|
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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.81
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$288.86
|
| 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 |
$371.57
|
| 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 |
$288.86
|
| 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
|
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 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$188.62 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| 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 Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health Medicare |
$190.51
|
| 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
|
|
|
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 |
$188.62 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$196.16
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| 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 Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health Medicare |
$190.51
|
| 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
|
|
|
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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.00
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$288.86
|
| 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 |
$288.86
|
| 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 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| 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 Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$205.72
|
| 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
|
|
|
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 |
$203.68 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$211.83
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| 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 Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$205.72
|
| 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
|
|
|
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 |
$150.57 |
| 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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.43
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$150.57
|
| 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 |
$288.86
|
| 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 |
$160.09
|
| 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 |
$288.86
|
| 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 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 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$209.77 |
| Max. Negotiated Rate |
$517.40 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: BCBS Complete |
$318.40
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| 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 Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health Medicare |
$211.87
|
| 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
|
|
|
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 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 |
$209.77 |
| Max. Negotiated Rate |
$517.40 |
| Rate for Payer: Aetna Commercial |
$281.09
|
| Rate for Payer: Aetna Medicare |
$218.16
|
| Rate for Payer: BCBS Complete |
$318.40
|
| Rate for Payer: BCBS MAPPO |
$209.77
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.26
|
| 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 Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health Medicare |
$211.87
|
| 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
|
|
|
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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.95
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$288.86
|
| 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 |
$288.86
|
| Rate for Payer: VA VA |
$199.00
|
| 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 |
$251.20 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$346.94
|
| Rate for Payer: Aetna Medicare |
$269.27
|
| Rate for Payer: BCBS Complete |
$251.20
|
| Rate for Payer: BCBS MAPPO |
$258.91
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.86
|
| 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 Cigna Priority Health |
$408.20
|
| Rate for Payer: Priority Health Medicare |
$261.50
|
| 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
|
|
|
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
|
| Min. Negotiated Rate |
$137.99 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$184.91
|
| Rate for Payer: Aetna Medicare |
$143.51
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$137.99
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.89
|
| 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 Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$139.37
|
| 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
|
|
|
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 |
$137.99 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$184.91
|
| Rate for Payer: Aetna Medicare |
$143.51
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$137.99
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.89
|
| 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 Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$139.37
|
| 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
|
|
|
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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.72
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.17
|
| 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 |
$288.86
|
| 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 |
$105.55
|
| 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 |
$288.86
|
| 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 2.6-7.5 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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.07
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$288.86
|
| 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 |
$132.81
|
| 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 |
$288.86
|
| 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
|
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 |
$184.98 |
| Max. Negotiated Rate |
$341.90 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS MAPPO |
$184.98
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.23
|
| 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 Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health Medicare |
$186.83
|
| 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
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$341.90 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS MAPPO |
$184.98
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.23
|
| 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 Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health Medicare |
$186.83
|
| 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
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$339.64 |
| Max. Negotiated Rate |
$744.25 |
| Rate for Payer: Aetna Commercial |
$455.12
|
| Rate for Payer: Aetna Medicare |
$353.23
|
| Rate for Payer: BCBS Complete |
$458.00
|
| Rate for Payer: BCBS MAPPO |
$339.64
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.62
|
| 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 Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$343.04
|
| 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
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$204.50 |
| Max. Negotiated Rate |
$367.25 |
| Rate for Payer: Aetna Commercial |
$274.03
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: BCBS Complete |
$226.00
|
| Rate for Payer: BCBS MAPPO |
$204.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.72
|
| 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 Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health Medicare |
$206.54
|
| 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
|
|
|
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 |
$464.73
|
| 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 |
$442.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.31
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| 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 |
$442.57
|
| 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 |
$471.77
|
| 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 |
$442.57
|
| Rate for Payer: VA VA |
$141.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.75
|
|
