|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$381.70 |
| Max. Negotiated Rate |
$981.50 |
| Rate for Payer: Aetna Commercial |
$759.08
|
| Rate for Payer: Aetna Medicare |
$589.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.73
|
| Rate for Payer: BCBS Complete |
$400.79
|
| Rate for Payer: BCBS MAPPO |
$566.48
|
| Rate for Payer: BCN Commercial |
$904.83
|
| Rate for Payer: BCN Medicare Advantage |
$566.48
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Commercial |
$759.08
|
| Rate for Payer: Cofinity Commercial |
$815.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$594.80
|
| Rate for Payer: Meridian Medicaid |
$400.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$623.13
|
| Rate for Payer: Nomi Health Commercial |
$679.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$971.25
|
| Rate for Payer: PACE SWMI |
$566.48
|
| Rate for Payer: PHP Commercial |
$793.07
|
| Rate for Payer: PHP Medicare Advantage |
$566.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$967.25
|
| Rate for Payer: Priority Health Medicare |
$566.48
|
| Rate for Payer: Priority Health SBD |
$967.25
|
| Rate for Payer: Priority Health Tiered Network |
$967.25
|
| Rate for Payer: Railroad Medicare Medicare |
$566.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$981.50
|
| Rate for Payer: UHC Core |
$981.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$566.48
|
| Rate for Payer: UHC Exchange |
$981.50
|
| Rate for Payer: UHC Medicaid |
$381.70
|
| Rate for Payer: UHCCP Medicaid |
$381.70
|
| Rate for Payer: UMR Bronson Commercial |
$595.70
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$714.75 |
| Rate for Payer: Aetna Commercial |
$416.47
|
| Rate for Payer: Aetna Medicare |
$323.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.55
|
| Rate for Payer: BCBS Complete |
$214.92
|
| Rate for Payer: BCBS MAPPO |
$310.80
|
| Rate for Payer: BCN Commercial |
$516.41
|
| Rate for Payer: BCN Medicare Advantage |
$310.80
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cofinity Commercial |
$416.47
|
| Rate for Payer: Cofinity Commercial |
$447.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.34
|
| Rate for Payer: Meridian Medicaid |
$214.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$341.88
|
| Rate for Payer: Nomi Health Commercial |
$372.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$714.75
|
| Rate for Payer: PACE SWMI |
$310.80
|
| Rate for Payer: PHP Commercial |
$435.12
|
| Rate for Payer: PHP Medicare Advantage |
$310.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$552.02
|
| Rate for Payer: Priority Health Medicare |
$310.80
|
| Rate for Payer: Priority Health SBD |
$552.02
|
| Rate for Payer: Priority Health Tiered Network |
$552.02
|
| Rate for Payer: Railroad Medicare Medicare |
$310.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.17
|
| Rate for Payer: UHC Core |
$686.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$310.80
|
| Rate for Payer: UHC Exchange |
$686.17
|
| Rate for Payer: UHC Medicaid |
$204.69
|
| Rate for Payer: UHCCP Medicaid |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$438.38
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,154.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$558.06 |
| Max. Negotiated Rate |
$3,115.50 |
| Rate for Payer: Aetna Commercial |
$1,151.74
|
| Rate for Payer: Aetna Medicare |
$893.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.69
|
| Rate for Payer: BCBS Complete |
$585.96
|
| Rate for Payer: BCBS MAPPO |
$859.51
|
| Rate for Payer: BCN Commercial |
$1,452.61
|
| Rate for Payer: BCN Medicare Advantage |
$859.51
|
| Rate for Payer: Cash Price |
$3,323.20
|
| Rate for Payer: Cash Price |
$3,323.20
|
| Rate for Payer: Cofinity Commercial |
$1,151.74
|
| Rate for Payer: Cofinity Commercial |
$1,237.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$859.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$902.49
|
| Rate for Payer: Meridian Medicaid |
$585.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$945.46
|
| Rate for Payer: Nomi Health Commercial |
$1,031.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,115.50
|
| Rate for Payer: PACE SWMI |
$859.51
|
| Rate for Payer: PHP Commercial |
$1,203.31
|
| Rate for Payer: PHP Medicare Advantage |
$859.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,552.80
|
| Rate for Payer: Priority Health Medicare |
$859.51
|
| Rate for Payer: Priority Health SBD |
$1,552.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,552.80
|
| Rate for Payer: Railroad Medicare Medicare |
$859.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,679.81
|
| Rate for Payer: UHC Core |
$1,679.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$859.51
|
| Rate for Payer: UHC Exchange |
$1,679.81
|
| Rate for Payer: UHC Medicaid |
$558.06
|
| Rate for Payer: UHCCP Medicaid |
$558.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,910.84
