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.64
|
| Rate for Payer: UHC Exchange |
$339.64
|
| Rate for Payer: UHC Medicare Advantage |
$339.64
|
| Rate for Payer: UHCCP Medicaid |
$227.48
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: Aetna Medicare |
$146.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.56
|
| Rate for Payer: BCBS Complete |
$455.33
|
| Rate for Payer: BCBS MAPPO |
$141.25
|
| Rate for Payer: BCBS Trust/PPO |
$464.49
|
| Rate for Payer: BCN Commercial |
$439.29
|
| Rate for Payer: BCN Medicare Advantage |
$141.25
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.25
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.75
|
| Rate for Payer: Mclaren Medicaid |
$433.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.31
|
| Rate for Payer: Meridian Medicaid |
$455.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: Nomi Health Commercial |
$463.30
|
| Rate for Payer: PACE Senior Care Partners |
$134.19
|
| Rate for Payer: PACE SWMI |
$141.25
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: PHP Medicare Advantage |
$141.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health HMO/PPO |
$491.55
|
| Rate for Payer: Priority Health Medicare |
$142.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$378.55
|
| Rate for Payer: Railroad Medicare Medicare |
$141.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.20
|
| Rate for Payer: UHC Core |
$471.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.25
|
| Rate for Payer: UHC Exchange |
$141.25
|
| Rate for Payer: UHC Medicare Advantage |
$141.25
|
| Rate for Payer: UHCCP Medicaid |
$433.62
|
| Rate for Payer: VA VA |
$141.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.75
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$367.25 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: BCBS Trust/PPO |
$461.21
|
| Rate for Payer: BCN Commercial |
$436.63
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: Nomi Health Commercial |
$463.30
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health HMO/PPO |
$491.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$378.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.20
|
| Rate for Payer: UHC Core |
$471.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.75
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
12044
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$560.51 |
| Rate for Payer: Aetna Commercial |
$274.03
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$204.50
|
| Rate for Payer: BCBS Trust/PPO |
$361.61
|
| Rate for Payer: BCN Commercial |
$560.51
|
| Rate for Payer: BCN Medicare Advantage |
$204.50
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$294.48
|
| Rate for Payer: Cofinity Commercial |
$274.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.50
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.72
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Nomi Health Commercial |
$245.40
|
| Rate for Payer: PACE SWMI |
$204.50
|
| Rate for Payer: PHP Medicare Advantage |
$204.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health HMO/PPO |
$289.88
|
| Rate for Payer: Priority Health Medicare |
$206.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.50
|
| Rate for Payer: UHC Exchange |
$204.50
|
| Rate for Payer: UHC Medicare Advantage |
$204.50
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$560.51 |
| Rate for Payer: Aetna Commercial |
$274.03
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$204.50
|
| Rate for Payer: BCBS Trust/PPO |
$361.61
|
| Rate for Payer: BCN Commercial |
$560.51
|
| Rate for Payer: BCN Medicare Advantage |
$204.50
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$294.48
|
| Rate for Payer: Cofinity Commercial |
$274.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.50
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.72
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Nomi Health Commercial |
$245.40
|
| Rate for Payer: PACE SWMI |
$204.50
|
| Rate for Payer: PHP Medicare Advantage |
$204.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health HMO/PPO |
$289.88
|
| Rate for Payer: Priority Health Medicare |
$206.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.50
|
| Rate for Payer: UHC Exchange |
$204.50
|
| Rate for Payer: UHC Medicare Advantage |
$204.50
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$459.81 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$459.81
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Mclaren Medicaid |
$155.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Nomi Health Commercial |
$276.64
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health HMO/PPO |
$326.90
|
| Rate for Payer: Priority Health Medicare |
$232.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.53
|
| Rate for Payer: UHC Exchange |
$230.53
|
| Rate for Payer: UHC Medicare Advantage |
$230.53
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Aetna Commercial |
$589.90
|
| Rate for Payer: Aetna Medicare |
$180.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.88
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$173.50
|
| Rate for Payer: BCBS Trust/PPO |
$570.54
|
| Rate for Payer: BCN Commercial |
$539.58
|
| Rate for Payer: BCN Medicare Advantage |
$173.50
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$596.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.50
|
| Rate for Payer: Healthscope Commercial |
$624.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.50
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.18
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.90
|
| Rate for Payer: Nomi Health Commercial |
$569.08
|
| Rate for Payer: PACE Senior Care Partners |
$164.82
|
| Rate for Payer: PACE SWMI |
$173.50
|
| Rate for Payer: PHP Commercial |
$589.90
|
