|
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
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna American Axle |
$507.00
|
| Rate for Payer: Aetna Commercial |
$663.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$546.00
|
| Rate for Payer: Cofinity Commercial |
$670.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.00
|
| Rate for Payer: Healthscope Commercial |
$702.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$546.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.00
|
| Rate for Payer: PHP Commercial |
$663.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health SBD |
$491.40
|
| Rate for Payer: UMR Bronson Commercial |
$343.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$175.09 |
| Max. Negotiated Rate |
$431.20 |
| Rate for Payer: Aetna Commercial |
$289.67
|
| Rate for Payer: BCBS Complete |
$183.84
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Meridian Medicaid |
$183.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.65
|
| Rate for Payer: Priority Health Narrow Network |
$336.65
|
| Rate for Payer: Priority Health SBD |
$336.65
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna American Axle |
$266.50
|
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.50
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$287.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.50
|
| Rate for Payer: PHP Commercial |
$348.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health SBD |
$258.30
|
| Rate for Payer: UMR Bronson Commercial |
$180.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$142.44 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$266.50
|
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.50
|
| 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 |
$435.04
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$287.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.50
|
| 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 |
$348.50
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$348.50
|
| 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 |
$287.00
|
| 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 |
$258.30
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$151.70
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: BCBS Complete |
$97.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Meridian Medicaid |
$97.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.15
|
| Rate for Payer: Priority Health Narrow Network |
$177.15
|
| Rate for Payer: Priority Health SBD |
$177.15
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: BCBS Complete |
$97.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Meridian Medicaid |
$97.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.15
|
| Rate for Payer: Priority Health Narrow Network |
$177.15
|
| Rate for Payer: Priority Health SBD |
$177.15
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$227.04 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna American Axle |
$335.40
|
| Rate for Payer: Aetna Commercial |
$438.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.40
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$361.20
|
| Rate for Payer: Cofinity Commercial |
$443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$438.60
|
| Rate for Payer: PHP Commercial |
$438.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health SBD |
$325.08
|
| Rate for Payer: UMR Bronson Commercial |
$227.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.00
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$190.92 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$335.40
|
| Rate for Payer: Aetna Commercial |
$438.60
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.40
|
| 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 |
$426.65
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$361.20
|
| Rate for Payer: Cofinity Commercial |
$443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$361.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.00
|
| 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 |
$438.60
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$438.60
|
| 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 |
$361.20
|
| 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 |
$325.08
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$191.88
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$190.92
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.00
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
12042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$361.20 |
| Rate for Payer: Aetna Commercial |
$208.95
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.41
|
| Rate for Payer: Priority Health Narrow Network |
$238.41
|
| Rate for Payer: Priority Health SBD |
$238.41
|
| Rate for Payer: UMR Bronson Commercial |
$237.36
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 12042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$361.20 |
| Rate for Payer: Aetna Commercial |
$208.95
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.41
|
| Rate for Payer: Priority Health Narrow Network |
$238.41
|
| Rate for Payer: Priority Health SBD |
$238.41
|
| Rate for Payer: UMR Bronson Commercial |
$237.36
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$786.10 |
| Rate for Payer: Aetna Commercial |
$383.37
|
| Rate for Payer: BCBS Complete |
$237.52
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Meridian Medicaid |
$237.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.65
|
| Rate for Payer: Priority Health Narrow Network |
$433.65
|
| Rate for Payer: Priority Health SBD |
$433.65
|
| Rate for Payer: UMR Bronson Commercial |
$516.58
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$243.76 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna American Axle |
$360.10
|
| Rate for Payer: Aetna Commercial |
$470.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.10
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$387.80
|
| Rate for Payer: Cofinity Commercial |
$476.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.20
|
| Rate for Payer: Healthscope Commercial |
$498.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$470.90
|
| Rate for Payer: PHP Commercial |
$470.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.80