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$867.60 |
| Max. Negotiated Rate |
$1,626.75 |
| Rate for Payer: Aetna Medicare |
$1,084.50
|
| Rate for Payer: BCBS Complete |
$867.60
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,626.75
|
| Rate for Payer: UMR Bronson Commercial |
$997.74
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$267.74 |
| Max. Negotiated Rate |
$1,145.25 |
| Rate for Payer: Aetna Commercial |
$548.10
|
| Rate for Payer: Aetna Medicare |
$425.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.00
|
| Rate for Payer: BCBS Complete |
$281.13
|
| Rate for Payer: BCBS MAPPO |
$409.03
|
| Rate for Payer: BCN Commercial |
$700.17
|
| Rate for Payer: BCN Medicare Advantage |
$409.03
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cash Price |
$1,221.60
|
| Rate for Payer: Cofinity Commercial |
$589.00
|
| Rate for Payer: Cofinity Commercial |
$548.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$429.48
|
| Rate for Payer: Meridian Medicaid |
$281.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$449.93
|
| Rate for Payer: Nomi Health Commercial |
$490.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,145.25
|
| Rate for Payer: PACE SWMI |
$409.03
|
| Rate for Payer: PHP Commercial |
$572.64
|
| Rate for Payer: PHP Medicare Advantage |
$409.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$659.34
|
| Rate for Payer: Priority Health Medicare |
$409.03
|
| Rate for Payer: Priority Health SBD |
$659.34
|
| Rate for Payer: Priority Health Tiered Network |
$659.34
|
| Rate for Payer: Railroad Medicare Medicare |
$409.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$823.26
|
| Rate for Payer: UHC Core |
$823.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$409.03
|
| Rate for Payer: UHC Exchange |
$823.26
|
| Rate for Payer: UHC Medicaid |
$267.74
|
| Rate for Payer: UHCCP Medicaid |
$267.74
|
| Rate for Payer: UMR Bronson Commercial |
$702.42
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$227.70 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Aetna Commercial |
$463.61
|
| Rate for Payer: Aetna Medicare |
$359.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.21
|
| Rate for Payer: BCBS Complete |
$239.09
|
| Rate for Payer: BCBS MAPPO |
$345.98
|
| Rate for Payer: BCN Commercial |
$566.70
|
| Rate for Payer: BCN Medicare Advantage |
$345.98
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$463.61
|
| Rate for Payer: Cofinity Commercial |
$498.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.28
|
| Rate for Payer: Meridian Medicaid |
$239.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$380.58
|
| Rate for Payer: Nomi Health Commercial |
$415.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.00
|
| Rate for Payer: PACE SWMI |
$345.98
|
| Rate for Payer: PHP Commercial |
$484.37
|
| Rate for Payer: PHP Medicare Advantage |
$345.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$605.78
|
| Rate for Payer: Priority Health Medicare |
$345.98
|
| Rate for Payer: Priority Health SBD |
$605.78
|
| Rate for Payer: Priority Health Tiered Network |
$605.78
|
| Rate for Payer: Railroad Medicare Medicare |
$345.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.80
|
| Rate for Payer: UHC Core |
$641.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$345.98
|
| Rate for Payer: UHC Exchange |
$641.80
|
| Rate for Payer: UHC Medicaid |
$227.70
|
| Rate for Payer: UHCCP Medicaid |
$227.70
|
| Rate for Payer: UMR Bronson Commercial |
$616.40
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$380.03 |
| Rate for Payer: Aetna Commercial |
$270.02
|
| Rate for Payer: Aetna Medicare |
$209.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.17
|
| Rate for Payer: BCBS Complete |
$138.66
|
| Rate for Payer: BCBS MAPPO |
$201.51
|
| Rate for Payer: BCN Commercial |
$331.65
|
| Rate for Payer: BCN Medicare Advantage |
$201.51
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$270.02
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.59
|
| Rate for Payer: Meridian Medicaid |
$138.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.66
|
| Rate for Payer: Nomi Health Commercial |
$241.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.75
|
| Rate for Payer: PACE SWMI |
$201.51
|
| Rate for Payer: PHP Commercial |
$282.11
|
| Rate for Payer: PHP Medicare Advantage |
$201.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$361.28
|
| Rate for Payer: Priority Health Medicare |
$201.51
|
| Rate for Payer: Priority Health SBD |
$361.28
|
| Rate for Payer: Priority Health Tiered Network |
$361.28
|
| Rate for Payer: Railroad Medicare Medicare |
$201.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.03
|
| Rate for Payer: UHC Core |
$380.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.51
|
| Rate for Payer: UHC Exchange |
$380.03
|
| Rate for Payer: UHC Medicaid |
$132.06
|
| Rate for Payer: UHCCP Medicaid |
$132.06
|
