|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.01
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Commercial |
$341.66
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UMR Bronson Commercial |
$413.08
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna American Axle |
$583.70
|
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$628.60
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$628.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$628.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$673.50
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$565.74
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$1,140.93
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: UMR Bronson Commercial |
$332.26
|
| Rate for Payer: VA VA |
$597.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.68
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Commercial |
$109.37
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna American Axle |
$182.65
|
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.65
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$196.70
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health SBD |
$177.03
|
| Rate for Payer: UMR Bronson Commercial |
$103.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$123.64 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna American Axle |
$182.65
|
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.65
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$196.70
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.85
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health SBD |
$177.03
|
| Rate for Payer: UMR Bronson Commercial |
$123.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.68
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCN Medicare Advantage |
$78.12
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$104.68
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.03
|
| Rate for Payer: Nomi Health Commercial |
$93.74
|
| Rate for Payer: PACE SWMI |
$78.12
|
| Rate for Payer: PHP Commercial |
$109.37
|
| Rate for Payer: PHP Medicare Advantage |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$189.93 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$254.51
|
| Rate for Payer: Aetna Medicare |
$197.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.51
|
| Rate for Payer: BCBS Complete |
$220.80
|
| Rate for Payer: BCBS MAPPO |
$189.93
|
| Rate for Payer: BCN Medicare Advantage |
$189.93
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$254.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.43
|
| Rate for Payer: Nomi Health Commercial |
$227.92
|
| Rate for Payer: PACE SWMI |
$189.93
|
| Rate for Payer: PHP Commercial |
$265.90
|
| Rate for Payer: PHP Medicare Advantage |
$189.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health Medicare |
$189.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.93
|
| Rate for Payer: UHC Medicare Advantage |
$189.93
|
| Rate for Payer: UMR Bronson Commercial |
$253.92
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.59
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Commercial |
$324.49
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.59
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Commercial |
$324.49
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$246.42 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna American Axle |
$432.90
|
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$466.20
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.50
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$419.58
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$1,140.93
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: UMR Bronson Commercial |
$246.42
|
| Rate for Payer: VA VA |
$597.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.50
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$293.04 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Aetna American Axle |
$432.90
|
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.90
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$466.20
|
| Rate for Payer: Cofinity Commercial |
$572.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Healthscope Commercial |
$599.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$466.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$499.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health SBD |
$419.58
|
| Rate for Payer: UMR Bronson Commercial |
$293.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.50
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.56
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Commercial |
$95.66
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$91.56
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.40
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCN Medicare Advantage |
$68.33
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$91.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.75
|
| Rate for Payer: Nomi Health Commercial |
$82.00
|
| Rate for Payer: PACE SWMI |
$68.33
|
| Rate for Payer: PHP Commercial |
$95.66
|
| Rate for Payer: PHP Medicare Advantage |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$130.89 |
| Max. Negotiated Rate |
$307.45 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: Aetna Medicare |
$136.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.39
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCBS MAPPO |
$130.89
|
| Rate for Payer: BCN Medicare Advantage |
$130.89
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$175.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.43
|
| Rate for Payer: Nomi Health Commercial |
$157.07
|
| Rate for Payer: PACE SWMI |
$130.89
|
| Rate for Payer: PHP Commercial |
$183.25
|
| Rate for Payer: PHP Medicare Advantage |
$130.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health Medicare |
$130.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.89
|
| Rate for Payer: UHC Medicare Advantage |
$130.89
|
| Rate for Payer: UMR Bronson Commercial |
$217.58
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,223.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$929.71 |
| Max. Negotiated Rate |
$2,744.95 |
| Rate for Payer: Aetna Commercial |
$1,245.81
|
| Rate for Payer: Aetna Medicare |
$966.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.81
|
| Rate for Payer: BCBS Complete |
$1,689.20
|
| Rate for Payer: BCBS MAPPO |
$929.71
|
| Rate for Payer: BCN Medicare Advantage |
$929.71
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,338.78
|
| Rate for Payer: Cofinity Commercial |
$1,245.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.20
|
| Rate for Payer: Nomi Health Commercial |
$1,115.65
|
| Rate for Payer: PACE SWMI |
$929.71
|
| Rate for Payer: PHP Commercial |
$1,301.59
|
| Rate for Payer: PHP Medicare Advantage |
$929.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.95
|
| Rate for Payer: Priority Health Medicare |
$929.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.71
|
| Rate for Payer: UHC Medicare Advantage |
$929.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,942.58
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$780.40 |
| Max. Negotiated Rate |
$1,338.90 |
| Rate for Payer: Aetna Commercial |
$1,245.92
|
| Rate for Payer: Aetna Medicare |
