|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$330.19 |
| Max. Negotiated Rate |
$952.70 |
| Rate for Payer: Aetna Commercial |
$753.27
|
| Rate for Payer: BCBS Complete |
$389.37
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Meridian Medicaid |
$389.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$893.13
|
| Rate for Payer: Priority Health Narrow Network |
$893.13
|
| Rate for Payer: Priority Health SBD |
$893.13
|
| Rate for Payer: UMR Bronson Commercial |
$626.06
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$1,227.10 |
| Rate for Payer: Aetna Commercial |
$986.20
|
| Rate for Payer: BCBS Complete |
$505.00
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Meridian Medicaid |
$505.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,155.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,155.09
|
| Rate for Payer: Priority Health SBD |
$1,155.09
|
| Rate for Payer: UMR Bronson Commercial |
$806.38
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$972.79 |
| Rate for Payer: Aetna Commercial |
$816.06
|
| Rate for Payer: BCBS Complete |
$425.83
|
| Rate for Payer: BCBS Trust/PPO |
$132.08
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Meridian Medicaid |
$425.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$972.79
|
| Rate for Payer: Priority Health Narrow Network |
$972.79
|
| Rate for Payer: Priority Health SBD |
$972.79
|
| Rate for Payer: UMR Bronson Commercial |
$590.18
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,895.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$1,326.50 |
| Rate for Payer: Aetna Commercial |
$950.15
|
| Rate for Payer: BCBS Complete |
$486.66
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: Cash Price |
$1,516.00
|
| Rate for Payer: Cash Price |
$1,516.00
|
| Rate for Payer: Meridian Medicaid |
$486.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,115.78
|
| Rate for Payer: Priority Health SBD |
$1,115.78
|
| Rate for Payer: UMR Bronson Commercial |
$871.70
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$937.55 |
| Rate for Payer: Aetna Commercial |
$793.05
|
| Rate for Payer: BCBS Complete |
$409.50
|
| Rate for Payer: BCBS Trust/PPO |
$154.79
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Meridian Medicaid |
$409.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$937.55
|
| Rate for Payer: Priority Health Narrow Network |
$937.55
|
| Rate for Payer: Priority Health SBD |
$937.55
|
| Rate for Payer: UMR Bronson Commercial |
$566.72
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$221.09 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$468.22
|
| Rate for Payer: BCBS Complete |
$232.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Meridian Medicaid |
$232.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$531.59
|
| Rate for Payer: Priority Health Narrow Network |
$531.59
|
| Rate for Payer: Priority Health SBD |
$531.59
|
| Rate for Payer: UMR Bronson Commercial |
$417.22
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$3,954.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$614.51 |
| Max. Negotiated Rate |
$2,767.80 |
| Rate for Payer: Aetna Commercial |
$1,282.82
|
| Rate for Payer: BCBS Complete |
$645.24
|
| Rate for Payer: BCBS Trust/PPO |
$746.49
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Meridian Medicaid |
$645.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,767.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,466.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,466.59
|
| Rate for Payer: Priority Health SBD |
$1,466.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,818.84
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,065.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$826.00 |
| Max. Negotiated Rate |
$1,445.50 |
| Rate for Payer: BCBS Complete |
$826.00
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.50
|
| Rate for Payer: UMR Bronson Commercial |
$949.90
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$294.79 |
| Max. Negotiated Rate |
$1,017.80 |
| Rate for Payer: Aetna Commercial |
$589.31
|
| Rate for Payer: BCBS Complete |
$309.53
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Meridian Medicaid |
$309.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.15
|
| Rate for Payer: Priority Health Narrow Network |
$637.15
|
| Rate for Payer: Priority Health SBD |
$637.15
|
| Rate for Payer: UMR Bronson Commercial |
$668.84
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Aetna Commercial |
$490.73
|
| Rate for Payer: BCBS Complete |
$251.38
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Meridian Medicaid |
$251.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.34
|
| Rate for Payer: Priority Health Narrow Network |
$567.34
|
| Rate for Payer: Priority Health SBD |
$567.34
|
| Rate for Payer: UMR Bronson Commercial |
$586.50
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$452.22 |
| Rate for Payer: Aetna Commercial |
$277.43
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS Trust/PPO |
$452.22
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.70
|
| Rate for Payer: Priority Health Narrow Network |
$350.70
|
| Rate for Payer: Priority Health SBD |
$350.70
|
| Rate for Payer: UMR Bronson Commercial |
$184.46
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$192.77 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna Commercial |
$322.34
|
| Rate for Payer: BCBS Complete |
$202.41
|
| Rate for Payer: BCBS Trust/PPO |
$364.91
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Meridian Medicaid |
$202.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.47
|
| Rate for Payer: Priority Health Narrow Network |
$367.47
|
| Rate for Payer: Priority Health SBD |
$367.47
|
| Rate for Payer: UMR Bronson Commercial |
$458.62
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$305.20 |
| Rate for Payer: Aetna Commercial |
$180.03
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.16
|
| Rate for Payer: Priority Health Narrow Network |
$207.16
|
| Rate for Payer: Priority Health SBD |
$207.16
|
| Rate for Payer: UMR Bronson Commercial |