| Rate for Payer: UMR Bronson Commercial |
$193.66
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$187.65 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$299.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.39
|
| Rate for Payer: BCBS Complete |
$197.03
|
| Rate for Payer: BCBS MAPPO |
$287.77
|
| Rate for Payer: BCN Commercial |
$452.66
|
| Rate for Payer: BCN Medicare Advantage |
$287.77
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cofinity Commercial |
$385.61
|
| Rate for Payer: Cofinity Commercial |
$414.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.16
|
| Rate for Payer: Meridian Medicaid |
$197.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$316.55
|
| Rate for Payer: Nomi Health Commercial |
$345.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$786.00
|
| Rate for Payer: PACE SWMI |
$287.77
|
| Rate for Payer: PHP Commercial |
$402.88
|
| Rate for Payer: PHP Medicare Advantage |
$287.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.31
|
| Rate for Payer: Priority Health Medicare |
$287.77
|
| Rate for Payer: Priority Health SBD |
$414.31
|
| Rate for Payer: Priority Health Tiered Network |
$414.31
|
| Rate for Payer: Railroad Medicare Medicare |
$287.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.78
|
| Rate for Payer: UHC Core |
$525.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$287.77
|
| Rate for Payer: UHC Exchange |
$525.78
|
| Rate for Payer: UHC Medicaid |
$187.65
|
| Rate for Payer: UHCCP Medicaid |
$187.65
|
| Rate for Payer: UMR Bronson Commercial |
$482.08
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$169.46 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna American Axle |
$297.70
|
| Rate for Payer: Aetna Commercial |
$389.30
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$298.34
|
| Rate for Payer: BCN Commercial |
$298.34
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Advantage |
$320.60
|
| Rate for Payer: Cofinity Commercial |
$393.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$412.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.50
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.30
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$389.30
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$288.54
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$169.46
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$343.50 |
| Rate for Payer: Aetna Commercial |
$194.30
|
| Rate for Payer: Aetna Medicare |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.80
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$145.00
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$145.00
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$208.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.25
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.50
|
| Rate for Payer: Nomi Health Commercial |
$174.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE SWMI |
$145.00
|
| Rate for Payer: PHP Commercial |
$203.00
|
| Rate for Payer: PHP Medicare Advantage |
$145.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.45
|
| Rate for Payer: Priority Health Medicare |
$145.00
|
| Rate for Payer: Priority Health SBD |
$232.45
|
| Rate for Payer: Priority Health Tiered Network |
$232.45
|
| Rate for Payer: Railroad Medicare Medicare |
$145.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.58
|
| Rate for Payer: UHC Core |
$292.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.00
|
| Rate for Payer: UHC Exchange |
$292.58
|
| Rate for Payer: UHC Medicaid |
$95.21
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
| Rate for Payer: UMR Bronson Commercial |
$210.68
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$343.50 |
| Rate for Payer: Aetna Commercial |
$194.30
|
| Rate for Payer: Aetna Medicare |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.80
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$145.00
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$145.00
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$194.30
|
| Rate for Payer: Cofinity Commercial |
$208.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.25
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.50
|
| Rate for Payer: Nomi Health Commercial |
$174.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE SWMI |
$145.00
|
| Rate for Payer: PHP Commercial |
$203.00
|
| Rate for Payer: PHP Medicare Advantage |
$145.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.45
|
| Rate for Payer: Priority Health Medicare |
$145.00
|
| Rate for Payer: Priority Health SBD |
$232.45
|
| Rate for Payer: Priority Health Tiered Network |
$232.45
|
| Rate for Payer: Railroad Medicare Medicare |
$145.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.58
|
| Rate for Payer: UHC Core |
$292.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.00
|
| Rate for Payer: UHC Exchange |
$292.58
|
| Rate for Payer: UHC Medicaid |