$966.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.92
|
| Rate for Payer: BCBS Complete |
$780.40
|
| Rate for Payer: BCBS MAPPO |
$929.79
|
| Rate for Payer: BCN Medicare Advantage |
$929.79
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$1,338.90
|
| Rate for Payer: Cofinity Commercial |
$1,245.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.28
|
| Rate for Payer: Nomi Health Commercial |
$1,115.75
|
| Rate for Payer: PACE SWMI |
$929.79
|
| Rate for Payer: PHP Commercial |
$1,301.71
|
| Rate for Payer: PHP Medicare Advantage |
$929.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health Medicare |
$929.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$929.79
|
| Rate for Payer: UHC Medicare Advantage |
$929.79
|
| Rate for Payer: UMR Bronson Commercial |
$897.46
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$587.75 |
| Max. Negotiated Rate |
$1,409.85 |
| Rate for Payer: Aetna Commercial |
$787.59
|
| Rate for Payer: Aetna Medicare |
$611.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.59
|
| Rate for Payer: BCBS Complete |
$867.60
|
| Rate for Payer: BCBS MAPPO |
$587.75
|
| Rate for Payer: BCN Medicare Advantage |
$587.75
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$846.36
|
| Rate for Payer: Cofinity Commercial |
$787.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.14
|
| Rate for Payer: Nomi Health Commercial |
$705.30
|
| Rate for Payer: PACE SWMI |
$587.75
|
| Rate for Payer: PHP Commercial |
$822.85
|
| Rate for Payer: PHP Medicare Advantage |
$587.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health Medicare |
$587.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.75
|
| Rate for Payer: UHC Medicare Advantage |
$587.75
|
| Rate for Payer: UMR Bronson Commercial |
$997.74
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$421.77 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$565.17
|
| Rate for Payer: Aetna Medicare |
$438.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.17
|
| Rate for Payer: BCBS Complete |
$500.00
|
| Rate for Payer: BCBS MAPPO |
$421.77
|
| Rate for Payer: BCN Medicare Advantage |
$421.77
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$607.35
|
| Rate for Payer: Cofinity Commercial |
$565.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.86
|
| Rate for Payer: Nomi Health Commercial |
$506.12
|
| Rate for Payer: PACE SWMI |
$421.77
|
| Rate for Payer: PHP Commercial |
$590.48
|
| Rate for Payer: PHP Medicare Advantage |
$421.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health Medicare |
$421.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.77
|
| Rate for Payer: UHC Medicare Advantage |
$421.77
|
| Rate for Payer: UMR Bronson Commercial |
$575.00
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$778.02 |
| Max. Negotiated Rate |
$1,340.95 |
| Rate for Payer: Aetna Commercial |
$1,042.55
|
| Rate for Payer: Aetna Medicare |
$809.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,120.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.55
|
| Rate for Payer: BCBS Complete |
$825.20
|
| Rate for Payer: BCBS MAPPO |
$778.02
|
| Rate for Payer: BCN Medicare Advantage |
$778.02
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$1,120.35
|
| Rate for Payer: Cofinity Commercial |
$1,042.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$816.92
|
| Rate for Payer: Nomi Health Commercial |
$933.62
|
| Rate for Payer: PACE SWMI |
$778.02
|
| Rate for Payer: PHP Commercial |
$1,089.23
|
| Rate for Payer: PHP Medicare Advantage |
$778.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.95
|
| Rate for Payer: Priority Health Medicare |
$778.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$778.02
|
| Rate for Payer: UHC Medicare Advantage |
$778.02
|
| Rate for Payer: UMR Bronson Commercial |
$948.98
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$482.90 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$647.09
|
| Rate for Payer: Aetna Medicare |
$502.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.09
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$482.90
|
| Rate for Payer: BCN Medicare Advantage |
$482.90
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$695.38
|
| Rate for Payer: Cofinity Commercial |
$647.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.05
|
| Rate for Payer: Nomi Health Commercial |
$579.48
|
| Rate for Payer: PACE SWMI |
$482.90
|
| Rate for Payer: PHP Commercial |
$676.06
|
| Rate for Payer: PHP Medicare Advantage |
$482.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$482.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.90
|
| Rate for Payer: UHC Medicare Advantage |
$482.90
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: Aetna Commercial |
$385.37
|
| Rate for Payer: Aetna Medicare |
$299.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.37
|
| Rate for Payer: BCBS Complete |
$269.60
|
| Rate for Payer: BCBS MAPPO |
$287.59
|
| Rate for Payer: BCN Medicare Advantage |
$287.59
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$414.13
|
| Rate for Payer: Cofinity Commercial |
$385.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.97
|
| Rate for Payer: Nomi Health Commercial |
$345.11
|
| Rate for Payer: PACE SWMI |
$287.59
|
| Rate for Payer: PHP Commercial |
$402.63
|
| Rate for Payer: PHP Medicare Advantage |
$287.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health Medicare |
$287.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.59
|
| Rate for Payer: UHC Medicare Advantage |
$287.59
|
| Rate for Payer: UMR Bronson Commercial |
$310.04
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$530.19 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$710.45
|
| Rate for Payer: Aetna Medicare |
$551.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.45
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$530.19
|
| Rate for Payer: BCN Medicare Advantage |
$530.19
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$710.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.70
|
| Rate for Payer: Nomi Health Commercial |
$636.23
|
| Rate for Payer: PACE SWMI |
$530.19
|
| Rate for Payer: PHP Commercial |
$742.27
|
| Rate for Payer: PHP Medicare Advantage |
$530.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$530.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.19
|
| Rate for Payer: UHC Medicare Advantage |
$530.19
|
| Rate for Payer: UMR Bronson Commercial |
$638.48
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$690.78 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$718.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.65
|
| Rate for Payer: BCBS Complete |
$715.20
|
| Rate for Payer: BCBS MAPPO |
$690.78
|
| Rate for Payer: BCN Medicare Advantage |
$690.78
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cofinity Commercial |
$994.72
|
| Rate for Payer: Cofinity Commercial |
$925.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.32
|
| Rate for Payer: Nomi Health Commercial |
$828.94
|
| Rate for Payer: PACE SWMI |
$690.78
|
| Rate for Payer: PHP Commercial |
$967.09
|
| Rate for Payer: PHP Medicare Advantage |
$690.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health Medicare |
$690.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$690.78
|
| Rate for Payer: UHC Medicare Advantage |
$690.78
|
| Rate for Payer: UMR Bronson Commercial |
$822.48
|
|
