|
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 |
$471.77
|
| 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 |
$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 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
|
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 |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$173.50
|
| Rate for Payer: BCBS Trust/PPO |
$570.54
|
| Rate for Payer: BCN Commercial |
$539.59
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.18
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.53
|
| 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 |
$288.86
|
| 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 |
$288.86
|
| 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
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$451.10 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: BCBS Complete |
$277.60
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.06
|
| 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 Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health Medicare |
$232.84
|
| 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
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$451.10 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: BCBS Complete |
$277.60
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.06
|
| 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 Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health Medicare |
$232.84
|
| 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
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$271.12 |
| Max. Negotiated Rate |
$564.85 |
| Rate for Payer: Aetna Commercial |
$363.30
|
| Rate for Payer: Aetna Medicare |
$281.96
|
| Rate for Payer: BCBS Complete |
$347.60
|
| Rate for Payer: BCBS MAPPO |
$271.12
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.68
|
| 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 Cigna Priority Health |
$564.85
|
| Rate for Payer: Priority Health Medicare |
$273.83
|
| 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
|
|
|
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
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$142.46 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$148.16
|
| Rate for Payer: BCBS Complete |
$157.60
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| 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 Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health Medicare |
$143.88
|
| 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
|
|
|
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 |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$98.50
|
| Rate for Payer: BCBS Trust/PPO |
$323.91
|
| Rate for Payer: BCN Commercial |
$306.33
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.42
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$288.86
|
| 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 |
$288.86
|
| 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 2.5 CM/<
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$142.46 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$148.16
|
| Rate for Payer: BCBS Complete |
$157.60
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| 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 Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health Medicare |
$143.88
|
| 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
|
|
|
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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.04
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$288.86
|
| 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 |
$288.86
|
| 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
|
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 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$179.15 |
| Max. Negotiated Rate |
$326.95 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$186.32
|
| Rate for Payer: BCBS Complete |
$201.20
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| 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 Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health Medicare |
$180.94
|
| 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
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$179.15 |
| Max. Negotiated Rate |
$326.95 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$186.32
|
| Rate for Payer: BCBS Complete |
$201.20
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| 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 Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health Medicare |
$180.94
|
| 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
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$492.70 |
| Rate for Payer: Aetna Commercial |
$421.62
|
| Rate for Payer: Aetna Medicare |
$327.23
|
| Rate for Payer: BCBS Complete |
$303.20
|
| Rate for Payer: BCBS MAPPO |
$314.64
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.37
|
| 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 Cigna Priority Health |
$492.70
|
| Rate for Payer: Priority Health Medicare |
$317.79
|
| 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
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$202.03
|
| Rate for Payer: BCBS Complete |
$256.40
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$279.73
|
| Rate for Payer: Cofinity Commercial |
$260.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.97
|
| Rate for Payer: Nomi Health Commercial |
$233.11
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.26
|
| Rate for Payer: UHC Exchange |
$194.26
|
| Rate for Payer: UHC Medicare Advantage |
$194.26
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.24 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna Commercial |
$544.85
|
| Rate for Payer: Aetna Medicare |
$166.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.31
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$160.25
|
| Rate for Payer: BCBS Trust/PPO |
$526.97
|
| Rate for Payer: BCN Commercial |
$498.38
|
| Rate for Payer: BCN Medicare Advantage |
$160.25
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.25
|
| Rate for Payer: Healthscope Commercial |
$576.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.75
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.26