$95.21
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
| Rate for Payer: UMR Bronson Commercial |
$210.68
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$201.52 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Aetna American Axle |
$297.70
|
| Rate for Payer: Aetna Commercial |
$389.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.70
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Advantage |
$320.60
|
| Rate for Payer: Cofinity Commercial |
$393.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.40
|
| Rate for Payer: Healthscope Commercial |
$412.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PHP Commercial |
$389.30
|
| Rate for Payer: Priority Health SBD |
$288.54
|
| Rate for Payer: UMR Bronson Commercial |
$201.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.50
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Aetna Commercial |
$225.46
|
| Rate for Payer: Aetna Medicare |
$174.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$168.25
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: BCN Medicare Advantage |
$168.25
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$225.46
|
| Rate for Payer: Cofinity Commercial |
$242.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.66
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.07
|
| Rate for Payer: Nomi Health Commercial |
$201.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PACE SWMI |
$168.25
|
| Rate for Payer: PHP Commercial |
$235.55
|
| Rate for Payer: PHP Medicare Advantage |
$168.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$274.39
|
| Rate for Payer: Priority Health Medicare |
$168.25
|
| Rate for Payer: Priority Health SBD |
$274.39
|
| Rate for Payer: Priority Health Tiered Network |
$274.39
|
| Rate for Payer: Railroad Medicare Medicare |
$168.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.82
|
| Rate for Payer: UHC Core |
$346.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.25
|
| Rate for Payer: UHC Exchange |
$346.82
|
| Rate for Payer: UHC Medicaid |
$110.12
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
| Rate for Payer: UMR Bronson Commercial |
$265.42
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$253.88 |
| Max. Negotiated Rate |
$519.30 |
| Rate for Payer: Aetna American Axle |
$375.05
|
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Advantage |
$403.90
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: Priority Health SBD |
$363.51
|
| Rate for Payer: UMR Bronson Commercial |
$253.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna American Axle |
$375.05
|
| Rate for Payer: Aetna Commercial |
$490.45
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$538.73
|
| Rate for Payer: BCN Commercial |
$538.73
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Advantage |
$403.90
|
| Rate for Payer: Cofinity Commercial |
$496.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$519.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.75
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$490.45
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$363.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$213.49
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Aetna Commercial |
$225.46
|
| Rate for Payer: Aetna Medicare |
$174.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$168.25
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: BCN Medicare Advantage |
$168.25
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$225.46
|
| Rate for Payer: Cofinity Commercial |
$242.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.66
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.07
|
| Rate for Payer: Nomi Health Commercial |
$201.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.75
|
| Rate for Payer: PACE SWMI |
$168.25
|
| Rate for Payer: PHP Commercial |
$235.55
|
| Rate for Payer: PHP Medicare Advantage |
$168.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$274.39
|
| Rate for Payer: Priority Health Medicare |
$168.25
|
| Rate for Payer: Priority Health SBD |
$274.39
|
| Rate for Payer: Priority Health Tiered Network |
$274.39
|
| Rate for Payer: Railroad Medicare Medicare |
$168.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.82
|
| Rate for Payer: UHC Core |
$346.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.25
|
| Rate for Payer: UHC Exchange |
$346.82
|
| Rate for Payer: UHC Medicaid |
$110.12
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
| Rate for Payer: UMR Bronson Commercial |
$265.42
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$119.28 |
| Max. Negotiated Rate |
$489.75 |
| Rate for Payer: Aetna Commercial |
$244.63
|
| Rate for Payer: Aetna Medicare |
$189.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.89
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$182.56
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$182.56