| Rate for Payer: PHP Medicare Advantage |
$173.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health HMO/PPO |
$603.78
|
| Rate for Payer: Priority Health Medicare |
$175.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$464.98
|
| Rate for Payer: Railroad Medicare Medicare |
$173.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$610.72
|
| Rate for Payer: UHC Core |
$579.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.50
|
| Rate for Payer: UHC Exchange |
$173.50
|
| Rate for Payer: UHC Medicare Advantage |
$173.50
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$173.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$451.10 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Aetna Commercial |
$589.90
|
| Rate for Payer: BCBS Trust/PPO |
$566.51
|
| Rate for Payer: BCN Commercial |
$536.32
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$596.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.20
|
| Rate for Payer: Healthscope Commercial |
$624.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.90
|
| Rate for Payer: Nomi Health Commercial |
$569.08
|
| Rate for Payer: PHP Commercial |
$589.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health HMO/PPO |
$603.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$464.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$610.72
|
| Rate for Payer: UHC Core |
$579.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$459.81 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$459.81
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Mclaren Medicaid |
$155.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Nomi Health Commercial |
$276.64
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health HMO/PPO |
$326.90
|
| Rate for Payer: Priority Health Medicare |
$232.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.53
|
| Rate for Payer: UHC Exchange |
$230.53
|
| Rate for Payer: UHC Medicare Advantage |
$230.53
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$564.85 |
| Rate for Payer: Aetna Commercial |
$363.30
|
| Rate for Payer: Aetna Medicare |
$281.96
|
| Rate for Payer: BCBS Complete |
$191.00
|
| Rate for Payer: BCBS MAPPO |
$271.12
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$510.07
|
| Rate for Payer: BCN Medicare Advantage |
$271.12
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$390.41
|
| Rate for Payer: Cofinity Commercial |
$363.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.12
|
| Rate for Payer: Mclaren Medicaid |
$181.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.68
|
| Rate for Payer: Meridian Medicaid |
$191.00
|
| Rate for Payer: Nomi Health Commercial |
$325.34
|
| Rate for Payer: PACE SWMI |
$271.12
|
| Rate for Payer: PHP Medicare Advantage |
$271.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.85
|
| Rate for Payer: Priority Health HMO/PPO |
$382.44
|
| Rate for Payer: Priority Health Medicare |
$273.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.12
|
| Rate for Payer: UHC Exchange |
$271.12
|
| Rate for Payer: UHC Medicare Advantage |
$271.12
|
| Rate for Payer: UHCCP Medicaid |
$181.90
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$310.99 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$148.16
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$310.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.46
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$190.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.46
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$170.95
|
| Rate for Payer: PACE SWMI |
$142.46
|
| Rate for Payer: PHP Medicare Advantage |
$142.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO |
$205.00
|
| Rate for Payer: Priority Health Medicare |
$143.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.46
|
| Rate for Payer: UHC Exchange |
$142.46
|
| Rate for Payer: UHC Medicare Advantage |
$142.46
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$256.10 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: BCBS Trust/PPO |
$321.62
|
| Rate for Payer: BCN Commercial |
$304.48
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.20
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.90
|
| Rate for Payer: Nomi Health Commercial |
$323.08
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO |
$342.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.72
|
| Rate for Payer: UHC Core |
$328.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$310.99 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$148.16
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$310.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.46
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$190.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.46
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$170.95
|
| Rate for Payer: PACE SWMI |
$142.46
|
| Rate for Payer: PHP Medicare Advantage |
$142.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO |
$205.00
|
| Rate for Payer: Priority Health Medicare |
$143.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.46
|
| Rate for Payer: UHC Exchange |
$142.46
|
| Rate for Payer: UHC Medicare Advantage |
$142.46
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: Aetna Medicare |
$102.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.12
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$98.50
|
| Rate for Payer: BCBS Trust/PPO |
$323.91
|
| Rate for Payer: BCN Commercial |
$306.34
|
| Rate for Payer: BCN Medicare Advantage |
$98.50
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.50
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.50
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.42
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.90
|
| Rate for Payer: Nomi Health Commercial |
$323.08
|