$200.56
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$305.20 |
| Rate for Payer: Aetna Commercial |
$180.03
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.16
|
| Rate for Payer: Priority Health Narrow Network |
$207.16
|
| Rate for Payer: Priority Health SBD |
$207.16
|
| Rate for Payer: UMR Bronson Commercial |
$200.56
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$161.32 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$283.40
|
| Rate for Payer: Aetna Commercial |
$370.60
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$235.46
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$374.96
|
| Rate for Payer: Cofinity Commercial |
$305.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$392.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.00
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.60
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$370.60
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$274.68
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$166.34
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$161.32
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$191.84 |
| Max. Negotiated Rate |
$392.40 |
| Rate for Payer: Aetna American Axle |
$283.40
|
| Rate for Payer: Aetna Commercial |
$370.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.40
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$305.20
|
| Rate for Payer: Cofinity Commercial |
$374.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.80
|
| Rate for Payer: Healthscope Commercial |
$392.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.60
|
| Rate for Payer: PHP Commercial |
$370.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health SBD |
$274.68
|
| Rate for Payer: UMR Bronson Commercial |
$191.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Aetna Commercial |
$213.15
|
| Rate for Payer: BCBS Complete |
$133.52
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Meridian Medicaid |
$133.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.74
|
| Rate for Payer: Priority Health Narrow Network |
$243.74
|
| Rate for Payer: Priority Health SBD |
$243.74
|
| Rate for Payer: UMR Bronson Commercial |
$252.54
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$241.56 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Aetna American Axle |
$356.85
|
| Rate for Payer: Aetna Commercial |
$466.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.85
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$384.30
|
| Rate for Payer: Cofinity Commercial |
$472.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.20
|
| Rate for Payer: Healthscope Commercial |
$494.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.65
|
| Rate for Payer: PHP Commercial |
$466.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health SBD |
$345.87
|
| Rate for Payer: UMR Bronson Commercial |
$241.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$356.85
|
| Rate for Payer: Aetna Commercial |
$466.65
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$425.18
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$384.30
|
| Rate for Payer: Cofinity Commercial |
$472.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$494.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.75
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.65
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$466.65
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$345.87
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$195.48
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$203.13
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Aetna Commercial |
$213.15
|
| Rate for Payer: BCBS Complete |
$133.52
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Meridian Medicaid |
$133.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.74
|
| Rate for Payer: Priority Health Narrow Network |
$243.74
|
| Rate for Payer: Priority Health SBD |
$243.74
|
| Rate for Payer: UMR Bronson Commercial |
$252.54
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna American Axle |
$404.30
|
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.30
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$435.40
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.70
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health SBD |
$391.86
|
| Rate for Payer: UMR Bronson Commercial |
$273.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$404.30
|
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$199.59
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$534.92
|
| Rate for Payer: Cofinity Commercial |
$435.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$559.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.50
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.70
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$528.70
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$391.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$210.87
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$230.14
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$435.40 |
| Rate for Payer: Aetna Commercial |
$230.84
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Narrow Network |
$263.07
|
| Rate for Payer: Priority Health SBD |
$263.07
|
| Rate for Payer: UMR Bronson Commercial |
$286.12
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$435.40 |
| Rate for Payer: Aetna Commercial |
$230.84
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Narrow Network |
$263.07
|
| Rate for Payer: Priority Health SBD |
$263.07
|
| Rate for Payer: UMR Bronson Commercial |
$286.12
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$140.37 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Commercial |
$235.75
|
| Rate for Payer: BCBS Complete |
$147.39
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Meridian Medicaid |
$147.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.82
|
| Rate for Payer: Priority Health Narrow Network |
$268.82
|
| Rate for Payer: Priority Health SBD |
$268.82
|
| Rate for Payer: UMR Bronson Commercial |
$358.80
|
|