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Commercial |
$244.63
|
| Rate for Payer: Cofinity Commercial |
$262.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.69
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.82
|
| Rate for Payer: Nomi Health Commercial |
$219.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PACE SWMI |
$182.56
|
| Rate for Payer: PHP Commercial |
$255.58
|
| Rate for Payer: PHP Medicare Advantage |
$182.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$182.56
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: Priority Health Tiered Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$182.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.32
|
| Rate for Payer: UHC Core |
$375.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.56
|
| Rate for Payer: UHC Exchange |
$375.32
|
| Rate for Payer: UHC Medicaid |
$119.28
|
| Rate for Payer: UHCCP Medicaid |
$119.28
|
| Rate for Payer: UMR Bronson Commercial |
$300.38
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$287.32 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Aetna American Axle |
$424.45
|
| Rate for Payer: Aetna Commercial |
$555.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.45
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Advantage |
$457.10
|
| Rate for Payer: Cofinity Commercial |
$561.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$522.40
|
| Rate for Payer: Healthscope Commercial |
$587.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$489.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PHP Commercial |
$555.05
|
| Rate for Payer: Priority Health SBD |
$411.39
|
| Rate for Payer: UMR Bronson Commercial |
$287.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$489.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$119.28 |
| Max. Negotiated Rate |
$489.75 |
| Rate for Payer: Aetna Commercial |
$244.63
|
| Rate for Payer: Aetna Medicare |
$189.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.89
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$182.56
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$182.56
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Commercial |
$244.63
|
| Rate for Payer: Cofinity Commercial |
$262.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.69
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.82
|
| Rate for Payer: Nomi Health Commercial |
$219.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PACE SWMI |
$182.56
|
| Rate for Payer: PHP Commercial |
$255.58
|
| Rate for Payer: PHP Medicare Advantage |
$182.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$182.56
|
| Rate for Payer: Priority Health SBD |
$295.80
|
| Rate for Payer: Priority Health Tiered Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$182.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.32
|
| Rate for Payer: UHC Core |
$375.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.56
|
| Rate for Payer: UHC Exchange |
$375.32
|
| Rate for Payer: UHC Medicaid |
$119.28
|
| Rate for Payer: UHCCP Medicaid |
$119.28
|
| Rate for Payer: UMR Bronson Commercial |
$300.38
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna American Axle |
$424.45
|
| Rate for Payer: Aetna Commercial |
$555.05
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$252.90
|
| Rate for Payer: BCN Commercial |
$252.90
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Advantage |
$457.10
|
| Rate for Payer: Cofinity Commercial |
$561.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$522.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$587.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$489.75
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.05
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$555.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$411.39
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$241.61
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$489.75
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$360.80 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna American Axle |
$533.00
|
| Rate for Payer: Aetna Commercial |
$697.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Advantage |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$705.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.00
|
| Rate for Payer: Healthscope Commercial |
$738.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$574.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$697.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PHP Commercial |
$697.00
|
| Rate for Payer: Priority Health SBD |
$516.60
|
| Rate for Payer: UMR Bronson Commercial |
$360.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$259.30
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.65
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCBS MAPPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$330.16
|
| Rate for Payer: BCN Medicare Advantage |