|
| Rate for Payer: Priority Health SBD |
$349.02
|
| Rate for Payer: UMR Bronson Commercial |
$243.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
12044
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$387.80 |
| Rate for Payer: Aetna Commercial |
$229.21
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS Trust/PPO |
$361.61
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.01
|
| Rate for Payer: Priority Health Narrow Network |
$261.01
|
| Rate for Payer: Priority Health SBD |
$261.01
|
| Rate for Payer: UMR Bronson Commercial |
$254.84
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$202.79 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna American Axle |
$360.10
|
| Rate for Payer: Aetna Commercial |
$470.90
|
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$202.79
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$387.80
|
| Rate for Payer: Cofinity Commercial |
$476.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$498.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.50
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$470.90
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$470.90
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$349.02
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.26
|
| Rate for Payer: UHC Exchange |
$210.22
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: UMR Bronson Commercial |
$204.98
|
| Rate for Payer: VA VA |
$558.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$387.80 |
| Rate for Payer: Aetna Commercial |
$229.21
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS Trust/PPO |
$361.61
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.01
|
| Rate for Payer: Priority Health Narrow Network |
$261.01
|
| Rate for Payer: Priority Health SBD |
$261.01
|
| Rate for Payer: UMR Bronson Commercial |
$254.84
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$260.49
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.13
|
| Rate for Payer: Priority Health Narrow Network |
$295.13
|
| Rate for Payer: Priority Health SBD |
$295.13
|
| Rate for Payer: UMR Bronson Commercial |
$312.80
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$442.00
|
| Rate for Payer: Aetna Commercial |
$578.00
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.00
|
| 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 |
$398.96
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cofinity Commercial |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$584.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.00
|
| 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 |
$578.00
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$578.00
|
| 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 |
$476.00
|
| 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 |
$428.40
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$237.07
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$251.60
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.00
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna American Axle |
$442.00
|
| Rate for Payer: Aetna Commercial |
$578.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cofinity Commercial |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$584.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.00
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$578.00
|
| Rate for Payer: PHP Commercial |
$578.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.00
|
| Rate for Payer: Priority Health SBD |
$428.40
|
| Rate for Payer: UMR Bronson Commercial |
$299.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.00
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$260.49
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Cash Price |
$544.00
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.13
|
| Rate for Payer: Priority Health Narrow Network |
$295.13
|
| Rate for Payer: Priority Health SBD |
$295.13
|
| Rate for Payer: UMR Bronson Commercial |
$312.80
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$596.40 |
| Rate for Payer: Aetna Commercial |
$306.51
|
| Rate for Payer: BCBS Complete |
$189.43
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Meridian Medicaid |
$189.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.44
|
| Rate for Payer: Priority Health Narrow Network |
$344.44
|
| Rate for Payer: Priority Health SBD |
$344.44
|
| Rate for Payer: UMR Bronson Commercial |
$391.92
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$169.84 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Aetna American Axle |
$250.90
|
| Rate for Payer: Aetna Commercial |
$328.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.90
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$270.20
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.80
|
| Rate for Payer: Healthscope Commercial |
$347.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.10
|
| Rate for Payer: PHP Commercial |
$328.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.20
|
| Rate for Payer: Priority Health SBD |
$243.18
|
| Rate for Payer: UMR Bronson Commercial |
$169.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$142.82 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$250.90
|
| Rate for Payer: Aetna Commercial |
$328.10
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.90
|
| 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 |
$398.96
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$270.20
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$347.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.50
|
| 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 |
$328.10
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$328.10
|
| 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 |
$270.20
|
| 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 |
$243.18
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$148.66
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$142.82
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$270.20 |
| Rate for Payer: Aetna Commercial |
$161.34
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.38
|
| Rate for Payer: Priority Health Narrow Network |
$185.38
|
| Rate for Payer: Priority Health SBD |
$185.38
|
| Rate for Payer: UMR Bronson Commercial |
$177.56
|
|