| Rate for Payer: PACE Senior Care Partners |
$93.58
|
| Rate for Payer: PACE SWMI |
$98.50
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: PHP Medicare Advantage |
$98.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO |
$342.78
|
| Rate for Payer: Priority Health Medicare |
$99.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.98
|
| Rate for Payer: Railroad Medicare Medicare |
$98.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.72
|
| Rate for Payer: UHC Core |
$328.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.50
|
| Rate for Payer: UHC Exchange |
$98.50
|
| Rate for Payer: UHC Medicare Advantage |
$98.50
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$98.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: Aetna Commercial |
$427.55
|
| Rate for Payer: Aetna Medicare |
$130.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.19
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$125.75
|
| Rate for Payer: BCBS Trust/PPO |
$413.52
|
| Rate for Payer: BCN Commercial |
$391.08
|
| Rate for Payer: BCN Medicare Advantage |
$125.75
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$432.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.75
|
| Rate for Payer: Healthscope Commercial |
$452.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.25
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.04
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.55
|
| Rate for Payer: Nomi Health Commercial |
$412.46
|
| Rate for Payer: PACE Senior Care Partners |
$119.46
|
| Rate for Payer: PACE SWMI |
$125.75
|
| Rate for Payer: PHP Commercial |
$427.55
|
| Rate for Payer: PHP Medicare Advantage |
$125.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO |
$437.61
|
| Rate for Payer: Priority Health Medicare |
$127.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.01
|
| Rate for Payer: Railroad Medicare Medicare |
$125.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.64
|
| Rate for Payer: UHC Core |
$420.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.75
|
| Rate for Payer: UHC Exchange |
$125.75
|
| Rate for Payer: UHC Medicare Advantage |
$125.75
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$125.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$358.50 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$186.32
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$358.50
|
| Rate for Payer: BCN Medicare Advantage |
$179.15
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$257.98
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.15
|
| Rate for Payer: Mclaren Medicaid |
$122.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Nomi Health Commercial |
$214.98
|
| Rate for Payer: PACE SWMI |
$179.15
|
| Rate for Payer: PHP Medicare Advantage |
$179.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO |
$257.37
|
| Rate for Payer: Priority Health Medicare |
$180.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.15
|
| Rate for Payer: UHC Exchange |
$179.15
|
| Rate for Payer: UHC Medicare Advantage |
$179.15
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$358.50 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$186.32
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$358.50
|
| Rate for Payer: BCN Medicare Advantage |
$179.15
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$257.98
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.15
|
| Rate for Payer: Mclaren Medicaid |
$122.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Nomi Health Commercial |
$214.98
|
| Rate for Payer: PACE SWMI |
$179.15
|
| Rate for Payer: PHP Medicare Advantage |
$179.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO |
$257.37
|
| Rate for Payer: Priority Health Medicare |
$180.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.15
|
| Rate for Payer: UHC Exchange |
$179.15
|
| Rate for Payer: UHC Medicare Advantage |
$179.15
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$326.95 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: Aetna Commercial |
$427.55
|
| Rate for Payer: BCBS Trust/PPO |
$410.60
|
| Rate for Payer: BCN Commercial |
$388.72
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$432.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.40
|
| Rate for Payer: Healthscope Commercial |
$452.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.55
|
| Rate for Payer: Nomi Health Commercial |
$412.46
|
| Rate for Payer: PHP Commercial |
$427.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO |
$437.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.64
|
| Rate for Payer: UHC Core |
$420.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$1,594.65 |
| Rate for Payer: Aetna Commercial |
$421.62
|
| Rate for Payer: Aetna Medicare |
$327.23
|
| Rate for Payer: BCBS Complete |
$221.19
|
| Rate for Payer: BCBS MAPPO |
$314.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.65
|
| Rate for Payer: BCN Commercial |
$571.33
|
| Rate for Payer: BCN Medicare Advantage |
$314.64
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cofinity Commercial |
$453.08
|
| Rate for Payer: Cofinity Commercial |
$421.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.64
|
| Rate for Payer: Mclaren Medicaid |
$210.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.37
|
| Rate for Payer: Meridian Medicaid |
$221.19
|
| Rate for Payer: Nomi Health Commercial |
$377.57
|
| Rate for Payer: PACE SWMI |
$314.64
|
| Rate for Payer: PHP Medicare Advantage |
$314.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
| Rate for Payer: Priority Health HMO/PPO |
$444.29
|
| Rate for Payer: Priority Health Medicare |
$317.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.64
|
| Rate for Payer: UHC Exchange |
$314.64
|
| Rate for Payer: UHC Medicare Advantage |
$314.64
|
| Rate for Payer: UHCCP Medicaid |
$210.66
|
|