$193.51
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$259.30
|
| Rate for Payer: Cofinity Commercial |
$278.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.19
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$212.86
|
| Rate for Payer: Nomi Health Commercial |
$232.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PACE SWMI |
$193.51
|
| Rate for Payer: PHP Commercial |
$270.91
|
| Rate for Payer: PHP Medicare Advantage |
$193.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.19
|
| Rate for Payer: Priority Health Medicare |
$193.51
|
| Rate for Payer: Priority Health SBD |
$302.19
|
| Rate for Payer: Priority Health Tiered Network |
$302.19
|
| Rate for Payer: Railroad Medicare Medicare |
$193.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.38
|
| Rate for Payer: UHC Core |
$386.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$193.51
|
| Rate for Payer: UHC Exchange |
$386.38
|
| Rate for Payer: UHC Medicaid |
$125.67
|
| Rate for Payer: UHCCP Medicaid |
$125.67
|
| Rate for Payer: UMR Bronson Commercial |
$377.20
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna American Axle |
$533.00
|
| Rate for Payer: Aetna Commercial |
$697.00
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$366.66
|
| Rate for Payer: BCN Commercial |
$366.66
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Advantage |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$705.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$738.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$574.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.00
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$697.00
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$697.00
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$516.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: UMR Bronson Commercial |
$303.40
|
| Rate for Payer: VA VA |
$405.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.00
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$259.30
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.65
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCBS MAPPO |
$193.51
|
| Rate for Payer: BCN Commercial |
$330.16
|
| Rate for Payer: BCN Medicare Advantage |
$193.51
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$259.30
|
| Rate for Payer: Cofinity Commercial |
$278.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.19
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$212.86
|
| Rate for Payer: Nomi Health Commercial |
$232.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.00
|
| Rate for Payer: PACE SWMI |
$193.51
|
| Rate for Payer: PHP Commercial |
$270.91
|
| Rate for Payer: PHP Medicare Advantage |
$193.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.19
|
| Rate for Payer: Priority Health Medicare |
$193.51
|
| Rate for Payer: Priority Health SBD |
$302.19
|
| Rate for Payer: Priority Health Tiered Network |
$302.19
|
| Rate for Payer: Railroad Medicare Medicare |
$193.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.38
|
| Rate for Payer: UHC Core |
$386.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$193.51
|
| Rate for Payer: UHC Exchange |
$386.38
|
| Rate for Payer: UHC Medicaid |
$125.67
|
| Rate for Payer: UHCCP Medicaid |
$125.67
|
| Rate for Payer: UMR Bronson Commercial |
$377.20
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$171.25 |
| Max. Negotiated Rate |
$485.25 |
| Rate for Payer: Aetna Commercial |
$349.57
|
| Rate for Payer: Aetna Medicare |
$271.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.65
|
| Rate for Payer: BCBS Complete |
$179.81
|
| Rate for Payer: BCBS MAPPO |
$260.87
|
| Rate for Payer: BCN Commercial |
$409.84
|
| Rate for Payer: BCN Medicare Advantage |
$260.87
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cofinity Commercial |
$349.57
|
| Rate for Payer: Cofinity Commercial |
$375.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.91
|
| Rate for Payer: Meridian Medicaid |
$179.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.96
|
| Rate for Payer: Nomi Health Commercial |
$313.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.25
|
| Rate for Payer: PACE SWMI |
$260.87
|
| Rate for Payer: PHP Commercial |
$365.22
|
| Rate for Payer: PHP Medicare Advantage |
$260.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$375.11
|
| Rate for Payer: Priority Health Medicare |
$260.87
|
| Rate for Payer: Priority Health SBD |
$375.11
|
| Rate for Payer: Priority Health Tiered Network |
$375.11
|
| Rate for Payer: Railroad Medicare Medicare |
$260.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$469.26
|
| Rate for Payer: UHC Core |
$469.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$260.87
|
| Rate for Payer: UHC Exchange |
$469.26
|
| Rate for Payer: UHC Medicaid |
$171.25
|
| Rate for Payer: UHCCP Medicaid |
$171.25
|
| Rate for Payer: UMR Bronson Commercial |
$297.62
|
|