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.85
|
| Rate for Payer: Nomi Health Commercial |
$525.62
|
| Rate for Payer: PACE Senior Care Partners |
$152.24
|
| Rate for Payer: PACE SWMI |
$160.25
|
| Rate for Payer: PHP Commercial |
$544.85
|
| Rate for Payer: PHP Medicare Advantage |
$160.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO |
$557.67
|
| Rate for Payer: Priority Health Medicare |
$161.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.47
|
| Rate for Payer: Railroad Medicare Medicare |
$160.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.08
|
| Rate for Payer: UHC Core |
$535.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.25
|
| Rate for Payer: UHC Exchange |
$160.25
|
| Rate for Payer: UHC Medicare Advantage |
$160.25
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$160.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.75
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$416.65 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna Commercial |
$544.85
|
| Rate for Payer: BCBS Trust/PPO |
$523.25
|
| Rate for Payer: BCN Commercial |
$495.36
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.80
|
| Rate for Payer: Healthscope Commercial |
$576.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.85
|
| Rate for Payer: Nomi Health Commercial |
$525.62
|
| Rate for Payer: PHP Commercial |
$544.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO |
$557.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.08
|
| Rate for Payer: UHC Core |
$535.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.75
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$202.03
|
| Rate for Payer: BCBS Complete |
$256.40
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$279.73
|
| Rate for Payer: Cofinity Commercial |
$260.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.97
|
| Rate for Payer: Nomi Health Commercial |
$233.11
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.26
|
| Rate for Payer: UHC Exchange |
$194.26
|
| Rate for Payer: UHC Medicare Advantage |
$194.26
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$650.56 |
| Rate for Payer: Aetna Commercial |
$605.39
|
| Rate for Payer: Aetna Medicare |
$469.85
|
| Rate for Payer: BCBS Complete |
$304.80
|
| Rate for Payer: BCBS MAPPO |
$451.78
|
| Rate for Payer: BCN Medicare Advantage |
$451.78
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$650.56
|
| Rate for Payer: Cofinity Commercial |
$605.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.37
|
| Rate for Payer: Nomi Health Commercial |
$542.14
|
| Rate for Payer: PACE SWMI |
$451.78
|
| Rate for Payer: PHP Medicare Advantage |
$451.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health Medicare |
$456.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.78
|
| Rate for Payer: UHC Exchange |
$451.78
|
| Rate for Payer: UHC Medicare Advantage |
$451.78
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$823.09 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,102.94
|
| Rate for Payer: Aetna Medicare |
$856.01
|
| Rate for Payer: BCBS Complete |
$1,892.80
|
| Rate for Payer: BCBS MAPPO |
$823.09
|
| Rate for Payer: BCN Medicare Advantage |
$823.09
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,185.25
|
| Rate for Payer: Cofinity Commercial |
$1,102.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.24
|
| Rate for Payer: Nomi Health Commercial |
$987.71
|
| Rate for Payer: PACE SWMI |
$823.09
|
| Rate for Payer: PHP Medicare Advantage |
$823.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health Medicare |
$831.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$823.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$823.09
|
| Rate for Payer: UHC Exchange |
$823.09
|
| Rate for Payer: UHC Medicare Advantage |
$823.09
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$257.08 |
| Rate for Payer: Aetna Commercial |
$239.23
|
| Rate for Payer: Aetna Medicare |
$185.67
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: BCBS MAPPO |
$178.53
|
| Rate for Payer: BCN Medicare Advantage |
$178.53
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$257.08
|
| Rate for Payer: Cofinity Commercial |
$239.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.46
|
| Rate for Payer: Nomi Health Commercial |
$214.24
|
| Rate for Payer: PACE SWMI |
$178.53
|
| Rate for Payer: PHP Medicare Advantage |
$178.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health Medicare |
$180.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.53
|
| Rate for Payer: UHC Exchange |
$178.53
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$479.05 |
| Rate for Payer: Aetna Commercial |
$330.07
|
| Rate for Payer: Aetna Medicare |
$256.17
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: BCBS MAPPO |
$246.32
|
| Rate for Payer: BCN Medicare Advantage |
$246.32
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$354.70
|
| Rate for Payer: Cofinity Commercial |
$330.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.64
|
| Rate for Payer: Nomi Health Commercial |
$295.58
|
| Rate for Payer: PACE SWMI |
$246.32
|
| Rate for Payer: PHP Medicare Advantage |
$246.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health Medicare |
$248.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.32
|
| Rate for Payer: UHC Exchange |
$246.32
|
| Rate for Payer: UHC Medicare Advantage |
$246.32
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$692.27 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$927.64
|
| Rate for Payer: Aetna Medicare |
$719.96
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS MAPPO |
$692.27
|
| Rate for Payer: BCN Medicare Advantage |
$692.27
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$996.87
|
| Rate for Payer: Cofinity Commercial |
$927.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.88
|
| Rate for Payer: Nomi Health Commercial |
$830.72
|
| Rate for Payer: PACE SWMI |
$692.27
|
| Rate for Payer: PHP Medicare Advantage |
$692.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health Medicare |
$699.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$692.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$692.27
|
| Rate for Payer: UHC Exchange |
$692.27
|
| Rate for Payer: UHC Medicare Advantage |
$692.27
|
|
